Lecture Notes Flashcards

Rules and Regulations for Physicians

• Rules and regulations are established through medical practice acts, enacted by each state. These acts provide the legal framework governing medical practice within that state.

• State statutes give a detailed scope of the practice of medicine, outlining what actions and procedures are considered within the boundaries of medical practice.

• They prescribe methods of licensure, detailing the qualifications, examinations, and procedures required to obtain a medical license.

• They dictate guidelines for the suspension or revocation of a license, specifying the grounds and processes for disciplinary actions against physicians.

Requirements for Licensing (MDs and DOs)

1. A four-year undergraduate degree from an accredited institution is generally required as a prerequisite for medical school.

2. Graduation from an accredited medical school, either granting an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree.

3. Completion of an internship, providing practical experience in a clinical setting under supervision.

4. Successfully complete the United States Medical Licensing Exam (USMLE), a standardized examination required for medical licensure in the United States.

5. Compliance with state-specific requirements, which may include additional examinations, background checks, or specific training.

6. Submission of a comprehensive application to the state medical board, providing all necessary documentation and information.

7. Provide proof of required education and training, including transcripts, certifications, and other credentials.

8. Payment of an application fee to cover the costs of processing the application.

• Physicians have the option to work in multiple states, but they must fulfill the licensing criteria for each state in which they intend to practice.

• All states mandate the successful completion of the USMLE as a prerequisite for licensure before allowing physicians to practice medicine.

License Renewal

• Renewal is necessary every one to two years to maintain licensure and continue practicing medicine.

• Steps involved in renewal:

  • Completing a renewal application, providing updated information and attesting to continued compliance with licensing requirements.

  • Paying a renewal fee to cover the administrative costs of processing the renewal application.

  • Documenting continuing medical education (CMEs) to demonstrate ongoing professional development and competence.

• CMEs can be fulfilled through various activities:

  • Teaching health care professionals, sharing expertise and contributing to the education of others in the field.

  • Attending courses, workshops, or seminars, participating in structured learning activities to expand knowledge and skills.

  • Engaging in self-instruction, such as reading books and papers, independently pursuing learning opportunities to stay current with advancements in medicine.

• Some states may have simplified renewal processes, requiring only a fee payment for renewal without additional requirements such as CMEs.

License Revocation and Suspension

• Reasons for revocation or suspension of a medical license:

  1. Conviction of a crime, particularly those related to professional misconduct or posing a threat to public safety.

  2. Unprofessional conduct, including unethical behavior, violation of professional standards, or breach of patient trust.

  3. Personal or professional incapacity, rendering the physician unable to safely and competently practice medicine.

• These reasons are precisely outlined in state statutes, providing a legal basis for disciplinary actions against physicians.

• Examples:

  • Crime: Conviction of offenses such as child abuse or sexual assault against a client, demonstrating a severe breach of professional ethics and legal boundaries.

  • Unprofessional Conduct: Actions like falsifying medical records, engaging in dishonesty or fraud, or impersonating another practitioner, undermining the integrity of the medical profession.

  • Personal or Professional Incapacity: Conditions such as chronic substance abuse, practicing with severe physical limitations, or practicing outside the scope of training, compromising patient safety and quality of care.

• Charges are typically initiated by the state licensing board, which investigates allegations of misconduct and determines whether disciplinary action is warranted.

• Basic Procedure:

  • The physician is given sufficient notice of the charges, providing an opportunity to understand the allegations and prepare a defense.

  • This allows the physician to seek legal counsel and attend a hearing, where evidence is presented and the physician can respond to the charges.

  • Some states have provisions for temporary license suspension without a hearing in cases where there is an immediate threat to public safety.

• The state medical board that originally granted the license retains the authority to revoke or suspend it, ensuring accountability and oversight of medical practice.

Prescriptions

• Medical practitioners commonly use the terms nonopioid and opioid to categorize medications based on their pharmacological properties and potential for misuse.

• A prescription is a formal order issued by a licensed health care provider authorizing the dispensing of medication to a patient.

• Requirements:

  • For nonnarcotic prescriptions, the provider must hold a valid license to practice medicine in the state where the prescription is issued.

  • For narcotic prescriptions, the provider must be licensed in the state and possess a National Provider Identifier (NPI) number, indicating authorization to prescribe controlled substances.

• NPI numbers are unique 10-digit identifiers assigned to health care providers, used for prescribing medications and submitting claims to insurance companies and other payers.

• Prescriptions can be:

  • Handwritten, providing a traditional method of issuing medication orders.

  • Electronically printed, utilizing computer systems to generate prescriptions with improved legibility and accuracy.

  • E-scribed, transmitting prescriptions directly to the pharmacy from the EHR, streamlining the prescribing process and reducing errors.

  • Phoned in, allowing providers to verbally communicate prescriptions to pharmacists for immediate processing.

  • Faxed in, sending prescriptions via facsimile transmission, providing a convenient alternative to handwritten prescriptions.

Drug Formulary

• A drug formulary acts as a comprehensive list of medications covered under a specific insurance policy or by another entity, such as a pharmacy, outlining the drugs available at predetermined prices (e.g., the Walmart 4 prescriptions).

E-Prescribing

• E-prescribing enhances cost-effectiveness by promoting adherence to drug formularies and encouraging the use of generic medications, which typically have lower prices.

• Seamlessly integrated into EMR software systems, e-prescribing capabilities facilitate efficient prescription management.

• Recognizing its potential to minimize errors stemming from illegible handwriting, in 2011, Medicare and Medicaid programs introduced incentive payments to encourage providers to embrace e-prescribing.

• Medicare Part D mandates that all drug plans offer comprehensive support for electronic prescribing functionalities, further solidifying its adoption in healthcare practices.

Nonnarcotic vs. Narcotic Prescriptions

• Nonnarcotic:

  • Capable of transmission through various channels including fax, phone, traditional written prescriptions, or advanced e-scripts, providing flexibility in prescription methods.

  • Typically remains valid for a span ranging from six months to a year, affording clients ample time to fulfill their medication needs.

  • Encompasses medications such as birth control pills or treatments for chronic ailments like thyroid disorders, addressing a broad spectrum of health conditions.

  • Frequently prescribed for a duration of 30 days, coupled with the provision of up to five refills (equivalent to a six-month supply), contingent upon regular re-evaluations to ensure continued suitability and efficacy.

• Client Mail Prescriptions:

  • Facilitates the mailing of medications for a continuous three-month period, accompanied by necessary refills, offering convenience and accessibility to clients.

• Health care practitioners hold the responsibility of upholding stringent federal and state regulations when issuing prescriptions, ensuring compliance and patient safety.

• With the explicit approval of the provider, health care personnel are authorized to relay nonnarcotic prescriptions to a pharmacist, streamlining the prescription process and enhancing communication

Drug Sample Closet

• Drug sample closets serve as repositories for an assortment of medications readily available for distribution to patients initiating new treatments, allowing them to assess efficacy and tolerance before committing to a full prescription.

• This practice offers substantial cost savings for clients, particularly those lacking health insurance coverage, by providing access to essential medications at no immediate expense.

DEA Mandates for Narcotics

• Prescribing narcotics is subject to stringent regulations enforced by the Drug Enforcement Administration (DEA) to prevent misuse and diversion.

• Essential information required on narcotic prescriptions:

  • Patient's full name, date of birth, and current address for accurate identification and tracking.

  • Practitioner's full name, address, and DEA number to verify prescribing authority.

  • Precise drug name and strength to ensure correct medication and dosage.

  • Specific dosage form (e.g., pill, liquid, capsule) for administration clarity.

  • Clear directions for use to guide the patient in proper medication administration.

  • Exact quantity prescribed to control the amount of medication dispensed.

  • Number of refills, if any, to regulate ongoing access to the medication.

  • Issuance date and signature for prescription validation and authentication.

• Prescriptions for controlled substances necessitate being written in indelible ink, traditionally black, and manually signed by the prescribing practitioner to deter alteration or forgery.

• Insurance policies frequently impose limitations on the quantity of narcotics dispensed within a 30-day period, while regulatory schedules constrain the availability of refills, aiming to mitigate potential abuse.

• Clinics generally refrain from storing narcotics on-site due to concerns regarding theft, mandatory record-keeping obligations, and potential liability issues. Nonetheless, facilities conducting in-clinic surgical procedures may maintain a limited supply of narcotics for immediate procedural needs.

• Instances involving the loss of narcotics mandate prompt reporting to both the regional DEA office and local law enforcement authorities to facilitate prompt investigation and recovery efforts.

Substance Abuse

• Drugs and alcohol represent the most frequently abused substances, posing significant public health challenges and necessitating proactive intervention strategies.

• Providers and employees bear a collective responsibility to remain vigilant regarding potential substance abuse and actively contribute to prevention efforts within their communities.

• Examples of commonly cited excuses for lost prescriptions encompass scenarios such as misplacement during travel, inadvertent abandonment at home, or accidental disposal through plumbing systems, underscoring the need for heightened scrutiny and verification.

• The emergence of a provider as a so-called "script doctor" raises concerns regarding potential overprescribing practices and necessitates close monitoring to ensure appropriate prescribing behavior and patient safety.

• The integration of pharmacies into interconnected computer networks enhances monitoring capabilities, making it increasingly difficult for individuals to exploit the system and obtain controlled substances illicitly.

• Clinics may implement drug testing protocols to ascertain patient adherence to prescribed medications before authorizing refills, ensuring compliance and detecting potential misuse or diversion.

Alcohol Abuse

• Alcohol remains a prevalent substance of abuse, readily accessible and deeply ingrained in societal norms, contributing to widespread misuse and associated health risks.

• The proliferation of counterfeit identification documents exacerbates the problem, enabling underage individuals to procure alcohol unlawfully, underscoring the imperative for enhanced enforcement and prevention measures.

Prevention of Substance Abuse Clinic Policies

• Clinic policies play a pivotal role in mitigating narcotic abuse by establishing clear guidelines and protocols for prescribing, dispensing, and monitoring controlled substances.

• Recommended stipulations:

  • Mandate presentation of a valid picture identification card upon initial check-in to authenticate the client's identity and mitigate the risk of fraudulent activity.

  • Prohibit the authorization of controlled substance prescriptions without a prior in-person consultation with the client to facilitate comprehensive assessment and informed decision-making.

  • Require regular follow-up appointments with the client before authorizing refills to monitor treatment progress, assess adherence, and identify potential misuse or diversion concerns.

  • Insist on presentation of a picture identification card when picking up narcotic prescriptions to verify the recipient's identity and prevent unauthorized access.

• Providers and clinic staff utilizing handwritten prescriptions should exercise prudence in safeguarding prescription pads, storing them in secure locations, preferably under lock and key, to prevent theft or unauthorized access.

  • Prescription pads should never be left unattended in exam rooms, on reception counters, or within reach of clients to minimize the risk of misuse or diversion.

• The escalating adoption of e-prescribing modalities contributes to mitigating liability stemming from the theft of prescription pads, bolstering security and reducing the potential for fraudulent activities.

Health care professionals who demonstrate honesty and empathy in their interactions are more likely to establish rapport and foster trust with clients, facilitating open and constructive discussions regarding substance abuse issues and treatment options.

• Engaging in candid and forthright dialogues with all clients, encouraging them to abstain from drugs and alcohol, promotes awareness and empowers individuals to make informed choices regarding their health and well-being.

• Cultivating an environment conducive to open dialogue enables clients to feel more comfortable disclosing substance abuse problems, facilitating timely intervention and access to appropriate support services.

• Discussions with young adults are best conducted in the absence of parents or guardians to foster a sense of privacy and encourage honest communication, free from potential inhibitions or external influences.

• Health care professionals should undertake a comprehensive substance abuse history from all clients to identify potential risk factors, assess patterns of use, and tailor interventions to individual needs and circumstances.

• If a health care professional is struggling with substance abuse, their ability to provide safe and effective care is compromised, necessitating prompt intervention to safeguard both their well-being and that of their patients.

  • Such impairment may lead to disciplinary action, including the potential loss of professional licensing, underscoring the severity of the consequences associated with substance abuse in the health care profession.

Health Insurance Portability and Accountability Act (HIPAA)

• The HIPAA guidelines must be followed along with special iterations for HIV/AIDS patients, and with patients abusing substances.

• HIPAA addresses the integrity of an individual's identifiable health information (past, present, or future) and is the standard to follow to protect the patient.

• HIPAA established national standards to protect health information that includes audits and tracking breaches.

• The privacy rule assures that individuals' health information is properly protected while allowing the flow of information for high-quality care and public health.

• The privacy rule protects all individual's identifiable health information, known as protected health information (PHI), including audits and tracking breaches.

• HIPAA aims to allow information sharing on a need-to-know basis without unnecessary disclosure. The minimum is key.

Under HIPAA

• Clients must grant written consent or permission to provide or disclose PHI for any reason.

• Providers must provide clients with a notice of their privacy practice.

• Clients sign a form stating they've received the privacy statement annually.

• Clients must sign permission forms to allow information disclosure to lawyers, doctors, etc.

• Criminal penalties can be levied for noncompliance.

  • 100 per violation, up to 25,000 per person for all identified violations in a calendar year.

  • Fines can reach up to 1,500,000$$ and imprisonment for one year for breach of confidentiality.

Confidentiality

• Unless otherwise required by law, providers must keep confidential any communication necessary to treat clients. Following HIPAA is a must.

• This includes:

  • Receptionists keeping their voices down.

  • Logging off computers.

  • Positioning monitors so they cannot be viewed by others.

  • Not calling out patients' full names or birthdates aloud.

Health Care Reform Act of 2010

(Affordable Care Act)

• The goal was to make health care available to as many Americans as possible. The most vulnerable benefited.

• It puts American consumers back in charge of their own health coverage and care. Access to medical care was improved.

• Key provisions:

  • No pre-existing condition denials for children under 19. A huge win for children.

  • No arbitrary rescissions or cancellations of insurance coverage.

  • No lifetime limits anymore. Those needing long-term care benefited.

  • Restricted annual dollar limits on coverage.

  • Protection of the client's choice of doctors. Managed care restrictions were lessened.

  • Removal of insurance company barriers to emergency departments. A win for consumers.

Americans with Disabilities Amendment Act (ADAAA) of 2008

• Broadened the term of disability when it comes to the Americans with Disabilities Act (ADA). The definition of disability was broadened, allowing for more people to qualify