Prescription Monitoring: A New Concept for WC Defense Attorneys

Friday, November 6, 2009 | 0

By Eugene Keefe

Synopsis: New concept for everyone in the Illinois WC defense industry to consider for all major claims—prescription monitoring.
 
Editor’s comment: Illinois’ Prescription Monitoring Program (PMP) presents new web technology that will help change the face of managing Illinois Workers' Compensation system.  
 
At the 17th Annual SafeWorks Illinois Work Injury Prevention and Control Strategies conference held in Champaign, Ill. on Oct. 29, one of the highlights for many conference goers were the discussions on the various new technologies available to help facilitate the management of workers' compensation claim to maximize recovery. Dr. David Fletcher spoke about the new Illinois Prescription Monitoring Program which allows any licensed physician or pharmacist to determine if a patient is getting narcotic prescriptions from multiple providers and even determine if an injured worker may have received narcotics pain medication prior to a work injury. The Illinois Prescription Monitoring Program is open only to licensed pharmacists and physicians in Illinois—for claims adjusters and risk managers who want to know what is on the database, you need to run the inquiry through an occupational medicine doctor or independent medical examiner (IME).
 
So far, this new technology and related website has seemingly stayed under the claims radar and not widely know even though it provides valuable information that improves patient care for injured workers and helps prevent substance abuse and diversion of narcotics. The PMP is authorized by 720 ILCS 570/321, known as the Illinois Controlled Substances Act and applies to Schedule II, III, IV, and V prescription medications. The PMP Prescription Information Library (PIL) data base contains all Schedule 2, 3, 4 and 5 prescriptions dispensed by Illinois retail pharmacies. All retail pharmacies that dispense scheduled drugs are required to report their scripts to the PIL on a weekly basis. The database in the PIL updated is updated on Friday of each week.
 
IME doctors need to add this quick and simple web search to their day-to-day evaluation protocols
 
Accessing this new technology should be part of every independent medical examination that is conducted for any Illinois workers’ comp claimant. We don’t feel an IME physician can do a solid job if he/she doesn’t readily access this simple website to confirm the patient is taking only those drugs prescribed for the condition. Both sides of the WC bar want to know the patient is taking only what they are supposed to be taking and any surprises eliminated. We suggest this web search be added as a normal course of IME practice and put into every IME report.
 
In states that have the web service, a routine PMP search should also be part of all occupational health care.
 
As part of fitness for duty evaluations, some occupational medicine practitioners are using the site to check new hires that are seen for post job offer physical exams to determine the truthfulness of the responses to post job offer questionnaires about current drug use. In all occupational health settings, a PMP search should be de rigueur—we assert the occupational health doc can’t do solid job without insuring accurate review of a patient’s use of scheduled drugs for the last six months.
 
We also assume every emergency room in the State of Illinois should access this site as part a protocol for any patient that is prescribed narcotics or other controlled substances.
 
Attacking doctor-shopping and illegal prescription drug reselling for WC claimants
 
The PIL database is most useful for detecting and preventing "doctor-shopping." It is also helpful if you note a particular claimant is getting more narcotics than they could possibly or safely ingest by themselves and therefore may be illegally reselling the extra drugs for cash.

After a provider's registration is approved, the provider can log on and view the last six months of controlled substance prescriptions for a given patient. If a physician sees a pattern of excessive use of controlled substances, violations of narcotic contracts, or multiple providers they can change the treatment plan as well as alert other providers who may also prescribing controlled substances to the patient. Providers who been given a password access to the system by the Illinois Department of Human Services can access patient information by getting logged into the website http://www.ilpmp.org.

Providers input the patient’s first and last name and date of birth (DOB). The database then kicks out a chart listing any narcotic prescriptions, listing most recent dates first. The chart lists the number of pills dispensed, the pharmacy which pills were dispensed from, and the provider who prescribed the medication.

Health Insurance Portability and Privacy Act (HIPAA) and all confidentiality and disclosure provisions of Illinois law cover the information contained in this database. All users must fully comply with HIPAA Privacy Rule Requirements when using this system. Access to this database is yet another reason we recommend all workers’ comp accident or claim investigations start with both an accident reporting form and execution of a HIPAA-compliant release. If you need a HIPAA-compliant release, send a reply and we will email it to you.
As of November 2008, 38 states had enacted legislation that required prescription drug monitoring programs: 32 of those programs are currently operating. In FY2005, the Federal Department of Justice Harold Rogers Prescription Drug Monitoring Program received $10 million in funding and Illinois was one of 22 states awarded grants to start a PMP. The Illinois PMP went on-line in January 2008.

According to the PIL (Prescription Information Library maintained by PMP) because the disclosures of information to the PIL by pharmacies are mandated by law and not discretionary, the patient does not need to be informed of the disclosure, and does not need to consent to it. The PMP has been helpful in bringing to light addiction and drug-seeking issues in patients who are requesting narcotics at levels that appear out of sync with the level of physical findings on exam and diagnosis. Examples include one recent soft tissue injury patient found to be receiving narcotics from another local provider, who it turns out was managing the patient for a chronic pain issue which the patient failed to mention. In addition this patient had signed a narcotics contract with the other provider stating she would not receive narcotics from any other providers.

Another patient was found to have ‘made the rounds’ of local providers, including dentists, receiving multiple narcotics prescriptions. When challenged with this information and told her physician would no longer dispense or write narcotics prescriptions, the patient abruptly dropped her workers' compensation claim and never returned.
 
Another solid feature is the physician’s ability to learn the prescriptions have been written with his/her DEA number. This allows the physician to run a report displaying all scheduled drugs recently prescribed. This feature allows the physician to determine if someone is stealing scripts from their office or impersonating the doctor to fraudulently use their DEA number. It also allows the physician to monitor and detect pharmacy errors with this feature.
 
Recent discussions and presentations about PMP were presented by Dr. David Fletcher at REBEX (Regional RIMS conference in Wheeling) and the 17th Annual Safeworks Illinois Work Injury conference where the response to learning about this new technology was overwhelming positive. We are also advised the folks at the Department of Health and Human Services liked the public relations impact. They heard the news on the topic and have contacted Safeworks Illinois about it. They are applying for additional federal grants to expand the program, which is already saving lives and money by decreasing inappropriate narcotic prescriptions and putting unscrupulous doctors on notice that they are being closely monitored.
 
In summary, the PMP has changed the face of Illinois workers' compensation case management with the ability to access historical information on controlled substances and assists with the proper management of chronic pain patients. For more information on the Illinois Prescription Monitoring Program, contact: Stan Tylman, 401 North Fourth Street, Springfield IL, 62702 Phone: 217 524-9074; Fax 217-557-7975.

Eugene Keefe is a partner with Keefe, Campbell and Associates in Chicago. This column was reprinted with is permission from the firm's newsletter.