* Develop a uniform (standardized) electronic prior authorization form for use by every health care service plan and health insurer that provides medical services or prescription drug benefits;

   * Allow every prescribing health care provider the ability to submit electronic prior authorization for medical services or prescription drug benefits via a web portal or Electronic Medical Record (EMR), to the health care service plan or health insurer, and

   * Require those plans and health insurers to utilize and accept those electronic prior authorization forms for medical services or prescription drug benefits.

     Successful passage of this bill will streamline the health insurance prior authorization process, help stem the rising tide of health care costs and protect access to timely and effective care for patients in the District. In May 2012, MSDC released the results of a membership survey examining the impact of health insurance prior authorization protocols on patient care in Washington, DC. Our study revealed that health insurer prior authorization protocols are a burden on medical practices and undermine patient care. Specifically, there were widespread concerns among our physicians, with over 93% of respondents saying that insurance company requirements are having a negative impact on their ability to treat patients.

     B19-934 will help bring the prior authorization process into the 21st century, alleviate the time-consuming burden on doctors and their staffs, and ensure that Washingtonians have access to timely, effective and affordable care. Every hour spent navigating complex administrative tasks is an hour not spent with patients. B19-934 is not only a common-sense solution to help control rising health care costs, it is also a relatively small change to the way health care is administered that will have an enormous impact on the ability of DC providers to care for their patients. At a time when physicians, and all health care stakeholders are looking for ways to reduce health care costs without sacrificing quality care, it's crucial to pass legislation like B19-934 and unleash the enormous potential for savings that advances in technology hold.

The stated purpose of Bill 19-881 is to require health insurance coverage for health care services provided by telemedicine or electronic media. To read a current copy of the "Telemedicine Reimbursement Act of 2012" click here. 

ACTION by Tuesday, November 13th

     Physicians who wish to join MSDC as individual supporters and testify should contact Edward Fisher,  Committee Director, at (202) 741-0898 or via email at efisher@dccouncil.us providing your name, address, telephone number, organizational affiliation and title (if any) by close of business on Tuesday, November 13, 2012. Persons wishing to testify should submit 15 copies of written testimony. If submitted by the close of business on Tuesday, November 13, 2012, the testimony will be distributed to Councilmembers before the hearing.  Witnesses should limit their testimony to four minutes; less time will be allowed if there are a large number of witnesses.

     If you are unable to testify at the hearing, written statements are encouraged and will be made a part of the official record.  Copies of written statements should be submitted either to Mr. Fisher, or to Ms. Nyasha Smith, Secretary to the Council, Room 5 of the Wilson Building, 1350 Pennsylvania Avenue, N.W. Washington, D.C. 20004.  The record will close at 5:00 p.m. on November 28, 2012.

   The Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) are working with the Tennessee Department of Health (TDH) to investigate a cluster of at least 12 patients with thrombotic thrombocytopenic purpura (TTP) who have injected the opioid pain reliever, Opana ER® (oxymorphone extended-release), for nonmedical reasons since February 2012. Investigation is ongoing.

   On August 13, 2012, a nephrologist notified the TDH of a cluster of three cases of TTP in a small rural community in northeastern Tennessee. All patients had a history of intravenous use of the prescription opioid pain reliever Opana ER, which is only intended to be taken orally. Initial cases were reported to the FDA by the manufacturer. The FDA contacted the CDC to discuss further investigation on October 5. The FDA issued an alert regarding the issue on October 11.

    As of October 22, 2012, case-finding efforts by the TDH had uncovered a total of 12 cases among Tennessee residents. A case was defined as hemolytic anemia combined with thrombocytopenia (platelet count <50,000/microliter) in the absence of any obvious explanation such as advanced cancer or systemic infection. The first case was diagnosed on April 16, the index cluster in mid-July, and the most recent case on October 19. Eleven of 12 case patients were non-pregnant women 20 to 50 years of age. All were hospitalized, and 10 were treated with plasmapheresis. At least five patients have had recurrent episodes, but no deaths have occurred. All 12 patients reported IV use of Opana ER® to the TDH or to hospital staff.  Case patients all had a history of chronic IV use of Opana ER® for nonmedical purposes until 1-2 days prior to diagnosis. Most patients did not have a prescription for Opana ER® and obtained the drug from other, undisclosed sources.   

Recommendations for Clinicians 

   The extent of this problem is not clear because there is no requirement to report such cases and because IV drug use might not be suspected or reported among patients with TTP. To provide optimal care and assist in public health surveillance, the CDC recommends that:   

   Clinicians treating patients with TTP of unknown etiology should:  

1. Ask patients about intravenous drug use. Patients who report IV drug use should be asked about the specific drugs injected.
2. Perform a urine drug test.  A negative drug test is not definitive because the interval between the critical drug use and diagnosis might be greater than the time during which a drug can be detected in the urine, which is probably not more than 4 days in the case of opioids.
3. Request a copy of the patient's prescriptions for controlled substances from the state prescription drug monitoring program to determine if any doctor has prescribed the patient Opana ER®. This information might be more accurate than the patient's report of drug sources.

   Clinicians treating patients with TTP who report IV use of Opana ER® should:

1. Counsel patients regarding the risks of continued IV drug use, including blood-borne infections, fatal overdose, and TTP.
2. Refer them to substance abuse treatment programs in their community.  A list of substance abuse treatment facilities is located at:  http://www.samhsa.gov/treatment/index.aspx 
3. Notify other clinicians who have prescribed the patient Opana ER® of the diagnosis of TTP and the reported association with that drug.

     Primary Care Physicians are in the best position to improve adolescent and adult vaccination rates. Immunization for Flu, Pneumococcal, Shingles, and Tdap vaccines continue to fall short of the U.S Department of Health and Human Services objectives.

     Fortunately, the Medical Society of DC has a strong partner in providing our members the resources and support to cost-effectively improve immunization rates, and in turn, strengthen your practice.  Atlantic Health Partners, the nation's leading vaccine buying group, offers you the lowest vaccine prices and finest customer service to improve the performance of your immunization initiatives.  Atlantic even has a program that enables you to provide vaccines like Zostavax (Shingles) and Adacel (Tdap) to Medicare Part D patients.

     MSDC members that currently participate with Atlantic are very satisfied with the savings and support.  We encourage you to contact Atlantic at 800-741-2044 or info@atlantichealthpartners.com to better determine how they can benefit your practice.