AN UPDATE FROM THE OFFICE OF THE MEDICAL DIRECTOR

1. AN UPDATE FROM THE OFFICE OF THE MEDICAL DIRECTOR Katharine D. Kovacs, PA-C Assistant Medical Director, NCMB

2. OMD • Consists of a fulltime Chief Medical Officer, a full time Associate Medical Director and a fulltime PA/Assistant Medical Director. • Review of duties.

3. Continuing Medical Education

4. CME Rule • 2015 state budget provision requires NCMB and other boards to establish CME requirement for licensees who prescribe controlled substances • CME must cover controlled substances prescribing, pain management and avoiding abuse/diversion • Proposed rule requires physicians to complete three hours per three year CME cycle (2 hours every 2 years for PAs) beginning in July 2017

5. CME Rule • Audits- under special circumstances: • During an investigation, licensure, or for an Investigational Interview. • Licensees still need to maintain CME documentation for six years for audits or other inquiries.

6. Position Statements-2016 • Provide licensees guidance. • Available on the website, under resources. • Reviewed periodically to evaluate relevance. • Highlighted in the Forum and on the web when changes are significant.

7. Updated Position Statements • Physician-Patient Relationship • Policy for the use of Opioids for the Treatment of Pain • Medical Testimony • In November: Use of photography in exam rooms; End of life and palliative care

8. 2016 Updates • Physician-patient relationship • If employment is terminated, employer or physician should notify patients, provide new contact information and permit patient choice.

9. More Updates • Policy for the use of Opioids for the Treatment of Pain • Provides a link to the CDC guidelines • Prescribe responsibly and within the standards of acceptable and prevailing medical practice.

10. Updates • Medical Testimony • Includes the most recent version of the AMA Ethics opinion.

11. Change…

12. Change in staff privileges • Required by state law to report to the Board when an institution acts to limit, suspend or revoke a licensee’s clinical privileges FOR CAUSE. (90-14.3) • Within 30 days. • Summary actions. • Final actions. • Resignation/voluntary reduction in privileges.

13. Three Strikes- No more

14. Delinquent Medical Records Hospital reports for suspensions due to delinquent medical records are no longer required. These reports did not provide meaningful information, and the issue is best handled at the local level within hospitals.

15. What NOT to report to the Board • No need to report: • A resignation from practice due solely to completion of residency or fellowship.

16. Other Topics • Re-entry will require formal clinical skills assessment • Physicians returning to practice with restrictions or a public record…Call for assistance! • Safe Opioid Prescribing Initiative per Legislative Rules

17. Safe Opioid Prescribing • The Safe Opioid Prescribing Initiative will investigate: • Top one percent prescribing 100 milligrams of morphine equivalents (MME) per patient per day. • Top one percent prescribing 100 MMEs per patient per day in combination with any benzodiazepine and within the top one percent of all controlled substance prescribers by volume. • CS Prescribers with two or more patient deaths within a 12 –month period due to opioid poisoning.

18. Questions? Katharine.Kovacs@ncmedboard.org 919-326-1109, ext. 269