Archives for June 11, 2007

Surprise! Iraq War Bill Requires Secure Pads for Medicaid Prescriptions

Yes, that IS a surprise. Today’s email from the Texas Medical Association:

Surprise! Iraq War Bill Requires Secure Pads for Medicaid Prescriptions

All written prescriptions for Medicaid patients must be written on tamper-resistant pads, thanks to a provision slipped into the bill authorizing funding for the war in Iraq. The requirement, which originated in President Bush’s proposed 2008 budget but went nowhere until added to the Iraq bill without consulting the states, is supposed to prevent fraud and save money.

Helen Kent Davis, director of governmental affairs for TMA, says consultation with the American Medical Association and the Texas Health and Human Services Commission (HHSC) has unearthed several questions TMA and HHSC are working together to answer. For example:

· Who will be responsible for printing the forms used in Texas?

· How quickly can a printer produce the required number of forms? They’re supposed to be used starting Sept. 1.

· How will states pay for the printing costs? State Medicaid officials estimate that 10 to 15 million of the 30 million annual Medicaid prescriptions are written. (A faxed prescription is considered electronic, and telephone and electronic prescriptions are not affected.

· Will physicians be charged for the forms or will the state pay for them?

· How will the forms be distributed to physicians?

We’ll let you know the answers to these questions as soon as we get them.

First off, it doesn’t kick in until September 1st, so it’s NOT time to panic.

Second, what kind of prescription alterations are happening that it’s worth this much effort (and cost) to reduce? I write a ton of prescriptions, but have never worked in or near a pharmacy that fills them, so I wonder how much ‘script tinkering’ is going on? (I’ll send this to the Angry Pharmacist and see if he can enlighten me)(I would if he had an email address).

Third, and it’s not clear in the article, will there have to be a specific pad just for the medicaid patients, or would basically a generic script pad that’s made of ‘tamper resistant’ paper be okay? (And, either of these will result in more blank-pad theft). Seems to me the answer is to fax all the prescriptions to one medicaid clearinghouse, and the patient could then present themselves to any pharmacy, identify themselves, the the medicaid clearinghouse could forward the faxed script to them. No new printing, no new paper, more secure, better tracking of costs.

JCAHO Regains it Senses

at least temporarily.

From AAEM:

Dear AAEM Members,
On May 17, 2007, AAEM, along with leaders from ACEP and ENA, met face-to-face with The Joint Commission (TJC) to relay our concerns with Interim Standard MM 4.10.  I am happy to report that this has resulted in a positive and rapid change in The Joint Commission’s position.  The latest ruling and interpretive guidelines can be found at

Essentially, a medication ordered by an emergency physician can be administered by an emergency nurse (or respiratory therapist) without pre-approval by a pharmacist as long as the emergency physician is immediately available to intervene should the patient experience an adverse reaction.

Tom Scaletta, MD FAAEM
President, AAEM

Before this the rule wanted every medication checked by a pharmacist before it was administered, a stunning display of ignorance regarding how medicine is practiced and the realities of the numbers of pharmacists available to even do the job.  To do the job were it a good idea, which it isn’t.

The link has the following:

The Joint CommissionThe Joint Commission will now permit organizations to implement the two exceptions in Standard MM 4.10, EP 1 more broadly in order to minimize treatment delays and patient back-up.  To clarify this position, each exception is addressed below emphasizing its implementation in the ED:

  • Exception 1:  “…unless a licensed independent practitioner controls the ordering, preparation, and administration of the medication.”
    Implementation:  When using this exception, medications ordered by a licensed independent practitioner in the ED can be processed, including administration of the  medication, by a registered nurse or other licensed staff with medication administration  responsibilities (e.g. respiratory therapist) in accordance with law and regulation.  A licensed independent  practitioner will not be required to remain at the bedside when the 
    medication is administered. However, the licensed independent practitioner must remain available to provide immediate intervention should a patient experience an adverse medication event.
  • Exception 2:  “…in urgent situations when the resulting delay would harm the patient, including situations in which the patient experiences a sudden change in clinical status.”
    Implementation:  When using this exception, urgent care situations will be defined by the licensed independent practitioner who is providing care to the patient.

Which is how it has been, and should always have been. 

Rig Tour

I went on a tour of this drilling rig the other day. It’s in our neighborhood, at least temporarily, and the company is trying like crazy to be good neighbors. So, a tour.

I learned a little, mostly that modern oil and gas exploration is subcontracting. Nobody actually own anything, it’s all subcontracted. Not that that’s a bad thing, but it’s an interesting look into our modern oil business.

We went on a tour of the rig, and the three nearest the speaker probably got a nice talk, but the rest of us heard two big Cat diesels running at full-song making electricity for the drilling operation. Not a big deal, and it was interesting.

And, no, I’m not getting a cent from this, nor are any of me neighbors (except the one who owns the land the rig is on, and they didn’t come).

AtM with the first Calendar Doc

Addicted to Medblogs: June’s Calendar Doc is . . . Trenchy

I thought it was only right that Trenchy should be the first Doctors of the Blogosphere calendar boy. After all, I did steal his idea after he closed his blog. Trenchdoc was one of my favorite medblogs. Trenchy could make me laugh, he could make me cry, he could make me want to knock him on his ass. I’m gonna miss Trenchdoc.

Heck, I’d have quit blogging, just for the honor (and the answer to a trivia question 15 years from now).

And, yes, all ER docs look like Trenchy. Just usually not as wet.

EMS Tribute Video

By an anonymous EMT in North Carolina:

A very nice video, featuring a soundtrack by Nickelback.Hat tip to Diane for the link.