Opioid Prescribing and Physician Autonomy: A Quality of Care Perspective

21 U.S.C. §§ 823, 827–29 (West 2012); 21 C.F.R. § 1306.04(a) (2013); 21 C.F.R. § 1305 et seq. (2013); 42 C.F.R. § 8.12 (2013).

42 C.F.R §482.12 (2011); 42 C.F.R §482.21 (2011); 42 C.F.R §482.22 (2011).

N.Y. Educ. Law § 6520 et seq.

Angelos P Bedrosian I Euhus DM Herrmann VM Katz SJ Pusic A Contralateral prophylactic mastectomy: challenging considerations for the surgeonAnn Surg Oncol.201522103208–321210.1245/s10434-015-4758-y4836440

Barnett ML Gray J Zink A Jena A Coupling policymaking with evaluation—the case of the opioid crisisN Engl J Med20173772306–230910.1056/NEJMp1710014

Brady J Wunsch H DiMaggio C Lang BH Giglio J Li G Prescription drug monitoring and dispensing of prescription opioidsPublic Health Rep20141292139–14710.1177/0033354914129002073904893

Carlson RG Nahhas RW Martins SS Daniulaityte R Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: a natural history studyDrug Alcohol Depend.2016160127–13410.1016/j.drugalcdep.2015.12.0264767561

CDC Wonder 2017 Atlanta US Department of Health and Human Services, CDC

2015 National Survey on Drug Use and Health: Detailed Tables 2016 Rockville Substance Abuse and Mental Health Services Administration

Centers for Medicare Medicaid Services (CMS) Medicare and Medicaid programs; hospital conditions of participation: quality assessment and performance improvement. Final ruleFed Regist200368163435–3455

Centers for Medicare and Medicaid Services (n.d.) Guide for Developing a QAPI Plan. Available from https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/qapiplan.pdf. Accessed 10 Sept 2018.

Chan LS, Elabiad M, Zheng L, et al. A medical staff peer review system in a public teaching hospital—an internal quality improvement tool. J Healthc Qual. 2014;36(1):37–44.

Chang HY Lyapustina T Rutkow L Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: a comparative interrupted time series analysisDrug Alcohol Depend.20161651–810.1016/j.drugalcdep.2016.04.0334985620

CMS Issues Final Quality Assessment and Performance Improvement Conditions of Participation for Hospitals. The Centers for Medicare & Medicaid Services – Newsroom. January 23, 2003. Available from https://www.cms.gov/newsroom/press-releases/cms-issues-final-quality-assessment-and-performance-improvement-conditions-participation-hospitals. Accessed 10 Sept 2018.

Contact a state medical board. The Federation of State Medical Boards. Available from https://www.fsmb.org/contact-a-state-medical-board. Accessed 10 Sept 2018.

Credentialing and Privileging—Requirements for Physician Assistants and Advanced Practice Registered Nurses. The Joint Commission.

Crosswalk to Performance Improvement. The Joint Commission.

Davis CS Carr DH Self-regulating profession? Administrative discipline of “pill mill” physicians in FloridaSubst Abus2017383265–26810.1080/08897077.2017.1316812

Delcher C Wagenaar AC Goldberger BA Cook RL Maldonado-Molina MM Abrupt decline in oxycodone-caused mortality after implementation of Florida's prescription drug monitoring programDrug Alcohol Depend201515063–6810.1016/j.drugalcdep.2015.02.010

Deprez EE, Hui L, Wills K. Deadly Chinese fentanyl is creating a new era of drug kingpins. Bloomberg. 2018. Available from https://www.bloomberg.com/news/features/2018-05-22/deadly-chinese-fentanyl-is-creating-a-new-era-of-drug-kingpins. Accessed 10 Sept 2018.

Deyo-Svendsen PMR Albright JK Schilling KA Palmer KB A systematic approach to clinical peer review in a critical access hospitalQual Manag Health Care2016254213–21810.1097/QMH.00000000000001135054974

Edwards MT Clinical peer review program self-evaluation for US hospitalsAm J Med Qual2010256474–48010.1177/1062860610371224

Finley E Garcia A Rosen K McGeary D Pugh MJ Potter JS Evaluating the impact of prescription drug monitoring program implementation: a scoping reviewBMC Health Serv Res201717142010.1186/s12913-017-2354-55477729

Fudin J Atkinson TJ Opioid prescribing levels off, but is less really more?Pain Medicine2014152184–18710.1111/pme.12340

Fuqua A. The other opioid crisis: pain patients who cannot access the medicine we need. Washington Post. 2018. Available from https://www.washingtonpost.com/outlook/the-other-opioid-crisis-pain-patients-who-cant-access-the-medicine-they-need/2018/03/09/5ad83b24-2301-11e8-badd-7c9f29a55815_story.html. Accessed 10 Sept 2018.

García MC, Dodek AB, Kowalski T, et al. Declines in opioid prescribing after a private insurer policy change—Massachusetts, 2011–2015. MMWR Morb Mortal Wkly Rep. 2016;65:1125–1131.

Gounder C. Who is responsible for the pain-pill epidemic? New Yorker. 2013. Available from https://www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic. Accessed 10 Sept 2018.

Grant D Alfred KC Sanctions and recidivism: an evaluation of physician discipline by state medical boardsJ Health Polit Policy Law2007325867–88510.1215/03616878-2007-033

Griggs C Weiner S Feldman J Prescription drug monitoring programs: examining limitations and future approachesWest J Emerg Med201516167–7010.5811/westjem.2014.10.241974307729

Haegerich TM Paulozzi LJ Manns BJ Jones CM What we know, and do not know, about the impact of state policy and systems-level interventions on prescription drug overdoseDrug Alcohol Depend201414534–4710.1016/j.drugalcdep.2014.10.0016557270

Haffajee R Preventing opioid misuse with prescription drug monitoring programs: a framework for evaluating the success of state public health lawsHastings Law Journal20166761621–1694

Harris JA Byhoff E Variations by state in physician disciplinary actions by US medical licensure boardsBMJ Qual Saf2017263200–20810.1136/bmjqs-2015-004974

Hawk K D'Onofrio G Fiellin DA Past-year prescription drug monitoring program opioid prescriptions and self-reported opioid use in an emergency department population with opioid use disorderAcad Emerg Med2018255508–51610.1111/acem.13352

Centers for Medicare and Medicaid Services (n.d.). Hospital Quality Assessment Performance Improvement (QAPI) Worksheet. Available from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-12-Attachment-2.pdf. Accessed 10 Sept 2018.

Inserro A. Doctors wait to see how CMS’ opioid changes play out for patients in pain. AJMC Managed Markets Network. 2018. https://www.ajmc.com/newsroom/doctors-wait-to-see-how-cms-opioid-changes-play-out-for-patients-in-pain. Accessed 10 Sept 2018.

Jury awards $1.5 million in suit over untreated pain. Chicago Tribune. 2001. Available from https://www.chicagotribune.com/news/ct-xpm-2001-06-15-0106150039-story.html. Accessed 10 Sept 2018.

Knudsen HK Havens JR Lofwall MR Studts JL Walsh SL Buprenorphine physician supply: relationship with state-level prescription opioid mortalityDrug Alcohol Depend2017173Suppl 1S55–S6410.1016/j.drugalcdep.2016.08.6425584581

Law MT Hansen ZK Medical licensing board characteristics and physician discipline: an empirical analysisJ Health Polit Policy Law201035163–9310.1215/03616878-2009-041

Leibert M. Performance of state medical boards: implications for hospitals and health systems. Hosp Top. 2010;88:4:107–115.

Federation of State Medical Boards 2018 Leveraging Growth: 2018 Annual Report. Available from https://www.fsmb.org/siteassets/advocacy/publications/fsmb-current-annual-report.pdf. Accessed 10 Sept 2018.

Lyapustina T, Rutkow L, Chang HY, et al. Effect of a “pill mill” law on opioid prescribing and utilization: the case of Texas. Drug Alcohol Depend. 2016;159:190–197.

Maughan B Bachhuber MA Mitra N Starrels JL Prescription monitoring programs and emergency department visits involving opioids, 2004–2011Drug Alcohol Depend2015156282–28810.1016/j.drugalcdep.2015.09.0244911899

Meara E Horwitz J Powell W State legal restrictions and prescription-opioid use among disabled adultsN Engl J Med201637544–5310.1056/NEJMsa15143874985562

Miller KE Physician attitudes a barrier to pain managementAm Fam Physician200062102317–2318

N.J. Stat. Ann. § 24:21–15.1.

N.Y. Pub. Health Law § 230.

N.Y. Pub. Health Law § 230; § N.Y. Educ. Law § 6532.

N.Y. Pub. Health Law § 3309-a(3).

N.Y. Pub. Health Law § 3331(5)(b).

N.Y. Pub. Health Law § 3331(5).

N.Y. Pub. Health Law Article 33.

Nam YH Shea DG Shi Y Moran JR State prescription drug monitoring programs and fatal drug overdosesAm J Manag Care2017235297–303

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse. Phillips JK, Ford MA, Bonnie RJ, editors. Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. Washington (DC): National Academies Press (US) 2017. 4, Trends in opioid use, harms, and treatment. Available from https://www.ncbi.nlm.nih.gov/books/NBK458661. Accessed 10 Sept 2018.

Nedelman M. Doctors increasingly face charges for patient overdoses. CNN. 2017. Available from https://www.cnn.com/2017/07/31/health/opioid-doctors-responsible-overdose/index.html. Accessed 10 Sept 2018.

Neven D Paulozzi L Howell D A randomized controlled trial of a citywide emergency department care coordination program to reduce prescription opioid related emergency department visitsJ Emerg Med2016515498–50710.1016/j.jemermed.2016.06.0575568539

Nolan SW Burkard JF Clark MJ Davidson JE Agan DL Effect of morbidity and mortality peer review on nurse accountability and ventilator-associated pneumonia rates J Nurs Adm 2010 40 9 37483 10.1097/NNA.0b013e3181ee427b

Opioid Treatment Guidelines and Other Information for Health Care Professionals and Patients Center for Disease Control and Prevention. NY State: Department of Health. Available from https://www.health.ny.gov/professionals/narcotic/opioid_treatment_guidelines. Accessed 10 Sept 2018.

Osborn SR Yu J Williams B Vasilyadis M Blackmore CC Changes in provider prescribing patterns after implementation of an emergency department prescription opioid policyJ Emerg Med2017524538–54610.1016/j.jemermed.2016.07.120

Paone D Tuazon E Kattan J Decrease in rate of opioid analgesic overdose deaths—Staten Island, New York City, 2011–2013MMWR Morb Mortal Wkly Rep20156418491–4944584824

Penti B Liebschutz JM Kopcza B Xuan Z Odell C Saper R Novel peer review method for improving controlled substance prescribing in primary careJ Opioid Manag2016124269–27910.5055/jom.2016.0342

N.Y. Pub. Health Law § 3343-a; 10 NYCRR § 80.63; Fla. Stat. § 893.055 (2018); 37 Tex. Admin. Code §§ 13.71–86 (West 2005).

Physician and Physician Assistants Disciplinary and Other Actions. Department of Health. NY State: Department of Health. Revised July 2012.

Physician Information (Arthur Mercado). NY State: Department of Health.

Physician Information (Gregory Denzel). NY State: Department of Health.

Physician Information (Liviu Nastase). NY State: Department of Health.

Pomerleau AC Nelson LS Hoppe JA Salzman M Weiss PS Perrone J The impact of prescription drug monitoring programs and prescribing guidelines on emergency department opioid prescribingPain Med2017185889–897

Porter J Hershel J Addiction rare in patients treated with narcotics N Engl J Med 1980 302 123

Quality Assessment and Performance Improvement (QAPI) Program Description. Peach State Health Plan: 2017.

Reisman RM Shenoy PJ Atherly AJ Flowers CR Prescription opioid usage and abuse relationships: an evaluation of state prescription drug monitoring program efficacySubst Abuse2009341–513865068

Roe v. Wade and the right to abortion. National Women's Law Center. January 18, 2018.

Rose ME Are prescription opioids driving the opioid crisis? Assumptions vs. factsPain Medicine2017194793–80710.1093/pm/pnx048

S.D. Codified Laws § 34-23A-10.1; Mo. Ann. Stat. § 188.039.

Saunders K Shortreed S Thielke S Evaluation of health plan interventions to influence chronic opioid therapy prescribingClin J Pain2015319820–8294620063

Semeuls A. Are pharmaceutical companies to blame for the opioid epidemic? The Atlantic. 2017. Available from https://www.theatlantic.com/business/archive/2017/06/lawsuit-pharmaceutical-companies-opioids/529020. Accessed 10 Sept 2018.

Soelberg CD Brown RE Jr Du Vivier D Meyer JE Ramachandran BK The US opioid crisis: current federal and state legal issuesAnesth Analg201712551675–168110.1213/ANE.0000000000002403

Spooner L Fernandes K Martins D High-dose opioid prescribing and opioid-related hospitalization: a population-based study PLOS One 2016 12 1 e0170834

State Medical Board Is Too Slow. The Hartford Courant. July 23, 2013. Available from https://www.courant.com/opinion/editorials/hc-xpm-2013-07-23-hc-ed-medical-board-must-speed-up-20130723-story.html. Accessed 10 Sept 2018.

State Opioid Prescribing Policy: Florida. Florida Academy of Pain Medicine.

Substance Abuse and Mental Health Services Administration Prescription drug monitoring programs: a guide for healthcare providers In Brief 2017 10 1 10.1016/j.dib.2016.11.054

Sun BC Charlesworth CJ Lupulescu-Mann N Effect of automated prescription drug monitoring program queries on emergency department opioid prescribingAnn Emerg Med2018713337–34710.1016/j.annemergmed.2017.10.023

Tex. Health & Safety Code Ann. § 171.012; Wis. Stat. Ann. § 253.10.

Texas Medical Association House of Delegates: Responsible Opioid Prescribing for Pain Management. Texas Pain Society. Available from https://www.texaspain.org/assets/resolution313.pdf. Accessed 10 Sept 2018.

Tricco AC Ivers NM Grimshaw JM Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysisLancet201237998332252–226110.1016/S0140-6736(12)60480-2

Understanding New York's Medical Conduct Program—Physician Discipline. NY State: Department of Health. Revised March 2016. Available from https://www.health.ny.gov/publications/1445. Accessed 10 Sept 2018.

Vyas D Hozain AE Clinical peer review in the United States: history, legal development and subsequent abuseWorld J Gastroenterol201420216357–636310.3748/wjg.v20.i21.63574047321

Wadhwani A. Tennessee sometimes takes years to discipline doctors. Tennessean.  2015. Available from https://www.tennessean.com/story/news/2015/10/12/state-lags-behind-doctor-discipline/73817306/. Accessed 10 Sept 2018.

Waisbren SJ The opioid epidemic and the Minnesota Board of Medical PracticeMinn Med201699339–41

Webster L. The pain epidemic versus the opioid crisis; in Worley SL. New directions in the treatment of chronic pain: National pain strategy will guide prevention, management, and research. PT. 2016;41:107–115.

Wollschlaeger v. Governor, Fla., 848 F.3d 1293 (11th Cir. 2017).