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2nd Ohio Pharmacy Advocacy Forum

Ohio College of Clinical Pharmacy, Ohio Colleges of Pharmacy
and Council for Ohio Health Care Advocacy
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ZIKA VIRUS

ZIKA VIRUS
Zika virus disease (Zika) is a disease caused by Zika virus that is spread to people primarily through …
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Proposed Bill Would Require Payment …

Proposed Bill Would Require Payment Disclosures to Advanced Practice Nurses and Physician Assistants

A proposed bi…
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Interprofessional Legislative Update

HPU-LogoBy Lori Herf, MA

The Ohio General Assembly has dedicated much of the winter and spring months to budget (HB 59) deliberations. With the new state fiscal year beginning on July 1st, 2013, legislative leaders will focus most of their attention not only on the fiscal operations of the state of Ohio, but also on the many policy changes made as amendments to state budget provisions.

APRNs and Physician Assistants

Language was considered that would have allowed advanced practice nurses and physician assistants to admit patients to hospitals. That provision is now being considered independently of the budget as HB 139.

Pharmacists

A number of pharmacy provisions remain part of the budget as well. One of the provisions would require that Medicaid managed care organiza-tions provide 90 days notice to pharmacies being terminated as a network provider and extends the notice to all types of health care providers. In the case of pharmacies, similarly the budget would require that 90 days advance notice be given regarding the removal of a prescribed drug from the formulary or preferred drug list used by the organization or administrator or any change in the terms governing access to the drug. The amendment that we are opposing in the budget which is HB 59 dealt with remote dispensing.

The amendment would have allowed a pharmacy that is licensed as a terminal distributor of dangerous drugs to use a remote drug dispensing system at a nursing home or residential care facility. The pharmacist would not be required to be physically present where the system is used to dispense the drugs. COHCA has strong concerns regarding this provision and asked legislators to remove the language from the budget bill. The Ohio Senate did remove the language from the substitute version of the bill; however the bill will be amended next week and then be considered by a conference committee that could reinsert the language into the final version of the bill.

Other Bills:

House Bill 44

HEALTH EMERGENCIES (McClain)
To require the Director of Health to develop protocols regarding the authority to administer, deliver, distribute, or dispense drugs during certain public health emergencies. This is currently pending in

House Health and Aging Committee where it has received two hearings.

Requires the Director of Health to develop one or more protocols that authorize certain licensed health professionals to administer, deliver, or distribute drugs during a public health emergency; requires the Director to develop protocols as well that authorize pharmacists and pharmacy interns to dispense limited quantities of dangerous drugs without a prescription or record of a prescription during a public health emergency; and provides that an individual who administers, delivers, distributes or dispenses a drug or dangerous drug in accordance with one or more of those protocols is not liable for, nor subject to civil damages, criminal prosecution, or professional disciplinary action, unless the individual’s acts of omissions constitute willful, wanton misconduct.

House Bill 60

MATERNITY UNITS (Huffman)
To require that rules governing maternity units, newborn care nurseries, and maternity homes include certain provisions pertaining to the authority to make decisions regarding the transfer of patients to other facilities and to specify procedures for granting variances or waivers of any requirement in the rules governing operation of such facilities.

Currently pending in House Health and Aging where it has received two hearings.

The bill codifies an administrative rule that authorizes the Director of Health to grant a variance from or waiver of any of the requirements of rules regarding the operation of a maternity unit, newborn care nursery, or maternity home; requires the Director to adopt rules regarding application forms to be used and procedures to be followed in applying for a variance or waiver; requires the Director to review all applications for variances and waivers and, not later than 90 days after receipt of an application, to determine whether to grant the variance or waiver and notify the applicant of the decision.

House Bill 83

PSYCHOLOGY LAWS (Hackett)
To make 14 major changes to the law that gov-erns the practice of psychology. Heard in the House Health and Aging Committee; reported out of committee; passed the House 96-1; currently pending in the Senate Medicaid, Health and Hu-man Services Committee.

House Bill 94

HEALTH PLANS (Gonzales)
To require a health insuring corporation, public employee benefit plan, or sickness and accident insurer to reimburse a board of health for any services provided to an individual by the board that is covered by a plan issued to the individual by the health insuring corporation, public employee benefit plan, or sickness and accident insurer upon request submitted by the Board of Health.

Currently pending in House Insurance Committee; has received two hearings.

House Bill 123

TELEHEALTH SERVICES (Gonzales, Wachtmann)
Regarding Medicaid and health insurance coverage of telehealth services.

Currently pending in House Health and Aging Committee where it has received two hearings.

The bill authorizes health care insurers to provide coverage of telehealth services provided by health care professionals and facilities, requires the Office of Medical Assistance to adopt rules establishing standards for Medicaid reimbursement of telehealth services provided by health care professionals and facilities; specifies that coverage of a telehealth service applies only if the service involves an immediate and direct interaction with a patient, is medically appropriate and necessary, and is provided by a licensed health care provider or facility; and requires that a health care provider seeking reimbursement for telehealth service maintain documentation of providing the service as part of the patient records the provider maintains.

House Bill 131

TANNING REGULATIONS (Johnson, Stinziano)
To regulate chemical tanning and prohibit tanning facilities from allowing the use of sun lamps by certain individuals under 18 years of age.

Currently pending in House Health and Aging Committee where it has received three hearings.

Prohibits an operator or employee of a tanning facility from allowing an individual under age 18 to use the facility’s fluorescent sun lamp tanning services unless the individual presents a prescription issued by a physician; and requires the State Board of Cosmetology to regulate chemical tanning facilities.

House Bill 139

HOSPITAL ADMISSIONS (Gonzales)
To permit certain advanced practice registered nurses and physician assistants to admit patients to hospitals.

Currently pending in House Health and Aging Committee where it has received two hearings.

Current law allows only physicians, dentists and podiatrists who are members of the medical staff to admit patients to hospitals. The bill would add clinical nurse specialists, certified nurse midwives and certified nurse practitioners who have a standard care arrangement with a physician or podiatrist who is a member of the medical staff. The bill would also allow physician’s assistants, under the supervision, control or direction of a physician or podiatrist who is a member of the medical staff, to admit patients to hospitals. The bill also would require the APRN or PA to notify the collaborating or supervising physician or podiatrist not later than 12 hours after admitting a patient to a hospital.

House Bill 147

MASTECTOMY GUIDANCE (Patmon, Wachtmann)
To require a surgeon performing a mastectomy, lymph node dissection, or lumpectomy in a hospital to guide the patient and provide referrals in accordance with the standards of the National Accreditation Program for Breast Centers and to name this act the Lizzie B. Byrd Act.”

Currently pending in the House Health and Aging Committee where it has had two hearings.

The bill, in addition to the above would require the sur-geon performing a mastectomy or lumpectomy to refer a patient if breast reconstruction is appropriate, and requires the surgeon to offer the patient a preoperative referral to a reconstructive or plastic surgeon in accordance with NAPBC standards.

House Bill 159

DENTAL SERVICES (Hacket, Schuring)
To prohibit a health insurer from establishing a fee schedule for dental providers for services that are not covered by any contract or participating provider agreement between the health insurer and the dental provider.

Currently the bill is pending in the House Insurance Committee where it has had one hearing.

Prohibits a contracting entity from requiring a dental provider to provide services to plan enrollees at a fee set by or subject to approval by the contracting entity unless certain circumstances are met; makes setting or requiring the insurer’s approval of fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances are met; and makes the offering of a health benefit plan that sets fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances apply.

House Bill 165

HYPERBARIC TECHNOLOGISTS (Roegner)
Exempts certified hyperbaric technologists from the laws governing the practice of respiratory care.

Currently pending in the House Health and Aging Committee. Has not been heard.

House Bill 170

DRUG OVERDOSES (Johnson, Stinziano)
To provide that a licensed health professional authorized to prescribe naloxone, if acting with reasonable care, may prescribe, administer, dispense or furnish naloxone to a person who is, or a person who is in a position to assist a person who is, apparently experiencing or who is likely to experience an opioid-related overdose without being subject to administrative action or criminal prosecution, to provide that a person who is in a position to assist a person who is apparently experiencing or who is likely to experience an opiod-related overdose is not subject to actions of professional licensing boards, administrative action, or criminal prosecution for a drug offense or practicing medicine without a license if the person acting in good faith, obtains naloxone prescription from a licensed health professional and administers it to a person for an opioid-related overdose, and to provide that peace officers and licensed emergency responders who are acting in good faith are not subject to administrative action or criminal prosecution for a drug offense or practicing medicine without a license for administering naloxone to a person who is apparently experiencing an opioid-related overdose.

Currently pending in the House Health and Aging Committee. It has not yet been heard by the committee.

Senate Bill 4

NEWBORN SCREENINGS (Manning, Oelslager)
To require a pulse oximetry screening for each newborn born in a hospital or freestanding birthing center.

Received two hearings in Senate Medicaid, Health and Human Services Committee, reported out of Committee; passed the Senate 33-0; referred to House Health and Aging Committee where it has received 5 hearings.

Requires hospitals and freestanding birthing centers to conduct a pulse oximetry screening on each newborn (unless a parent objects on religious grounds) for purposes of detecting critical congenital health defects; requires the Director of Health to adopt rules establishing standards and procedures for the pulse oximetry screenings.

Senate Bill 43

CIVIL COMMITMENT (Burke)
Makes a number of changes to the laws governing the civil commitment of and treatment provided to mentally ill persons.

Currently pending in Senate Criminal Justice Committee. It has received one hearing.

Senate Bill 99

CANCER MEDICATIONS (Oelslager, Tavares)
Regarding insurance coverage for rarely administered cancer medications.

Pending in Senate Insurance and Financial Institutions Committee where it has not received a hearing.

Neurosurgery Physician Assistant at Akron Children’s

Combines the Best of Care and Cure

Holly Zeller, PA-C sits down with Julie Tsirambidis, CNP to go over privilege delineation forms at Akron Children’s Hospital.  This is one of their many overlapping moments where NP and PA practice comes together.  Becoming more frequent is this visibility- that NPs and PAs sit side by side with their physician counterparts to enhance patient care.  After years of working in silos, these disciplines agree the time to work together is long overdue.  Hence, the Center for Advanced Practice at Akron Children’s Hospital was formed in April 2011.  The goals are vast, but include the practice and regulatory oversight of APNs and PAs, on boarding programs, and integration with medical staff leadership to name but a few.

Zeller, who is a board certified physician assistant, works in partnership with Dr. Roger Hudgins, director of the Division of Neurosurgery at Children’s Hospital.  When she is not examining patients during office hours, Holly assists Hudgins in the operating room and shares on-call duties with him for after-hours emergencies.  Additionally, on a daily basis, Zeller rounds on all inpatients, formulates plans of care, interprets imaging, triages new patient referrals, and completes various types of different procedures in the NICU, PICU, patient floors and ER.  At the end of each day, all “Mommy Call” questions which have accumulated throughout the day are addressed by calling the parent of the patient back to address their questions. “Every day is a little bit different,” she says.  Zeller, 44, of Richfield,Ohio, is one of now 18 physician assistants (PAs) who work all across Akron Children’s Hospital.  There are over 150 advanced practice providers at Akron Children’s with a director leading the way.  The center actually oversees and brings together Advanced Practice Nurses (CRNA, CNP, and CNS) and Physician Assistants under one umbrella.  The director, Julie Tsirambidis, CNP, truly believes this is the way of the future.  “We have more in common that we have separate.  Coming together to promote our professional needs, despite our regulatory difference truly sets us apart, and brings improved understanding to our patients, families, and hospital staff.”  “Many years ago, MDs and DOs, would not even work together in the same hospital, and see how far they have come- this journey is a similar beginning, in my opinion.” Tsirambidis said.

As part of their master’s degree program, PAs can elect a surgical track that prepares them to work in the operating room.   After college, Zeller worked in the pharmaceutical field before taking a break to stay home with her children.  When she decided to return to work, she wanted a job in the medical field but didn’t want to travel anymore.  She embarked upon graduate school education and completed the PA program.  The PA education is very similar to that of the medical school model.

Zeller initially practiced with the congenital heart surgical team at Rainbow Babies and Children’s Hospital inClevelandbefore joining Akron.  When Dr. Hudgins joined Children’s two years ago, he requested a PA for his team.  He has especially relied on Zeller to share the patient load since the death this summer of the hospital’s only other neurosurgeon, Dr. Henry Bartkowski.  When Dr. Bartkowski became ill, Dr. Hudgins and Zeller formulated a plan to continue the quality care provided to the neurosurgery patients, by trying to split the evening and weekend call, thus allowing the other some “off time.” The two divide and conquer on office days, with each visiting patients and talking with families.  They frequently huddle to compare notes and examine patients’ images and other test results.  Zeller will assist in the OR on surgery days, and often performs the closing procedures.  This teamwork allows Hudgins to dictate this post-operative notes and get ready for the next patient while Zeller finishes the procedures.  “It really becomes a seamless way for getting a lot more work done than you could by yourself, plus the families love her,” Hudgins said

For information, or to join our neurosurgery team, check us out at

https://www.akronchildrens.org/cms/careers/index.html

COHCA On Facebook

OD threat rises as antidote fails to work first time

Alert: Naloxone isn’t working on several recent ODs.

Be on alert: A spike in overdoses in Hamilton County emergency rooms coupled with a lack of effectiveness of the antidote naloxone is leading health officials to believe that deadly opioids are getting to heroin users.

The Hamilton County Heroin Coalition issued the warning Monday after Hamilton County Public Health noted a surge in hospital overdose cases.

The emergency department-visit surveillance system detected the increase over the weekend, beginning on Friday, health officials said.

The rolling, 24-hour surveillance of admissions usually detects 20 to 25 drug-related emergency department visits, but for the period starting Friday, the visits topped 30, which sets off a notification of emails. The health department does not have an absolute count of the overdoses.

Health and law enforcement officials said that during that period, several victims that did not respond to a usual dose of naloxone, the non-narcotic that can force someone into immediate withdrawal, restoring breathing.

The latest deadly opioid that’s been noted in the supply of drugs in Greater Cincinnati is carfentanil, a large-animal analgesic that is 100 times the strength of the synthetic opiate fentanyl, which, in turn, has been causing overdose deaths throughout the Tristate and in the nation.

Carfentanil is an analgesic used for elephants and other large animals. The Hamilton County Heroin Coalition reported its appearance in the region in July. The synthetic opioid is reported to be 10,000 times stronger than morphine on the streets.

That’s why people who are using what they believe to be heroin should be with someone if they do it, and others should carry the antidote and be prepared to use more than one dose, health officials said.

Hamilton County Health Commissioner Tim Ingram said the county is alerting those who work with drug users. He also noted that health-care workers and emergency responders should be aware that carfentanil’s effects last a long time in humans. "Several doses of naloxone may be needed to reverse an overdose," he said.

For the general public, Ingram offered these steps: “If you find an overdose victim, call 911, begin hands-on CPR and if possible, administer as many doses of naloxone as it takes to revive the victim.”

Carfentanil has been blamed for multiple overdoses in Akron and Columbus.

Lt. Tom Fallon of the Hamilton County Heroin Coalition said law enforcement has been finding heroin mixed with fentanyl routinely, and lately, carfentanil has been detected. "Both of these can have deadly consequences, especially if the user is unaware of their presence in the drug supply.

"For users, please don’t use alone,” Fallon said. “Those who slip into a bathroom or other private area to use are the ones we’re processing into the morgue.”

There’s no way to be sure yet what drug caused the overdoses, but lab work is being done, according to health officials.

Carfentanil has been blamed for multiple overdoses in Akron and Columbus.

Fentanyl, an opioid 100 times as potent as heroin,
Fentanyl, an opioid 100 times as potent as heroin, is among those being used to cut or substitute for heroin. (Photo: Provided)

The large-animal opioid has been spotted across the country, and beyond the United States.

The Canada Border Services Agency and Royal Canadian Mounted Police announced charges against a Calgary man related to the opioid on Aug. 9.

The agencies stated in a press release on June 27 that officers at the Vancouver International Mail Centre intercepted a kilogram of carfentanil in a parcel originating from China that was headed to a Calgary address. The package was marked as printer accessories, but when the officers inspected it, they found a white substance.

The border services stated that the drug was turned over to the mounted police for investigation, and the Calgary Police Service was also involved. Police charged Joshua Wrenn, 24, of Calgary, with one count of importation of a controlled substance and one for possession for the purpose of trafficking in a controlled substance.

Fentanyl, sometimes used for cancer patients, is has been blamed for overdose deaths across the nation. Regionally, the southwest Ohio counties Hamilton, Butler and Clermont, and the Kentucky Office of Drug Control Policy, have noted overdose death increases due to fentanyl or a mix of fentanyl and heroin for the past two years.

In Hamilton County, a crime lab worker examines heroin.Buy Photo
In Hamilton County, a crime lab worker examines heroin. (Photo: Enquirer file photo)

Police Chief Tom Synan, who heads the Hamilton County Heroin Coalition supply control, cautioned police to wear protective gear before touching any suspicious drug.

The U.S. Drug Enforcement Administration warns that people often don’t know they’re getting the opioids in heroin that’s sold on the street. The DEA has specifically cautioned narcotics officers, because even tiny particles of the drugs can be harmful if inhaled, and the toxins can be absorbed through the skin.

The Hamilton County Heroin Coalition combines resources to fight the heroin epidemic and disseminates information through Southwest Ohio, Northern Kentucky and Southeast Indiana to address the heroin and opiate epidemic.

Originally posted by Cincinnati Enquirer
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4 days ago  ·  

Medical marijuana is legal in a variety of states across the U.S.

The Ohio agency tasked with licensing medical marijuana dispensaries and registering patients and caregivers is preparing for a spate of hiring.

The Ohio Pharmacy Board is asking for $882,400 to help fund the Medical Marijuana Control Program.

The money would go toward adding staff, developing a software system to register patients and caregivers for medical marijuana cards, and maintaining a website educating the public.

The Ohio legislature passed a bill in June to legalize medical marijuana for adults with specific, serious illnesses. It takes effect next month, though does not have to be fully operational for another two years.

Here are the jobs the money would fund:
▪A full-time attorney to coordinate the Medical Marijuana Control Program. Duties include drafting all rules and regulations, preparing hearings and coordinating the board’s Medical Marijuana Advisory Committee. Lawmakers created the bipartisan committee to help craft rules and regulations around marijuana, and its members must be appointed within 30 days of the bill’s Sept. 8 start date.
▪A full-time legal assistant.
▪14 members of the advisory committee, which are unpaid positions other than per diem compensation and travel expenses.
▪A part-time licensing supervisor to oversee staff that register patients, caregivers and dispensaries.
▪2 part-time licensing coordinators.
▪A part-time fiscal analyst to advise the 14 committee members and deal with travel reimbursement and other expenses.

The Pharmacy Board plans to use revenue from the licensure program to pay for the new jobs. However, the Ohio Legislative Service Commission’s review of the legislation said it’s unclear whether revenue from fees and penalties will be sufficient to cover the additional costs.

Trade publication Marijuana Business Daily estimates annual sales in Ohio could eventually reach $400 million.
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2 weeks ago  ·  

New Study Shows Low-value Care Rates Similar for Advance Practice Clinicians (APCs) and Physicians

According to a new study, APCs (nurse practitioners and physician assistants) provide equivalent amounts of low-value health services in primary care in both hospital and office-based settings. The authors explain that this finding is important because, “according to a recent national survey, most physicians believe that APCs provide lower-quality care than they do, and nearly one quarter think that expanding their roles in U.S. practice would decrease the efficiency and value of health care.”

Using national data on ambulatory visits, researchers compared the use of potentially low-value health services, including use of antibiotics, plain radiography, advanced imaging and referrals to other physicians, between APCs and physicians in how they managed upper respiratory infections, back pain and headache. Researchers examined 12,170 physician and 473 APC office-based visits and 13,359 physician and 2,947 APC hospital-based visits.

According to researchers, the finding that “APCs order antibiotics, computed tomography or magnetic resonance imaging, radiography and referrals as frequently as physicians is reassuring given recent efforts to expand the number of APCs, as well as their role, to meet the increasing demand for primary care.”
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4 weeks ago  ·  

Shout out to APRNS……..

Early statistics concerning the GCOAT opioid guidelines video that was sent to prescribers has 486 APRNs having completed watching the video, compared to 2,852 physicians. The dentists are at 629. You might ask prescriber members to look for the e-mail that sent the video to them directly and take the 10-15 minutes to watch it and complete a couple questions.

New Actions to Fight U.S. Opioid Epidemic Announced

The Department of Health and Human Services (HHS) recently announced new actions to combat the U.S. opioid epidemic. Among the actions is a buprenorphine final rule that allows practitioners, who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to obtain a waiver to treat up to 275 patients. Practitioners eligible to obtain the waiver include those who have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board or professional society, or practice in a qualified setting as identified in the rule.

Other actions include:
• A proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions;
• A requirement for Indian Health Service prescribers and pharmacists to check state prescription drug monitoring program databases before prescribing or dispensing opioids for pain;
• The launch of more than a dozen new scientific studies on opioid misuse and pain treatment; and
• Solicitation of feedback to improve and expand prescriber education and training programs.
These new actions build on the HHS Opioid Initiative launched in March 2015. The initiative focuses on three key priorities:
• Improving opioid prescribing practices;
• Expanding access to medication-assisted treatment for opioid use disorder; and
• Increasing the use of naloxone to reverse opioid overdoses.

U.S. Surgeon General Supports Treating Opioid Abuse like a Chronic Disease
While recently visiting a substance abuse treatment center in New York, U.S. Surgeon General Vivek Murthy stated that policymakers, health care providers and the public should treat substance abuse like a chronic illness. Murthy stated that government action or medical intervention alone will not solve the problem, and that people need to understand that addiction is not a bad choice, it’s a chronic illness of the brain that requires the same compassion, skill and urgency that diabetes, heart disease or cancer require. According to Murthy, the stigma surrounding substance abuse and addiction is one of the biggest obstacles preventing deployment of a comprehensive approach.
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1 month ago  ·  

 

Health Care Professions…

 

COHCA – Partnering

in Patient Care

COHCA, a interprofessional group, are partners in patient care: better care, lower costs, a partnership that will help improve the quality, safety, and affordability of health care for all Ohioans. Nationally, healthcare initiatives are fostering partnerships in patient care.


 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST SUSTAINING ORGANIZATIONAL SPONSOR - Cleveland Clinic's Zielony Nursing Institute

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST GOLD SPONSOR AND A FOUNDING MEMBER - Dr. Jeri Milstead PhD, RN, NEA-BC, FAAN 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST PLATINUM ORGANIZATIONAL SPONSOR - The Southern Ohio Chapter of the American College of Nurse-Midwives 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA PLATINUM ORGANIZATIONAL SPONSOR - Ohio Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP)

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