Leadership Pulse – October 8, 2013

Welcome to Leadership Pulse!

Welcome to “Leadership Pulse,” our periodic newsletter for medical officers, where you will find valuable information, resources, and an opportunity to share information and insights on relevant topics. Included will be pertinent themes for leadership, quality, healthcare policy, hot issues and best practice.

We are also renewing our email communications in order to provide an open-forum platform for the medical officers to distribute comments or questions via email. Watch for an email next week.


John Vassall, MD
Physician Advisor, WSHA
Chair, Medical Officer Advisory Group


Swap Ideas, Ask Questions on Medical Officer E-list

The Washington State Hospital Association and WSMA are pleased offer medical officers a new platform to connect. The new email list platform gives participants a forum to share ideas, discoveries, and information.

We hope the list will complement the Safe Tables and provide a venue for members to ask general questions or poll their colleagues about helpful policies, quality, safety, and leadership topics. Additionally, we hope it will foster increased unity, collaboration and cooperation among medical officers in Washington state.

To kick-off this peer-to-peer service, we’ve subscribed all medical officers to the email communication list. We don’t anticipate it to be a high-volume communication platform, however. Recognizing that your inboxes are already full, we’ve set some guidelines, which will be included in the roll-out email, to make this communication platform more effective. Most importantly, it won’t duplicate official announcements about news or events that would be conveyed through separate channels.

An email will be sent to you soon regarding your subscription. You will be able to unsubscribe at any time. If you have any comments about the e-list or to unsubscribe, please email Tanya Carroccio, director of quality & performance improvement, directly at tanyac@wsha.org.


Have Pharmacists Delayed Filling Prescriptions for Your Patients?

Walgreens, Costco and CVS pharmacies were the subject of DEA actions in Florida recently, as a result of requiring substantial details of prescribers before filling prescriptions for controlled substances. For example, in a May 10 memo, Walgreens advises its Passport Health Plan providers that a pharmacist may contact the prescriber to obtain “additional information” including the “diagnosis, ICD-9 code, expected length of therapy and previous medications/therapies tried and failed.” The WSMA finds such requirements are overly broad and not supported by current state or federal laws or regulations.

Under federal law, prescriptions must be written for a legitimate purpose. There is currently no requirement under law for including ICD-9 codes or other detailed information related to the patient’s condition on a prescription. In fact most will find that such information cannot be added on a prescription generated by today’s electronic health record systems.

The WSMA Executive Committee supports the position that all valid prescriptions should be filled without delay. These burdensome requirements have the potential of placing needless additional administrative burdens on busy physicians and other prescriber and could delay or even deny patients’ access to needed medications.

Recently the Medical Quality Assurance Commission has recommended as a best practice that physicians include a “notation of purpose” (e.g. “for headache”) [pdf]. Additionally the commission has pointed to language in the rules for management of chronic non-cancer pain which states that opioid prescriptions need to include “indications for use” or ICD code (WAC 246-919-859(3)). The MQAC believes that what a physician puts on a prescription for a controlled substance is up to the prescriber and their comfort level with the patient.

WSMA will continue to work with all parties to try to assure that patient care does not suffer because of the new practices of the large pharmacies. WSMA has received written confirmation from the Seattle Drug Enforcement Agency office that the “DEA has placed no additional requirements on Washington pharmacies ‘when verifying certain prescriptions for controlled substances’.” WSMA is pursuing this issue locally with the state attorney general’s office and nationally in consultation with the AMA.

While WSMA continues to pursue this matter, if you are faced with a specific, particularly egregious delay or denial of a prescribed controlled substance for a patient, you can file a complaint with the state Board of Pharmacy. Be sure that you are adhering to Washington state regulations on prescribing controlled substances. For questions, contact Bob Perna at rjp@wsma.org or Denny Maher, MD, JD at dpm@wsma.org.


Engaging Physicians in Enrollment: Health Care Coverage Expansions

Physicians offices, hospitals and health systems across the state are working to help their communities access health care insurance coverage available under the Affordable Care Act. Key audiences to engage include physicians and medical staff. Swedish created a focused effort to reach this group.

To help with changes associated with the ACA and new health coverage options offered through the state’s expanded Medicaid program and the new health benefit exchange, Swedish formed a Quality Improvement Project Team. The “Medicaid Expansion/Exchange” QIP Team represents content experts from across the organization who have come together to establish an action plan for Swedish.

A core element of the QIP Team action plan is centered on physician/medical staff outreach and education including:

  • Physician leadership meetings: Action plans and resources are being presented at a series of upcoming meetings targeting physicians and all staff across the Swedish system
  • Targeted newsletters/publications: Updates on the ACA and specifically Medicaid expansion and the health benefit exchange will be shared via Swedish Medical staff news and other internal newsletters/publications
  • Onsite enrollment: Swedish providers will receive a list of Swedish trained “In-person assistors” who can help enroll patients at Swedish hospitals
  • Partnerships: Swedish Medical Group is partnering with federally qualified health centers (FQHCs) and other community clinics to help manage the influx of new patients
  • Online resources: A toolkit of medical staff and patient materials will be available via Swedish intranet pages.

The Swedish team will continue to evolve this action plan, as needed, to best meet the needs of Swedish staff and patients. For more information contact tom.gibbon@swedish.org


Medical Officers from Hospitals and Clinics Invited to Safe Table October 24

Join WSHA and WSMA for a Safe Table meeting of physician leaders from hospitals and clinics across the state on Thursday, October 24, 2013 from 9 a.m. to 2:30 p.m. at the SeaTac Double Tree Hotel.

Historically, attendance at our Chief Medical Officer Safe Table events has been limited to physician leaders from hospitals.  Because health systems are becoming more integrated and physician groups are aligning with larger systems, we’ve decided to extend an invitation to physician leaders from clinics across the state.

The agenda was created by medical officers and will address specific topics of interest to chief medical officers and physician leaders. Objectives for this Safe Table meeting include:

  1. Learn about different physician practice models used in Washington. What is working well? What will need to adjust as the delivery of health care evolves?
  2. Discuss the latest on the Washington State Health Benefit Exchange.
  3. Review the latest on Washington State Health Care Innovation Plan including cost/quality transparency and payment reform.
  4. Action Strategies: Discuss plan for Advanced Illness Planning (AIM)/Life Planning.
  5. Discuss Choosing Wisely® Campaign progress and updates.
  6. Understand where Washington stands on quality compared to other states including update on Partnership for Patients and LEAPT.


Literature Review – Heath Care Transparency is Inevitable

Article reviewed: The Transparency Imperative
by Robert P. Kocher, MD & Ezekiel J. Emanuel, MD, PhD
Annals of Internal Medicine 28 May 2013

The article’s authors argue that transparency of price, utilization and quality data must be made available to the public to shift the basis of health care competition from structural market power to the delivery of better value and service. They call this the transparency imperative and argue that currently available data is insufficient to achieve the system changes needed for better quality and cost control.

Achieving the transparency imperative will require a fundamental shift including a change in attitude by numerous stakeholders, publicly available claims data, improvement on privacy protection and transparent pricing for comparison by patients before decision-making on care occurs. Read more in the article


Have a great idea for a topic we should touch on? Please email your thoughts to Tanya Carroccio, Director of Quality & Performance Improvement, at tanyac@wsha.org or Jessica Martinson, Director of Clinical and Professional Development, at jessica@wsma.org