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Toxicology Testing MITIGATING PHYSICIAN LIABILITY RELATED TO DRUG PRESCRIPTIONS Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Agenda ▪ Introduction ▪ Our Program ▪ Next Steps Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved About Us ▪ MASS is a privately-held company focused on providing leading edge and innovative solutions to our network of physician providers ▪ Solutions provided include Electronic Wellness Visits, Toxicology Screening, Blood Testing, Pharmacogenomics (PGx) Testing, Anatomic Pathology, Gene ID/Cancer Screening, and Molecular Biology Testing Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Approach ▪ Introduce Revenue-Generating Service to physician practices ▪ Allergy Testing ▪ Electronic Wellness ▪ Blueprint Health HRT Then sell-through additional patient-facing services such as: ▪ Toxicology ▪ Pharmacogenomics (PGx) ▪ Cancer Screening ▪ DNA Testing (Optimized Fitness and Nutrition) Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Market Overview ▪ The market for pain management drugs and devices was valued at $35.4 billion in 2012. Total market valued is expected to reach $41.5 billion in 2017 after increasing at a five-year compound annual growth rate of 3.2%.1 ▪ Opiate abuse is now a widespread national epidemic ▪ You have a legal and ethical responsibility to uphold the law and to help protect society from drug abuse. ▪ You have a professional responsibility to prescribe controlled substances appropriately, guarding against abuse while ensuring that your patients have medication available when they need it. ▪ You have a personal responsibility to protect your practice from becoming an easy target for drug diversion. ▪ Physicians concerned about risk-mitigation are expressing interest in our Tox Screening program 1. Source: bcc Research: http://www.bccresearch.com/market-research/healthcare/pain-management-drugs-devices-hlc026d.html Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved In The News DEA is prosecuting providers who prescribe drugs to patients without a Tox screening program ▪ Doctor Convicted of Three Murders in Prescription Drug Overdose Case (http://www.dea.gov/divisions/la/2015/la103015.shtml) ▪ 2014 Conspiracy and Distribution of Controlled Substances - Rosaire M. Dubrule, MD, of Tiptonville, TN, was found guilty in U.S. District Court, Western District of Tennessee, of one count Conspiracy to Distribute Schedule II & III Controlled Substances and 44 counts Distribution of Controlled Substances. ▪ 2013- Norman Werther, MD, of Willow Grove, PA, was found guilty in U.S. District Court, Eastern District of Pennsylvania, of one count of Distribution of a Controlled Substance Resulting in Death, five counts of Conspiracy to Distribute a Controlled Substance; one count of Maintaining a Drug-Involved Premises; 117 counts of Money Laundering, and over 180 counts of Distribution of a Controlled Substance. ▪ 2013 - Jeffrey Friedlander, MD, of Tampa, FL, pled guilty in U.S. District Court, Middle District of Florida, to one count Conspiracy to Distribute and Dispense Controlled Substances Not For Legitimate Medical Purposes; and one count Conspiracy to Defraud a Health Care Benefit Program. ▪ 2016- Medical Doctor Arrested on Federal ‘Structuring’ Charges for Making Cash Deposits to Avoid Federal Reporting Requirements. According to data maintained by the state of California, the doctor issued nearly 10,000 controlled drug prescriptions over a three-year period that ended in March. ▪ Source: Dept of Justice, Office of Diversion Control Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Tox Testing Defined ▪ A toxicology screen is used to determine if a patient has used certain legal or illegal drugs ▪ The results can show the presence of one specific type drug or a variety of drugs at once ▪ Further confirmatory testing may be needed to determine the exact drug or amount of a particular drug in the body ▪ A tox screen can also be used to determine if other toxic substances are present in the body such as heavy metals Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Why do Tox Screening ▪ To determine is someone has taken a drug that could endanger their health or the health of someone else (i.e. unborn child) ▪ To screen for drug abuse or monitor someone with a substance abuse problem ▪ To identify denial and minimization of drug and alcohol use ▪ To detect and evaluate drug intoxication or overdose ▪ To monitor compliance with prescribed medications ▪ To assist with diagnosis and development of treatment planning ▪ To monitor treatment response ▪ To mitigating physician liability related to drug prescriptions Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Who Should be Screened? ▪ All new Patients ▪ Any Patient prescribed pain meds ▪ Any surgery Patient ▪ Any Patient asking for pain med for any reason ▪ Any Patient asking for a pain med refill Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Recognizing the Drug Abuser ▪ Unusual behavior in the waiting room. Assertive personality, often demanding immediate action ▪ Unusual appearance–extremes of either slovenliness or being over-dressed ▪ May show unusual knowledge of con- trolled substances and/or gives medical history with textbook symptoms OR gives evasive or vague answers to questions regarding medical history ▪ Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance ▪ Will often request a specific controlled drug and is reluctant to try a different drug ▪ Generally has no interest in diagnosis; fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation ▪ May exaggerate medical problems and/or simulate symptoms ▪ May exhibit mood disturbances, suicidal thoughts, lack of impulse control, thought disorders, and/or sexual dysfunction ▪ Cutaneous signs of drug abuse–skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved How to Do the Testing ▪ MASS will provide you with requisition forms to direct lab to run the Tox test ▪ A practice staff member will discuss the Tox test with the Patient to explain why Tox is needed ▪ Get Patient signed consent to the screening. Failure to do so can damage the physician-patient relationship and cause legal consequences for the physician ▪ Patient can opt out of testing if they wish … But need to stay in the screening program in order to continue to receive medications Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved How to Address Tox Screening With Your Patient ▪ Medication monitoring screening is a widely available and familiar method for monitoring opioid use in chronic pain patients and patients on controlled medications. ▪ The monitoring test will guarantee that you are taking the drugs prescribed and only those medications. If you were to stray from the medications prescribed, you could be placing your health at risk. ▪ Narcotic medications can have significant cross-reactions with other medications. A medication monitoring test may prevent an unnecessary adverse event. ▪ Your physician is ordering a medication monitoring test to protect his medical license. Physicians face significant risks by prescribing controlled medications. Patients may divert their prescriptions, take too much, or combine them with illicit substances, etc. These risks are reduced by physicians subjecting patients to medication monitoring testing, pill counts and pain agreements. ▪ Pain management safeguards are necessary in this day and age to protect both the patient and provider ▪ Ensuring compliance with a narcotic treatment program or controlled medications will allow better outcomes for the patients along with implementing appropriate safeguards for the doctor and his or her practice. The overlying theme for why it is appropriate to drug test patients in one word is: PROTECTION. Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Testing Options ▪ A tox screen may check for one certain drug or for up to 30 different drugs at once. These may include prescription medicines, nonprescription medicines (such as aspirin, vitamins, supplements, alcohol, and illegal drugs, such as cocaine and heroin. ▪ Testing is may be performed on urine or saliva instead of blood. Many drugs will show up in a urine or saliva sample. And urine and saliva tests are usually easier to do than blood tests. Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Compensation ▪ Direct compensation to physicians from insurance reimbursement is not allowed ▪ Physician may elect to purchase and resell an inventory of testing cups or kits (Point of Care) ▪ Point of Care services can drive significant new revenue Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Next Steps ▪ Go through the program yourself so that you understand the process ▪ Complete New Account Form ▪ Receive Tox Screening Training (In-Service Morning) ▪ Begin referring patients Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved Contact Jake Michel, CEO Dan Miller, COO 727-421-7496 941-544-2686 [email protected] [email protected] Private and Confidential Medical Advisory Solutions and Services, LLC – All Rights Reserved
