Rule change enables e-prescribing of all controlled substances nationwide

All controlled substances now legally can be electronically prescribed in any state, nationwide, after Vermontenacted updated administrative rules on Aug. 28.

While Missouri, in late July, became the last state to pass laws allowing the e-prescribing of controlled substances,according to its state medical association, Vermont, which had already allowed some e-prescribing, limited those efforts to Schedule 3-5 drugs. The Green Mountain State, last Friday, changed its rule to include Schedule 2 controlled substances, such as hydrocodone and morphine.

According to Surescripts CEO Tom Skelton, “throwing out the prescription pad” in lieu of electronic prescribing will help to curb potential fraud and drug abuse.

“Care providers, pharmacies and government officials are working together to combat the prescription drug abuse epidemic that plagues our nation,” Skelton said in an announcement touting Vermont’s decision.

In May, a progress report published by Surescripts noted that the health information network processed 6.5 billion healthcare data transactions in 2014, topping the volume of transactions handled by American Express and PayPal.

And according to a Centers for Medicare & Medicaid Services report published in April, if the electronic prescribing (eRx) incentive program is any indication, e-prescribing has been growing steadily.

The report, on trends in the eRx program and the Physician Quality Reporting System, found eligible professionals earned a combined $390,603,021 in incentive payments in the 2013 program year. The number of eligible professionals who qualified for the eRx program increased every year of the five year program, with a total of $171,732,673 in eRx incentives earned in 2013, the last year of the program. This included 259,401 eligible professionals within 54,854 practices. The average eRx incentive payment was $662 per professionals and $3,131 per practice.

In February, the Office of the National Coordinator for Health IT released a guide to help prescribers maximize the benefits of e-prescribing. That same month,Surescripts also published new tools to help prescribers learn more about the e-prescribing of controlled substances.

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Orion Health receives Healthcare IT Company of the Year Award

AMA concerned Tasmania’s health system lacks leadership as two senior jobs remain unfilled

Tasmanian Health Minister Michael Ferguson has dismissed concerns the state’s health system lacks strong leadership because two senior positions are yet to be filled.

The Tasmanian branch of the Australian Medical Association (AMA) said it was worried the new Tasmanian Health Service (THS) still did not have a CEO, as the State Government readied to implement its major shake up of hospitals.

The Health Department also needs a new Secretary.

Tim Greenaway from Tasmania’s AMA said he supported the process but was worried about a lack of leadership, in particular at the top of the new THS.

“There has been no announcement of even a short list of candidates for the CEO of the Tasmania health system,” he said.

It’s the case that we are looking for a permanent CEO and we look forward to governing council’s recommendations on that.

Health Minister Michael Ferguson

“There is still no confirmation, for example, of the acting secretary’s position.

“There’s also been no clinical governance framework set up for the Tasmanian Health System.”

The State Government announced the changes earlier this year as part of a plan to rationalise hospital services in efforts to improve health care.

Mr Ferguson said he was confident the current leadership structure was strong enough.

“It’s important for me to emphasise here that we do have strong leadership across the health system and stable leadership,” he said.

“It’s the case that we are looking for a permanent CEO and we look forward to governing council’s recommendations on that.”

The Health Minister said he was expecting an implementation plan for the hospital changes by the end of September.

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NHS personal health budgets spent on ‘patient treats’

Health IT: The Knockout Punch of All Cancer Treatments

A targeted beam of high-energy particles known as protons can kill cancer cells without damaging surrounding healthy tissue. Yet no facility in the Southern Hemisphere can currently deliver this kind of therapy. Now significant national and international momentum is building to include a Proton Therapy Unit as part of the planned expansion of SAHMRI, South Australia’s Health and Medical Research Institute. Cancer specialist and former CEO of Cancer Council Australia Professor Ian Oliver said South Australia was the obvious choice to create a Proton Therapy Unit that would service Australia and the region.

“There have been groups in New South Wales and Victoria also considering a bid to establish a proton facility, but South Australia is the furthest ahead,” he said.

“Because SAHMRI already operates a cyclotron, it already hashighly relevant experience in operating a particle accelerator as would be required for proton therapy.”

For proton therapy, purpose-built equipment known as a cyclotron accelerates the protons almost to the speed of light, and they are then directed through a probe to release their energy at the tumour site.

“The treatment itself takes less than two minutes,” said Prab Takhar, Director of the Molecular Imaging and Therapy Research Unit at SAHMRI.

“The protons do not interact with any other part of the body until the predetermined treatment point is reached, and the energy kills the cancer cells.”

Because it can be so precisely controlled, proton therapy is the best option for treating cancers when regular radiation is too risky due to small tumour size, or location adjacent to crucial organs like brain, spinal cord and heart. Childhood cancers are especially suited to proton therapy.

Director of Radiation Oncology at the Royal Adelaide Hospital Associate Professor Michael Penniment said that working closely with a software developer and clinicians across Australia and the United States had also played a key role in advancing South Australia’s case.

“Phillips makes a lot of the software used for proton therapy,” he said.

“By working with them, we were able to develop a method to perform objective comparisons between therapy with protons and other treatments.”

Nobody else had performed such comparative planning as it relates to proton therapy. The process also provided Professor Penniment with a crucial training opportunity.

“We now have staff that are already well versed in comparative planning for proton therapy, and the same process can easily be rolled out in other states,” he said.

With a Proton Therapy Unit established in South Australia, trained staff in hospitals across Australia and the Asia-Pacific could perform comparative planning with patients in their hometowns, and then send to Adelaide only those for whom the treatment would be suitable.

Early access to software from Phillips also allowed Professor Penniment to incorporate biological and mathematical modeling techniques to analyse the clinical impact of proton therapy on cancers and surrounding healthy tissues.

“We’re making sure the South Australian Proton Therapy Unit is centred on health economics and consumer-use data,” said Professor Penniment.

“Our work over many years has set us up in capability terms about 3 years ahead of any other Australian states.”

Professor Penniment’s team collaborates with medical institutions in the northern hemisphere that already operate proton cyclotrons and treatment centres.

“South Australia is well-placed to use its comparative advantage to locate the Proton Therapy Unit in Adelaide’s health and biomedical precinct,” said Professor Steve Wesselingh, Executive Director at SAHMRI.

“In the first instance, our focus will be on the treatment of cancer in children and then we will be able to move forward with developing protons for other types of cancer, such as prostate, brain and breast cancers.”

The centre will be able to treat between 600 and 800 patients every year.

SAHMRI, Flinders University and the Royal Adelaide Hospital have developed and contributed funding towards the AUD$280 million Proton Therapy Unit project. The South Australian government has recently requested support from its Federal counterpart to bring it to fruition.

SAHMRI’s commitment to developing a Proton Therapy Unit has received official support from the Cancer Council of Australia and advocacy body CanSpeak, as well as the Australian National University, the University of Wollongong, The Royal Melbourne Institute of Technology, the University of Melbourne, the University of Sydney and GE Healthcare.

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Medibank and Calvary resolve health insurance dispute at 11th hour

Medibank Private customers will be free to use hospitals run by Calvary Health Care following a last minute resolution to a dispute that would have ended the agreement between Australia’s largest private health fund and the chain on Monday.

Negotiations between the fund and the Catholic-affiliated hospital chain broke down in July after Medibank declared that it would no longer pay for 165 “highly preventable adverse events” and unplanned hospital readmissions within 28 days saying the crackdown would help eliminate mistakes.

“We had reached an agreement that will deliver enhanced clinical safety, quality care and affordability for members and patients,” both parties said upon signing a new three-year agreement. “It is good for both our organisations and all other stakeholders, be they staff or doctors.”

At the height of the dispute Medibank took out full-page newspaper advertisements to counter what it terms misleading and misinformed statements from Calvary.

“Unfortunately, unlike [other private hospitals] Calvary believes health insurers should pay for mistakes which can be prevented, like falls and pressure sores, even though they happen in their hospitals,” it said in advertisement.

Last week it offered to introduce an independent clinical review process to clarify situations where responsibility for adverse events was unclear.

Although neither party will reveal the terms of the new agreement it is likely to put pressure on other hospitals to adopt the rules Medibank was proposing.

Consumers Health Forum chief executive Leanne Wells said the secrecy was “not good enough”.

“Consumers pay thousands of dollars a year in health insurance premiums and the health fund involved is a publicly listed for-profit company.”

“For all members know, Calvary may have weakened and agreed to 160 or the 165 claims – hardly a big win for consumers because differential costs will still fall to consumers. Basically Medibank private members don’t know what they don’t know.”

Had the agreement not been signed, Medibank would have continued to pay for treatment at Calvary Hospitals, but the hospitals would have been free to charge patients extra where it felt it had not been paid enough.

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Are we prepared to pay taxes for health?

Just when the Government thinks it has a small bit of financial leeway, a hefty additional bill for the health services drops. It calls to mind the old millionaire businessman’s summation of “a few hundred million here and a few hundred million there… and suddenly you’re talking big money”.

The surprise about this really should be that anyone is surprised at all. We have been told for several months now that the Government has some €1.5bn to spare in the Budget next October.

Everyone assumes that this will be used by the Coalition parties to ensure they can win back power in the forthcoming general election. After seven years of doing far more for less, the people are understandably weary and would welcome the encouragement of even modest tax cuts.

But enter the Health Service Executive bosses with their 2016 Budget blueprint. The big picture looks like this: the 2015 health spend is €500m over what was provided; just matching current service levels in 2016 will cost another €650m; and then you must factor in addressing pressing deficiencies like substandard care facilities for the elderly and the other problems which have been unearthed by investigations conducted by the Health Information and Quality Authority (Hiqa).

The projected 2016 extra demand could be as high as €1.9bn, suggesting tax increases rather than cuts might be the more realistic option. It is a sobering thought and it should provoke a more measured adult debate.

Most people will agree our health services have fundamental problems which undermine the good work done by our healthcare professionals every day. We know that part of the problem is that we sometimes get bad value for money. But we also know that our services are, in fact, underfunded. So, it is time we asked: are we prepared to pay more taxes to fund a better health service?

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