Prescription Monitoring Program Activities Increase Nationally by ehz13319


                                                                                                     Alternate Members
                                                                                                     Help Boards Better
                                                                                                     Manage Case Workloads

Federation of State Medical Boards of the United States, Inc.                       July/Aug. 2009
                                                                                                     S  cheduling constraints and potential
                                                                                                        conflicts of interest can make it diffi-
                                                                                                     cult for state medical boards to convene
                                                                                                     board panels in a timely manner with the

Prescription Monitoring Program Activities                                                           required number of members. The Wyo-
                                                                                                     ming Board of Medicine and the Iowa
Increase Nationally                                                                                  Board of Medicine have recently taken
                                                                                                     steps to enable alternate members to

S    tates continue to implement and
     enhance Prescription Monitoring
 Programs (PMPs) to address the growing
                                                       six border states, making it easier for
                                                       physicians to more effectively recog-
                                                       nize cases of “doctor shopping” drug
                                                                                                     serve on hearing panels for disciplinary
                                                                                                     cases when regular board members are
                                                                                                     unavailable or unable to serve.
 nationwide problem of prescription drug               seekers.
 abuse. The programs have proven to be                                                               Wyoming: Appointing alternate
 a valuable tool for state medical boards            • Congressional approval in March
                                                                      of funding for the
                                                                                                     members on a case-by-case
 and physicians in
 their efforts to protect                                             National All Schedules         basis
 legitimate medical                                                   Prescription Elec-                  In March 2009, the Wyoming legis-
 uses of controlled                                                   tronic Reporting Act           lature passed a bill containing several
 substances for pain                                                  (NASPER) for the first         provisions modifying the Medical Prac-
 management while                                                     time since the law was         tice Act. Among them is a statute that
 minimizing opportu-                                                  enacted in 2005.               permits the board president to submit a
 nities for drug diver-                                                                              written request to the governor for the
 sion and abuse.                                                      Florida PMP                    appointment of one or more temporary
      Most states have                                                Legislation                    board members for the sole purpose of
 taken steps toward                                                                                  hearing a specifically named disciplinary
 implementing a PMP.                                                        As one of the 12         case. Only former members of the board
 Recent developments          “KASPER is one of the best tools states without a PMP,                 are eligible for temporary appointment.
 include:                    physicians have to combat doctor Florida became a                            “Wyoming is a small state; about
                                shopping and protect patient          magnet for individuals         1,000 physicians practice here and
   • Passage of a new                                                 involved in prescrip-          everyone knows everyone,” said Kevin
                             safety, and it’s been a tremendous
     law in Florida in                                                tion drug abuse across         Bohnenblust, J.D., executive director of
                              help to the board in conducting the eastern United
     June establish-                                                                                 the Wyoming Board of Medicine. “There’s
                                     timely investigations.”          States. Freestanding
     ing a PMP and                                                                                   a very reasonable chance that we might
     enabling greater                    – Mike Rodman,               pain clinics, which            be unable to raise a quorum to hear a
     regulation of pain Assistant Executive Director, Kentucky were able to operate                  disciplinary case and until this law was
     clinics, making it             Board of Medical Licensure        with little oversight by       passed, we had no clear-cut way to deal
     the 39th state to                                                accepting only cash,           with that possibility.”
     enact legislation requiring a PMP.                               facilitated widespread              Limiting eligibility for temporary
                                                   drug diversion.                                   board members to former board mem-
Inside this Issue:                                      This growing problem prompted                bers helps streamline the approval
Page 2: FCVS Enhancements                          the recent near unanimous passage by              process. The governor can appoint
                                                   the Florida legislature of the law requir-        temporary board members without
Page 3: FDA Shares LASIK Info
                                                   ing a PMP. The law also requires certain          state senate approval because all former
Page 4: USMLE Seeks Physician Board
                                                   pain management clinics to register               board members gained senate confirma-
          Members                                  with the Department of Health and                 tion at the time of their appointment. In
                                                   be subject to annual inspections or be            addition, former members are familiar
   • An announcement by Colorado in                nationally certified.                             with the board’s processes, which en-
     April of the availability of its electronic        “We consider the new law a big               ables them to get up to speed quickly.
     PMP, making it one of the 32 states to        step forward for patient safety,” said                 “We haven’t had to seek appoint-
     have an operational PMP, according to Larry McPherson, executive director of                    ment of an alternate member yet, but I
     the Drug Enforcement Administration. the Florida Board of Medicine. “Howev-                     can foresee cases later this summer that
                                                   er, the big challenge lies in implement-          may require us to do so,” said Bohnen-
   • The addition by Kentucky on its PMP           ing the bill.”                                    blust.
     website of links to the PMP sites for                               ...continued on page 2                            ...continued on page 3

                                                                Newsline | July/August 2009
  Prescription Monitoring Programs – continued from page 1
    The Florida Office of Drug Control is       for Drug Enforcement and Professional                                    as a matter of due diligence in the evalu-
working to obtain non-state funding to          Practice, which has oversight responsi-                                  ation and periodic review of patients
implement the PMP, as the law requires.         bility for KASPER.                                                       being treated with controlled substances.
The Florida Boards of Medicine and Os-               Sallengs estimates that of the nearly                               The Kentucky Board of Medical Licen-
teopathic Medicine are planning public          1,900 KASPER reports pulled by physi-                                    sure cited KASPER reports in its Opinion
meetings to develop rules for regulating        cians daily, only 10 percent are cases                                   Regarding the Use of Controlled Substances
the practice of physicians in pain clinics.     of suspected prescription drug abuse.                                    in Pain Treatment as a tool that physicians
                                                Instead, physicians are using the reports                                should use in evaluating patients and
                                                                                                                               reviewing their treatment plans.
Enhancing a well-estab-
                                                                                                                                    “KASPER is one of the best
lished PMP in Kentucky                                                                                                         tools physicians have to combat
     The Kentucky All Schedule                                                                                                 doctor shopping and protect
Prescription Electronic Report-                                                                                                patient safety, and it’s been a
ing system (KASPER) has been                                                                                                   tremendous help to the board in
operational since 1999 and was                                                                                                 conducting timely investigations,”
one of the first state PMPs to                                                                                                 said Mike Rodman, assistant execu-
convert to a self-service, Web-                                                                                                tive director of the Kentucky Board
based system. Approximately                                                                                                    of Medical Licensure.
2,000 reports are generated each                                                                                                    As part of its ongoing efforts
day by KASPER and 94 percent of                                                                                                to enhance KASPER, the Office of
those reports are generated for                                                                                                Drug Enforcement and Professional
physicians.                                                                                                                    Practice is working with the state
     “Physicians love the sys-                                                                                                 of Ohio to test live sharing of PMP
tem – they can pull reports to                                                                                                 data by year-end. The test is part of
make sure a drug is being used                                                                                                 broader effort to establish stan-
as intended and discuss usage                                                                                                  dards for transmitting PMP data
patterns with their patients,” said      Sources: Drug Enforcement Administration; University of Wisconsin Pain & Policy       between states via a shared hub
Dave Sallengs, branch manager            Studies Group.                                                                        server.

FCVS Introduces Enhancements to Increase Efficiencies and Improve
User Interface
T   he Federation Credentials Verification
    Service (FCVS) recently introduced
new product and service enhancements
                                                of GMEConnect, FCVS saw reductions
                                                of 12 percent in the average processing
                                                times for institutions using the service.
                                                                                            plication process less time-consuming.
                                                                                                  In addition, the application performs
                                                                                            data-validation functions behind the inter-
intended to decrease credentials verifica-           “We received a great deal of positive  face, preventing applicants from perform-
tion processing times and enhance the           feedback from programs who have signed      ing data entry errors such as a graduation
user experience.                                up for the service,” said Tracy Bevers,     date that is earlier than a birth date.
                                                manager of FCVS. “Programs are finding            “By ensuring application data is as
GMEConnect                                                    the service to be a time-saveraccurate as possible at the point of data
                                                              for staff and are pleased withentry, we can process files more efficiently,
     In May, FCVS
                                                              the efficiencies the service  which translates into reduced process-
released GMECon-
                                                              provides.”                    ing times,” said Kevin Caldwell, senior
nect, which is designed
                                                                                            director of FCVS. “We are very excited to
to increase the speed                                         Enhanced FCVS                 implement these enhancements knowing
and efficiency of grad-
uate medical education                                        Application                   we will be better positioned to meet the
(GME) credentialing                                               In July, FCVS released an future needs of our member boards and
verifications. GME pro-                                       enhanced online application applicants.”
                                                                                                  In conjunction with these technologi-
gram directors can now                                        designed to improve the ap-
                                                                                            cal enhancements, FCVS also has imple-
submit participant verification in a secure,    plicant experience by enhancing the look
Web-based environment, eliminating the          and feel of the application while employing mented a revised electronic evaluation sur-
                                                                                            vey to be completed by applicants after the
need to mail forms. The password-pro-           auto-data validation functionalities. The
                                                                                            initial application process. The evaluation
tected service also offers greater security     enhanced application will auto-populate
in the transfer of verification documents.      certain data elements currently housed
                                                                                                                     ...continued on page 4
During a one-year period of beta-testing        within the FCVS database, making the ap-

                                                          Newsline | July/August 2009 | Page 2
                                                                                             Alternate Members – continued
FDA Seeks to Share Information on LASIK                                                      from page 1

with Medical Boards                                                                         Iowa: Creating a pool of
                                                                                            alternate members
     The Food and Drug Administration’s           LASIK-related information has also
                                                                                                 The Iowa legislature passed a law in
Center for Devices and Radiological          been updated in SightNet, a program
                                                                                            2008 allowing the medical board to have
Health seeks to open communication           used by health care professionals at
channels between the FDA, clinicians,        participating facilities to share concerns     a pool of up to 10 alternate members to
patients and state medical boards            about ophthalmic medical devices with          substitute for board members on hear-
regarding issues related to laser-assisted   the FDA.                                       ing panels. Alternate members may be
in-situ keratomileusis (LASIK) procedures.        In addition, the FDA and the Ameri-       physicians or members of the public and
     In April 2008, the FDA convened         can Academy of Ophthalmology devel-            must be approved by the governor and
an advisory panel of outside experts to      oped a patient information card that           state senate. Individuals may serve in the
discuss patient experiences after LASIK      physicians can fill out with a patient’s       pool for up to nine years.
procedures. The committee identified         eye measurements before a LASIK proce-              “While hearing panels must have
the following issues from public com-        dure. Patients can keep this card for use      at least three members under Iowa law,
ments made at the meeting and submit-        in the event of future cataract surgery.       we always try to have a quorum or a
ted to a docket:                                                                            six-member hearing panel as it greatly
  • Potential under-reporting of severe                                                     reduces the appeals process,” said Mark
    problems such as halos, glare, night
                                             Outreach to patients
                                                                                            Bowden, executive director of the Iowa
    vision and dry eye post-LASIK;                The FDA has made it easier for pa-        Board of Medicine. “We were finding it
  • Inadequate quality and availability of   tients and clinicians to report problems       increasingly difficult to seat six-member
    post-surgery patient follow-up;          related to a LASIK procedure to Med-           panels.”
  • Inappropriate                                               Watch, FDA’s voluntary           The board has proposed nine indi-
    guarantees and                                              adverse-event report-       viduals to the governor’s office for the
    effectiveness claims                                        ing program, by adding
                                                                                            pool. Three have been approved to-date
    made in advertise-                                          a link to the FDA’s LASIK
                                                                                            and all happen to be former board mem-
    ments by certain                                            website at www.fda.
                                                                                            bers. Two of the alternate members have
    LASIK practitioners;                                        gov/cdrh/lasik.
                                                                                            successfully served on three panels this
  • Inadequate practice                                              Also, the online
                                                                public docket for LASIK     year and another is scheduled to serve
    of informed consent
                                                                remains open for peo-       on a panel in July.
    regarding likely side
    effects or the pos-                                         ple to post comments             “Our alternate members did an ex-
    sibility of retreat-                                        or concerns. Postings       ceptional job,” said Bowden. “They were
    ment;                                                       are reviewed by FDA         prepared, engaged and made it a seam-
  • Inadequate screening processes and                          staff on a regular basis.   less experience for everyone involved.”
    patient selection criteria.              The docket can be found at www.regula-              According to Bowden, having a pool
     “We believe there are approximately by typing the keyword “LASIK”        of alternate members not only improves
700,000 LASIK procedures performed           into the search block.                         the board’s flexibility and efficiency. It
each year, so even a small percentage of                                                    also enables the board to engage indi-
patients experiencing issues represents a    Outreach to state medical                      viduals who are interested in serving the
large number of people,” said Eva Rorer,     boards                                         public but might not be able to commit
M.D., chief ophthalmic medical officer                                                      to a more time-intensive role.
of FDA’s Division of Ophthalmic, Neuro-           “The FDA and state medical boards
logic, and ENT Devices.                      share a mission to protect public               For More Information about
                                             health,” said Dr. Rorer. “In addition to
                                                                                             Alternate Members
                                             taking enforcement actions as ap-
Outreach to clinicians                       propriate, we would like to encourage                 For more information about the
     In response to these issues, the        state medical boards to share with their        laws and processes related to alternate
FDA sent a letter earlier this year to eye   licensees the LASIK-related issues we’ve        board members in Wyoming and Iowa,
care professionals about issues related      identified.”                                    please contact Kevin Bohnenblust at
to advertising and promotion of LASIK.            The latest information related to and Mark Bowden
The American Academy of Ophthalmol-          LASIK is available on the FDA’s LASIK           at To refer-
ogy, the American Society of Cataract        website. State medical boards are also
                                                                                             ence the specific statutes enacted in
and Refractive Surgery, the American         encouraged to share relevant informa-
                                                                                             those states, please see:
Optometric Association, and the Opto-        tion on LASIK procedures with the FDA
metric Council on Refractive Technology      by contacting Dr. Jim Saviola, ophthalmic          • Subsection (f) of Wyoming Statute
disseminated the letter to their members     and ENT network leader, at (301) 796-                33-26-201
on behalf of the agency.                     5432 or                 • Chapter 148.2A of Code of Iowa

                                                    Newsline | July/August 2009 | Page 3
USMLE Seeks Physician Members of Boards to                                                                FCVS Enhancements –
Serve on Test Development Committees                                                                      continued from page 2

T   he United States Medical Licensing
    Examination® (USMLE®) seeks poten-
tial candidates to serve on USMLE test
                                                   annual item-writing workshop for state
                                                   medical board members hosted by the
                                                   FSMB. The next workshop is scheduled
                                                                                                          will provide additional data regarding
                                                                                                          user satisfaction and serve as an indi-
development committees and/or other                for spring 2010.                                       cator of where future service-oriented
related USMLE activities. The USMLE                      Because state medical boards are the             enhancements may be warranted.
relies upon the work of nearly 300 physi-          primary users of USMLE scores, it is im-                     “Greater insight into the experi-
cian and clinician volunteers in develop-          portant that physicians with experience                ences of our users will allow us to
ing and maintaining this national exami-           on state medical boards continue to offer              identify ways in which we can make
nation. This “national faculty” draws upon         their expertise to the program. For more               future improvements,” said Deborha
physicians and clinicians from multiple            information, contact David Johnson, M.A.,              Reed, manager of FCVS.
backgrounds, including medical licensing           vice president for Assessment Services, at                   The FSMB continues its commit-
boards, academia and private practice.    or (817) 868-4081.                   ment to making additional improve-
Physicians wishing to learn more about             For more information about the USMLE,                  ments to the FCVS product to ensure
the USMLE should inquire about the                 visit                                   a high level of efficiency, effectiveness
                                                                                                          and user satisfaction. As a part of this
 Upcoming Events                                                                                          initiative, FSMB is working closely
 Sept. 24-25, 2009: AIM Eastern and Southern Regional Meeting, Charleston, W.Va.                          with the Administrators in Medicine
 Oct. 8-9, 2009: AIM Western and Central Regional Meeting, Omaha, Neb.                                    organization and other user groups to
 Oct. 8-10, 2009: FSMB Board of Directors Meeting, Naples, Fla.                                           gather information regarding the cre-
 Oct. 30, 2009: FSMB Bylaws Committee Meeting, Washington, D.C.                                           dentialing and technological needs of
 Nov. 5-6, 2009: 2009 AIM Institute Physician Licensing, Profiles and Technology                          state medical boards.
 Workshops, Boston, Mass.                                                                                        For more information, please
 Nov. 12-13, 2009: FSMB Board Attorneys Workshop, Las Vegas, Nev.                                         contact Kevin Caldwell at kcaldwell@
 April 21, 2010: AIM Annual Meeting, Chicago, Ill.                                               or (817) 868-5001 or visit
 April 22-24, 2010: FSMB Annual Meeting, Chicago, Ill.                                          

 Please send your questions, comments and article ideas to: Drew Carlson, FSMB Newsline, P.O. Box 619850, Dallas, Texas 75261,,
 (817) 868-4043. Visit the FSMB’s website at

                            Federation of State Medical Boards
                            P.O. Box 619850                                                                                       Presorted STD
                            Dallas, TX 75261-9850
                                                                                                                                U.S. Postage Paid
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