The FDA recently released a new document regarding their approach to homeopathic drugs. There is currently an open comment period on it. Feel free to respond.
Pain management has become a very important topic in the practice of emergency medicine. In April, ACEP released a position statement regarding managing pain with both opioids and non-opioid alternatives in the ED. If you are interested in reading more, please click on the link for the full position statement.
MOCEP Policy on Specific CME Requirements
The Missouri College of Emergency Physicians (MOCEP) believes that board certification or board eligible status by the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM) demonstrates comprehensive training, knowledge, and skill in the practice of emergency medicine.
Additionally, maintenance of board certification requires mandatory retesting and continuing medical education (CME), making extraneous CME or required short courses redundant and undermines the ability of emergency physicians to participate in comprehensive continuing education that addresses the full spectrum of emergency medicine.
Accordingly, for physicians certified by ABEM or AOBEM, MOCEP strongly opposes the use of a specified number of CME hours in a sub-area of emergency medicine, as requirements for privileges, renewal of privileges, employment, or qualification by hospitals, city or state agencies, or any other credentialing organization to provide care for conditions as already outlined in the Model of the Clinical Practice of Emergency Medicine.
Missouri is the only state in the nation to not pass some form of a prescription drug monitoring bill. There have been several proposals, but MOCEP continues to push for the following critical pieces. First, include at a minimum controlled substances (schedule II – IV), second, ensure it is real time, and finally make it applicable to everyone. Drug addiction is not contained to one socioeconomic class. We do believe that eventually we will have to negotiate on these core principles to get a “starter” system approved.
There are presently 2 bills circulating in the legislature. We cannot support the first one. The author, who is a physician, states that it would create a PDMP. In reality, it would not. The physician would send a name to the Board of Healing Arts. Under some computerized system that has no specifics and has never been developed, the physician would get sent back a red flag or no flag. What that red flag means is not exactly clear or why there was a red flag is also not clear. Based on that, the physician could decide whether or not to give narcotics. The physician could call the Board if they have further questions. It is unclear if any of this information or if the flag would return in real time. The bill would also prevent cities from developing their own program and have to be approved by a statewide vote. While we believe in compromising, there is not a single part of this plan that we support.
The plan that we are supporting, even if it cannot get through the Senate for another 2 years, would allow ED physicians real-time access to a patient’s prescription history. It would be simple to use but would not be required. This plan has support in both the House and Senate and is supported by other physician groups in the state. As an update, the Senate bill was just passed out of the Senate. However, multiple amendments were added to avoid a filibuster. It is still unclear what exactly all these amendments will do and what the final version of this bill will look like after the House and Senate versions are reconciled. In the meantime, county wide programs are set to open. The first in Saint Louis county is set to start at the end of April 2017. The current plan is that nearly 80% of the state will be covered by the same county-wide program.
The House and Senate have conducted interim committees the past without much changing in the state. Transformation of the existing program has become a focus of the committees. Expansion is not a primary goal at the moment, but if they can achieve cost neutrality (savings in one part of the program to fund the expansion) their interest will increase in expanding medicaid eligibility. However at the present time, this is unlikely to occur in Missouri. In addition given the uncertainty in the Patient Protection and Affordable Care Act and what will happen at a national level, it is unlikely that any large changes will be made at the state level.
Missouri eligibility for persons 22-64 (non disabled or blind) is 20% of poverty. As discussed in the Advocacy section of the website, MOCEP is currently working to institute MMERP which will simultaneously improve care while cutting costs.
In 2005, MOCEP was part of a coalition that passed a bill lowering caps from $650,000 to $350,000, along with other tort reform measures. Unfortunately, the Missouri State Supreme Court, in the Watts decision, eliminated the non economic medical malpractice caps entirely (except for wrongful death cases – cap remains since it was not part of the suit). After the Watts decision Missouri had NO cap on non economic damages. After the caps were overturned, MOCEP went back to work. We formed a coalition with other providers, and while it took time, we were able to get legislation passed that re-instituted caps. There is now a dual system of caps: one for wrongful death and catastrophic injuries and one for everything else. Keep in mind this is only for non-economic damages. We believe this serves to protect physicians but also compensates patients for substandard care if they incurred a bad outcome related to the substandard care.