Earlier this week, the Michigan State Medical Society (MSMS) Board of Directors met to address the opioid laws, prior authorization, and payer issues. Below are some of the highlights:
New Prescribing Laws on Opioids:
David Neff, DO, Chief Medical Director with the Michigan Department of Health and Human Services, presented to the board on the latest opioid laws that are now being implemented, despite organized advocacy by MSMS and other health care organizations:
- Informed consent when prescribing an opioid to a minor
- Informed consent when prescribing an opioid to an adult
- Mandatory MAPS check for controlled substances of quantities more than 3 days
- Limit prescriptions for opioids for acute pain to 7 days
- To prescribe controlled substance physician must have a bona fide prescriber-patient relationship
- When treating an overdose physician must provide info on substance use disorder services
Because 1,257 Michigan residents lost their lives to opioids in 2015 and Michigan ranks 10th in the nation for prescribing opioids, the Michigan Legislature was determined to pass bills that would reduce the supply. Even when MSMS presented compelling evidence of the impact on patient care and workflow, the legislative environment was not amenable to significant changes.
Michigan's investment in the new MAPS, grants for EHR integration, conflicting positions from the medical community, and the overdose statistics, made it difficult to convince the Legislature physician’s concerns were warranted.
In the end, MSMS was able to secure a few significant changes:
- Delays on some of the implementation dates
- Excluded 3 day scripts for mandatory MAPS check
- Replaced "sanction schedule" for not pulling MAPS to a non-disciplinary warning letter
To assist with compliance, MSMS along with Michigan Academy of Family Physicians, and Michigan Osteopathic Association have partnered to create the following resources:
MSMS has begun educating physicians on the current prescriber requirements; however, MSMS will make every attempt to improve the bills through:
- Identifying specific points that require legislative reform (ie schedule 2-5, requirements for patient consent);
- Identifying issues that could be addressed through regulation and work with appropriate state agencies; and,
- Convening physician leadership meetings with Michigan lawmakers.
Informational reports included:
Down-coding. Several large member groups have notified MSMS to Blue Care Network’s (BCN) recent practice of down-coding Evaluation and Management (E&M) services without reviewing the medical record. It appears they are reviewing the diagnosis code(s) and determining the diagnosis does not meet the medical necessity of the level of E&M service code. MSMS has conducted a series of meetings with legal counsel to discuss the legality and options available to challenge this practice. An in-depth discussion with the BCN medical directors is scheduled for the February Tri-Staff meeting.
Knee Injections. BCBSM and BCN commercial plans will not cover hyaluronic acids, beginning April 1, 2018. BCBSM and BCN states there is insufficient evidence that hyaluronic acid therapy improves the net health outcome in patients with knee osteoarthritis. After discussing this at the January Tri-Staff meeting, MSMS will be facilitating a meeting with BCBSM, the Michigan Orthopedic Society and the Michigan Rheumatology Society.
Breast Tomosynthesis. Breast tomosynthesis is an advanced form of breast imaging, or mammography, that uses a low-dose x-ray system and computer reconstructions to create three-dimensional images of the breasts. Based on recent discussions with the Michigan Radiological Society, MSMS requested BCBSM to revisit this procedure and consider it for payment. The BCBSM Committee on Medical Affairs reviewed the latest clinical data and agreed cover starting March 1.
Post Delivery LARC Insertion. MSMS is working with a multi-stakeholder group to advocate for payment of long acting reversible contraceptive (LARC) insertion post delivery. MSMS has spoken to several payers who are supportive however, because post-delivery care is paid through a DRG code, plans have reservations regarding unbundling or carving out LARCs. MSMS will continue to work with its partners to determine feasibility of revising the payment model.