The Division of Workers' Compensation (DWC) has modified its draft physician fee schedule and has posted an online forum for members of the public to review and comment on the revised draft.

The forum can be found at http://www.dir.ca.gov/dwc/DWCWCABForum/dwc_PhysicianFeeSchedule.htm and members of the public may comment until July 20.

DWC’s new draft regulations propose adopting the resource based relative value scale (RBRVS), as well as ground rules relating to calculation of fees. While the initial proposal was budget neutral, the revision adds funding to the physician fee schedule accrued from reductions in spinal hardware and ambulatory surgical center fees, along with system savings gained through electronic billing.

Additionally, the revised proposal makes minor grammatical changes, changes for clarity or consistency, adds detail regarding status code indicators and professional/technical code indicators, and includes the following changes to conversion factors and report fees:

Title 8 CCR section 9789.12.4, conversion factors:

For services other than anesthesiology, the proposal includes the use of three conversion factors—surgery, radiology, and “all other.� The proposed conversion factors are 56 for surgery codes, 57 for radiology codes, and 42 for all others. Because anesthesia services are not comparable to the relative value units (RVUs) for other services, the category has its own conversion factor. The proposed conversion factor for anesthesia services is 34.

Title 8 CCR section 9789.13.2, California specific codes and section 9789.14.1, reimbursement for reports, duplicate reports, chart notes

Maximum reimbursement for California Code WC002, Treating Physician’s Progress Report (PR-2) by primary treating physician or secondary treating physician, issued in accordance with section 9785(f), using DWC form PR-2, its narrative equivalent, or letter format where allowed, is $11.69.
Labor Code section 5307.1 grants the DWC administrative director (AD) authority to revise the official medical fee schedule (OMFS) on a periodic basis.

The initial draft of the proposed physician fee schedule was posted on DWC forum for pre-rulemaking public comment on March 22 and closed April 5.

With the Senate's passage of a bill preventing cuts to Medicare physician reimbursement for another six months, we're only waiting on the House's action to boot the problem further down the road, where it can grow, and fester and frustrate just in time for the New Year.

That said, it isn't all bad news. The good news is the (short term) fix is paid for, it was the product of bipartisan action, and, for docs, it increases reimbursement by a touch above two percent.

With that said, this is so illuminating and so frustrating on so many levels, that it is worth exploring in detail.

NOV 18 -- (Newark) – Gerard P. McAleer, the Special Agent in Charge of the Drug Enforcement Administration (DEA) New Jersey Division and Angelo M. Valente, the Executive Director of the Partnership for a Drug-Free New Jersey (PDFNJ), announced today that over 9,000 pounds of medicine, with a street value of over $35 million, was collected during Operation Medicine Cabinet New Jersey, the first in the nation statewide day of disposal of unused, unwanted, and expired medicine. This statewide effort is being spearheaded by the DEA New Jersey Division, the New Jersey Office of the Attorney General (OAG), and the PDFNJ, with partnership and support by many other local and statewide prevention and enforcement organizations.

Ortho-McNeil-Janssen and FDA notified healthcare professionals of changes to the Warnings section of the prescribing information for tramadol. The strengthened Warnings information emphasizes the risk of suicide for patients who are addiction-prone, taking tranquilizers or antidepressant drugs and also warns of the risk of overdosage.

The Doctor Won’t See You (Mr. Pharma Rep), Now

— Number of ‘rep-accessible’ docs falls another 20 percent; ‘rep-inaccessible’ docs increase 50 percent — — Pharmacos respond with more precise sales force deployment strategies —

EVANSTON, Ill. — May 6, 2010 — Obtaining access to busy physicians grew still more difficult for pharmaceutical representatives in 2009, as the number of physicians willing to see most reps fell nearly 20 percent, the number of prescribers refusing to see most reps increased by half and the number of management-planned sales calls that were nearly impossible to complete topped 8 million.

The term Software as a Service (SaaS) has been around a long time. The term cloud is still relatively new for many. Putting them together has meant a world of hurt for many enterprises, especially when trying to integrate security into the mix.

During a joint panel discussion hosted by CSO Perspectives 2010 and SaaScon 2010 Wednesday, five guys who've been there sought to help attendees avoid the same ordeal. Perhaps the most important lesson is that contract negotiations between providers is everything. The problem is that you don't always know which questions to ask when the paperwork is being written.

Keith Waldorf has been selected to present at the SaaScon 2010 conference on April 6th and 7th. SaaScon is the destination conference in 2010 to learn everything about Software as a Service (SaaS) and related cloud-based services. Designed expressly for those engaged in purchasing, managing or developing cloud-based solutions, SaaScon will answer all of your tough questions about security, risk, integration and more.

StrataScale, Inc., makers of the world’s first fully automated managed hosting solution, today announced that Dr. Dispense, a point of care medication and e-prescribing dispensing solution for physicians groups, has selected StrataScale as its sole managed hosting provider. Dr. Dispense chose StrataScale’s flagship Automated Managed Hosting service because of its unparalleled ability to maintain the security and integrity of its platform and applications on fully managed, dedicated servers, while allowing them to scale physical systems at a moment’s notice with cloud-like abilities, effectively accommodating for the system demands and flexibility associated with rapid growth.

A consumer advocacy group is asking government regulators to recall a drug they approved last year for a little-understood pain ailment, saying the pill can lead to dangerously high blood pressure.

A letter Wednesday from Public Citizen calls on the Food and Drug Administration to pull Savella off the market, almost exactly a year after it was cleared to treat fibromyalgia.

The drug is co-marketed by Forest Laboratories Inc. and Cypress Bioscience Inc.

Fibromyalgia is characterized by a wide range of pain-related symptoms, including muscle soreness, headache, fatigue and depression. Last summer European regulators rejected the drug due to lack of effectiveness data and side effects. Public Citizen argues the FDA should have reached the same conclusion.

On October 15, 2009, the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) issued a joint warning letter to a Web site marketing fraudulent supplements that claim to help prevent the spread of the 2009 H1N1 influenza virus.

The warning letter, the first to be issued jointly by the agencies, advises the owners of the site that they must discontinue the fraudulent marketing of their product or face legal action. The letter further advises the owners of the site that they have 48 hours to give the agencies a plan to discontinue their fraudulent marketing.

Doctor Dispense is please to announce they will be attending the Academy's Annual Clinical Meeting and Conference in Phoenix Arizona Oct 8-11, 2009.

AAPM offers specialized educational opportunities in the field of integrative pain management. Every year the Academy provides state-of-the-art presentations by clinical experts in the field of pain management. The latest in treatment modalities are covered including: pharmacological management of pain, behavioral therapies, psychosocial and quality of life issues, along with current research related to pain management.

McNeil Consumer Healthcare and FDA notified consumers of a nationwide recall of certain Tylenol products as a precautionary measure because of potential manufacturing problems. The company initiated a recall of certain oral suspension products distributed between March 2008 and May 2008 due to the potential of bacteria in raw materials used to manufacture the finished product. There are no illnesses reported by patients using this product. The full list of recalled product lots can be accessed on the company’s website at http://www.tylenolprofessional.com/assets/TYLENOL_Letter_091809.pdf. McNeil is advising parents and caregivers who have administered affected product to their child or infant and have concerns to contact their healthcare providers. Parents and caregivers can find the lot numbers on the bottom of the box containing the product and also on the sticker that surrounds the product bottle.

[UPDATED 09/25/2009] New links added to provide information on emergency use in infants less than 1 year of age and directions to pharmacists on emergency compounding of oral suspension from capsules.

09/24/2009 The FDA issued a Public Health Alert to notify prescribers and pharmacists about potential dosing errors with Tamiflu (oseltamivir) for Oral Suspension. U.S. health care providers usually write prescriptions for liquid medicines in milliliters (mL) or teaspoons, while Tamiflu is dosed in milligrams (mg). The dosing dispenser packaged with Tamiflu has markings only in 30, 45 and 60 mg. The Agency has received reports of errors where dosing instructions for the patient do not match the dosing dispenser. Health care providers should write doses in mg if the dosing dispenser with the drug is in mg. Pharmacists should ensure that the units of measure on the prescription instructions match the dosing device provided with the drug.

The First Databank lawsuit settlement requires PBM's to reduce AWP from a 125% markup to 120% on approximately 1,400 generic medications.

PBM's have 18 months to comply with the changes but it is unclear when this will impact current pharmacy contracts or if the larger players will decrease discounts to pharmacies to offset the difference.

Yahoo News ATLANTA GA – Americans spend more than a 10th of their out-of-pocket health care dollars on alternative medicine, according to the first national estimate of such spending in more than a decade.

Chiropractors, massage therapists, acupuncturists and herbal remedies are commanding significant consumer dollars as people seek high-touch care in a high-tech society, the report released Thursday by the government shows.
Altogether, consumers spent an estimated $34 billion on those and other alternative remedies in 2007, the report found.

"We are talking about a very wide range of health practices that range from promising and sensible to potentially harmful," said Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine, the federal agency that leads research in this field.
More research into which therapies work is critically needed, because the spending on them is "substantial," she said.

FDA Issues Draft Guidance for Industry on Drug Anticounterfeiting
Focus on physical chemical identifiers
The U.S. Food and Drug Administration today issued a draft guidance on the use of inks, pigments, flavors, and other physical-chemical identifiers (PCIDs) by manufacturers to make drug products more difficult to duplicate by counterfeiters, and to make it easier to identify the genuine version of the drug.

The draft guidance is an important step in working with manufacturers to make drug products more difficult to duplicate by counterfeiters. The agency invites comments on the draft guidance, available online and titled “Draft Guidance for Industry: Incorporation of Physical-Chemical Identifiers into Solid Oral Dosage Form Drug Products for Anticounterfeiting.�

“Drug counterfeiting is a serious public health concern,� said Commissioner of Food and Drugs Margaret A. Hamburg, M.D. “We look forward to working with industry to help ensure that consumers are not exposed to products containing unknown, ineffective, or harmful ingredients.�

The document is intended to provide guidance to industry regarding the use of PCIDs in solid oral dosage forms, which include pills and capsules, for anticounterfeiting purposes.

A PCID is a substance or combination of substances possessing a unique physical or chemical property used to identify and authenticate a drug product or dosage. In addition to inks, pigments, and flavors, specific chemicals may be used as molecular tags in a PCID. In some cases, the PCID may be easily detected by wholesalers or pharmacists to determine if they have authentic products. In other cases, special analytical instruments may be necessary to identify whether the PCID is present.

In the draft guidance, the FDA anticipates that many of the potential PCID ingredients are already used as food additives, colorants, or other types of inactive ingredients with established safety profiles.

To minimize adverse effects, the draft guidance recommends using the lowest level of PCID that ensures identification of the product. It also recommends that the PCID be a substance with no medicinal effect, and placed within the dosage form so that it does not interact with the drug’s active ingredient.

WASHINGTON – The Senate health committee cast a milestone vote Wednesday to approve legislation expanding insurance coverage to nearly all Americans, becoming the first congressional panel to act on President Barack Obama's top domestic priority.

The 13-10 party line vote advanced a $600 billion measure that would require individuals to get health insurance and employers to contribute to the cost. Democratic leaders are driving for floor votes in the House and Senate before Congress goes on its August break.

Click the link below to view a summary of the Quality Affordable Health Care House Bill.

Retail Pharmacies are providing Medical Care and looking to take business from physicians writing scripts and sending patients to their facilities. Contact DrD to see how our service offerings can give you a competitive advantage.

Wal-Mart Medical Clinics Stumble

Two years ago, Wal-Mart Stores announced plans to have retail medical clinics in 400 of its stores by 2010 and said it saw the potential for as many as 2,000. By February 2008, the retailer had 78 clinics. But now,—after failed venture-capital collaborations, a few faulty partnerships, and a reassessment of the business model—it has only 31.

The U.S. Food and Drug Administration is taking several actions to reduce the risk of overdose in patients using pain medications such as Darvon and Darvocet that contain propoxyphene. The actions were taken because of data linking propoxyphene and fatal overdoses.

The agency is requiring manufacturers of propoxyphene-containing products to strengthen the label, including the boxed warning, emphasizing the potential for overdose when using these products. These manufacturers will also be required to provide a medication guide to patients stressing the importance of using the drugs as directed.

In addition, the FDA is requiring a new safety study assessing unanswered questions about the effects of propoxyphene on the heart at higher than recommended doses. Findings from this study, as well as other data, could lead to additional regulatory action.

“Physicians need to be aware of the risk of overdose when prescribing these drugs. They should carefully review patient histories and make appropriate treatment decisions based on the warnings and directions stated within the drug’s label,� said Janet Woodcock, M.D, director of the FDA’s Center for Drug Evaluation and Research. “Prescribers and patients should be aware of propoxyphene’s potential risks when used at doses higher than those recommended. Therefore, the FDA is requiring manufacturers to provide more information to help physicians and patients decide whether propoxyphene is the appropriate pain therapy.�

Word from Washington this morning is the 52 members of the House Blue Dog (moderate Democrat) caucus are none too happy with the high cost, employer mandate, and public option provisions of the House bill.

Meanwhile, Politico is applauding the Senate Finance Committee for actually making progress on a bill that they admit will never pass the full Senate. That's laudable? Seems more like Politico is awarding a medal for showing up for practice...

Please visit Doctor Dispense at the 2008 California Society of Physical Medicine & Rehabilitaion conference in Las Vegas May 2-4.

To be held at the Embassy Suites Hotel. 4315 Swenson Street, Las Vegas NV 89119.

Register now for the 2008 California Medical Group Management Association Annual Conference.

Doctor Dispense will be attending the conference at the Santa Clara Marriott, March 6 - 8, 2008

Top ten things to watch in California Comp. Posted to Work Comp Central on 01/15/2008

The Cleveland Clinic Department of Pain Management is pleased to announce â??The 10th Annual Pain Management Symposium.â?� DrD will be attending during the week of February 16-20, 2008, and join us in the beautiful setting of Loews Coronado Bay Resort & Spa in Coronado, California, to share in a dynamic five-day symposium focused on the advances in pain medicine and regional anesthesia/analgesia.

Doctor Dispense will be an exhibitor at the 2007 Western Occupational Health Conference.

The event will take place at Loews Coronado Resort located 20 minutes from San Diego airport on beautiful Coronado Island.

Please stop by and see us.

The California Division of Workers' Compensation files final pharmacy fee schedule regulation amendments with the Office of Administrative Law

The California Division of Workers' Compensation (DWC) has filed the final text of amendments to the pharmaceuticals section (9789.40) of the Official Medical Fee Schedule with the Office of Administrative Law (OAL). OAL will immediately file the regulations with the secretary of state and the changes will become effective Mar. 1, 2007.

The text of the regulations is the same as was proposed in the notice of rulemaking posted Sep. 12, 2006, except for technical changes in language, which were made to make the regulation more clear, and a change in the effective date from Dec. 1, 2006, to Mar. 1, 2007. Because section 9789.40, pharmacy, establishes or fixes rates within the meaning of Government Code section 11340.9(g), the regulation is not subject to review by OAL.

The adopted version of the amendments to the regulation closes a loophole created by legislation passed in 2003. Under that legislation, Labor Code section 5307.1 required that reimbursement rates for medical services, except physician fees, be in accordance with the relevant Medicare and Medi-Cal payment systems. However, the Medi-Cal system does not allow drugs to be dispensed by doctors in their offices. This loophole in the payment structure allowed doctors to be reimbursed for drugs dispensed during office visits at much higher rates than those paid to pharmacies for the same drugs. This regulation closes that loophole.

Concurrently with the adoption of this regulation, DWC is in the process of adopting a revision to the physician fee schedule within the Official Medical Fee Schedule, which will substantially increase the reimbursement rates for the most commonly used procedure codes for evaluation and management.

This regulation as filed with the OAL can be found below.

Recently enacted workers? compensation legislation (SB 899) provides strong reforms in an effort to save jobs, reduce costs for employers and improve care for injured workers. To make information about changes to the workers? compensation system accompanying these reforms easily accessible to its constituents, the Division of Workers? Compensation offers the following:

Read the text of Senate Bill 899 or review the Commission on Health and Safety and Workers? Compensation?s summary of reforms or its section by section summary.

Click on the link below to read all of the detail.