Medigram - October 18, 2007 | Wisconsin Medical Society

NEWS BRIEFS

Wisconsin law restricts use of DEA numbers to intended purpose

Physicians have fought for years to prevent the unnecessary disclosure and use of their Drug Enforcement Administration (DEA) registration numbers, which are issued by the DEA for the purpose of prescribing controlled substances. And throughout the past several years, the Wisconsin Medical Society has received numerous reports from physicians that health plans, pharmacies and others require them to provide DEA numbers for purposes other than prescribing controlled substances. Although the DEA has voiced its opposition to the use of DEA numbers as a means of identifying physicians and other DEA registrants in transactions unrelated to controlled substances for many years, it has been powerless to stop their inappropriate use. However, Wisconsin law now signals the end of the improper practice of using DEA numbers, in this state, for purposes other than engaging in transactions involving controlled substances.

Wisconsin Statute § 146.87 makes it unlawful in Wisconsin for any person to do the following:

Require a physician to include his or her DEA number on a prescription that is not a controlled substance.
Disclose a physician’s or other registrant’s DEA number without that person’s consent, for any purpose other than complying with or enforcing federal or state law related to controlled substances.
Use a DEA number to identify or monitor the prescribing practices of a physician or other DEA registrant.

Any person who violates Wis. Stat. § 146.87 may be subject to a fine of up to $10,000 per violation. This law and its associated penalties will finally put an end to the improper collection and use of DEA numbers for processing and paying claims for prescription and other medical services, monitoring individual prescribing practices and other tracking activities.

The Society intends to notify health plans, pharmacists and others about the statute so that they may begin to modify their operations, if necessary, to fully comply with all aspects of this statute. We expect that the Wisconsin Attorney General’s office will begin to prosecute violations of the statute occurring after May 23, 2008.

If you believe that your DEA number is being used for purposes other than controlled substance transactions, contact the Society at 866.442.3800 and ask for the “legal” voice mailbox. When you leave your message, please clearly identify yourself and the person or persons that you believe might be improperly using DEA numbers. You can also e-mail this information to Merry Earll. This information will help us educate other health care professionals and the public. It will also allow us to develop a list of potential violators for possible referral to the Attorney General’s office after the May 23, 2008, enforcement date.

Cash in those PIC shares pronto!

“Shareholders must exchange their old PIC Wisconsin stock for new ProAssurance shares in order to receive any value from their initial investment,” says Dave Mauer, Chief Operation Officer, PIC Wisconsin. If this is not done, the shares will go to the State of Wisconsin.

“The passage of time will make it more difficult to accomplish the exchange,” Mauer added.

Mellon Investor Services is responsible for the exchange process, as PIC Wisconsin is no longer responsible for shareholder related issues. PIC’s role is to help facilitate the exchange process so that founding shareholders recognize value from their initial investment in the company.

Even if shareholders cannot locate their original stock certificates, they can still request an exchange. Mellon requires a surety premium/service fee equal to 1% of the value of the stock. Another option is simply to assign these rights to the Wisconsin Medical Society Foundation and recognize a charitable deduction for the fair market value of the shares.

Contact Dave Maurer at 800.279.8331 or 608.826.5803 if you have questions.

YOUR PRACTICE. YOUR FUTURE.

Collaboration and supervision requirements for APNPs and CRNAs

A previous Medigram article entitled “APNPs must have individual insurance if prescribing independently” described the different insurance requirements for advanced practice nurse prescribers (APNPs) depending on whether they prescribe independently or under the direction and supervision of a physician or nurse anesthetist. Insurance requirements and what level of supervision or collaboration is required to perform delegated medical acts are two separate issues, and this article will describe collaboration/supervision requirements for APNPs and Certified Registered Nurse Anesthetists (CRNAs).

Chapter N 8 of the Wisconsin Administrative Code addresses collaboration requirements for APNPs. APNPs shall work in a collaborative relationship with a physician. The collaborative relationship is a process in which an APNP is working with a physician, in each other’s presence when necessary, to deliver health care services within the scope of the practitioner’s professional expertise. The APNP and the physician must document this relationship.

CRNAs are registered nurses who have graduated from an accredited nurse anesthesia education program and passed a national certification exam, thereby obtaining national certification as a CRNA. CRNAs who are certified as APNPs are required to work in a collaborative relationship with a physician, as is any APNP, as described above. CRNAs who are not certified as APNPs and who engage in delegated medical acts are required to act under the “general supervision” of a physician. “General supervision” means regularly to coordinate, direct and inspect the practice of another.

Under Wisconsin law, RNs, including CRNAs, shall

Accept only those delegated medical acts for which there are protocols or written or verbal orders;
Accept only those delegated medical acts for which the RN is competent to perform based on his or her nursing education, training or experience;
Consult with a physician, podiatrist, dentist or optometrist in cases where the RN knows or should know a delegated medical act may harm a patient;
Perform delegated medical acts under the general supervision or direction of a physician, podiatrist, dentist or optometrist.

APNPs who prescribe medication under the supervision of a CRNA are still required to collaborate with a physician as required by Wisconsin Administrative Code Chapter N 8.10(7).

EDUCATIONAL PROGRAMS

Practice management issues focus of upcoming teleconference

The ins-and-outs of professional courtesy, waiver of copayments and deductibles, cash discounts and patient incentives. These are some of the topics on the agenda for the Society’s upcoming Lunch and Learn teleconference. Join speaker Michelle Leiker, JD, the Society’s Assistant General Counsel Wednesday, Oct 31 to learn how to answer questions posed by family members, friends, colleagues and patients on these important topics. Click here for more information.

FYI: FOR YOUR INSURANCE

Dental plan options available for Society members

For the second year in a row the Delta Dental Plan for members of the Wisconsin Medical Society is holding steady—individual and group premium rates have not risen in two years.

That’s good news, because, according to the US Surgeon General’s report on oral health, working Americans lose an estimated 164 million hours annually to dental disease or dental visits. Delta Dental’s emphasis on regular, ongoing preventive care and early detection can significantly reduce the possibility of dental emergencies for you, your employees and their families, keeping people on the job rather than in the dentist’s chair.

Because people with dental insurance visit their dentists more often, they are more likely to avoid serious oral health problems that are expensive and time-consuming to treat. Dentists have always recommended preventive care, and Delta Dental Insurance is set up to emphasize prevention and early detection. At a time when increases in medical premiums are squeezing other benefits, this cost-control-by-prevention model is more important than ever before.

You can check out Dental Dental’s 2008 plans and rates by clicking here. And to learn more about available dental coverage and other products, please contact Wisconsin Medical Society Insurance and Financial Services at 866.442.3810, visit our Web site, or simply complete our on-line contact form for more information. One of our agents will work with you to meet your insurance needs.

Adapted with permission from Delta Dental Insurance, Dental Benefits Summary

FOUNDATION FOCUS

Contributions to Foundation benefit students

“Thank you for the generous scholarship in honor of *Earl and Alice Thayer. I will continue my involvement with the Wisconsin Medical Society and hope to one day give my financial resources back to other aspiring physicians.”

—Robert Beyer, Medical College of Wisconsin Student

Robert Beyer has truly undergone a transformation during medical school. After beginning school with his jaw wired shut due to a boating accident, he soon became known as an outspoken leader and class representative, serving in many key positions including student representative to the Wisconsin Medical Society Board of Directors, while still maintaining excellent academics.

After working on the “business side” of health care in Arizona, Beyer returned to Wisconsin to pursue his dream of becoming a physician. “Although improving health care systems was rewarding, nothing can compare with making a difference in people’s lives—one patient at a time” said Beyer. His interests include health policy, emergency medicine and health care administration and he hopes to practice in a Wisconsin community similar to his hometown of Shawano.

When you contribute to the Wisconsin Medical Society Foundation, you help us offer financial assistance and programs that encourage exceptional students like Beyer to remain in Wisconsin.

Please consider making a voluntary contribution to the Foundation when renewing your Wisconsin Medical Society dues or with a gift during the 2007 tax year. To make a contribution on-line, click here.

*Earl Thayer is former CEO of the Wisconsin Medical Society.

FAQ

Question:
Following a motor vehicle accident, a patient presented to our office for evaluation. Other than feeling “shaken up,” there was nothing wrong with the patient upon examination and no signs, symptoms or condition to code. What would I use as a diagnosis in this case?

Answer:
The “Worried Well” diagnosis code is V65.5, which ICD-9 describes as a “feared condition not demonstrated” or “problem was normal state.” The person has a feared complaint, but no diagnosis was made.

If you have questions about this or other coding matters, click here to review our FAQ archives, or e-mail efaq@wismed.org.

QUALITY CORNER

The Commonwealth Fund States in Action: Public programs using incentives to promote healthy behavior

There is growing interest among states in offering incentives to those enrolled in public health plans to promote healthy behaviors. A number of states are developing programs to motivate enrollees to curtail smoking, lose weight, and access timely child immunizations and prenatal care. By providing rewards for healthy behaviors, these states are trying to give members a greater stake in improving their health status, enhance prevention and health outcomes, and reduce program costs.

Focusing on behavioral change to improve health and control costs is a central concept of “patient engagement,” which is being promoted by the US Department of Health and Human Services. The premise is that the motivating power of financial rewards for practicing healthy behavior can make a significant impact on the efficiency and effectiveness of health care. Thus, many incentive programs focus on two major sources of morbidity and mortality—smoking and obesity. Using incentives to change unhealthy behaviors is also related to two other trends: value-driven purchasing, which involves providing consumers with information about health care quality and costs, and patient-centered care. Each of these movements encourages people to take a more active role in their care.

To read about incentive programs in Wisconsin and other states, click here.