CMS’ New Primary-Care Payment Model Projected to Affect 20,000 Physicians: The CMS’ new primary-care model seeks to reimburse practices with a monthly fee to manage care for as many as 25 million patients. This move marks the CMS’ largest plan to transform and improve how primary care is delivered and reimbursed across the nation. Titled “The Comprehensive Primary Care Plus” initiative, it will be implemented in up to 20 regions and include up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians. The CMS has yet to identify regions since it must first assess interest by payers and providers since the program would collaborate with commercial, state, and other federal insurance plans. There are two tracks available for practices to participate. Under Track 1, CMS will pay a monthly fee to practices that provide specific services. That fee is in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for care. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for evaluation and management services, they will receive reduced Medicare fee-for-service payments and up-front comprehensive primary-care payments. The CMS believes the Track 2 hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter. Practices in both tracks will receive upfront incentive payments that they might have to repay if they do not perform well on quality and utilization metrics. The CMS will accept practice applications in the determined regions from July 15 through September 1, 2016.
Computerized Systems Still Miss Major Drug Errors: A new study reveals that computerized systems meant to restrict prescribing errors routinely fail to detect harmful – and sometimes fatal – medication orders. The study found that computerized provider order-entry systems failed to flag nearly 2 out of every 5 incidents where the wrong drug was prescribed, the incorrect dosage was requested or follow-up reminders failed to appear. While the software can alert physicians to medication conflicts, identify patients’ potential allergic reactions and incorporate evidence-based guidance and recommendations, it does have its limitations. Some of the challenges computerized systems have include usability issues, such as the potential for selecting the wrong item from drop-down menus or having too many alerts, which providers can override. The study found that the systems failed to flag 39% of potentially harmful drug orders and 13% of potentially fatal ones, with the most common issues missed being wrong medications and wrong dosages.
Pharmacist owes a duty of care when filling a prescription issued by a physician: In the case of Abrams v. Bute, the defendant physician performed hemorrhoid surgery on the decedent. The physician wrote the decedent a prescription for hydromorphone and instructed the decedent to take eight milligrams of hydromorphone every three or four hours as needed for pain. The decedent filled the prescription at a CVS pharmacy, but about one hour after taking a dosage of the medication, the decedent was found “gasping for air,” and shortly thereafter, died. An autopsy concluded the decedent died of acute hydromorphone intoxication. The plaintiff sued the physician, CVS and the individual pharmacist who filled the prescription. The plaintiff alleged the physician was negligent in prescribing eight milligram doses of hydromorphone, and the CVS defendants were negligent for filling the prescription. The CVS defendants argued that it is the prescribing physician who is solely responsible for exercising professional judgment, and courts should not impose a standard of care on pharmacists which would go beyond the need to accurately fill the prescription. The CVS defendants argued that if the court imposed a duty on pharmacists to independently verify the propriety of a physician’s prescription, this would place an undue burden on pharmacists, would likely create antagonistic relations between pharmacists and physicians, and interfere with the patient-physician relationship. The plaintiff argued that a pharmacist is also a licensed professional, should be held to responsibilities as a professional, and should not be treated as a mere “warehouse for drugs” or a “shipping clerk” who must unquestioningly obey the written orders of the physician. The Appellate Division held that there is no merit to the CVS defendants’ categorical contention that a pharmacist’s duty will never extend beyond accurately filling a prescription. Instead, the appellate court held that the issue of a pharmacist’s duty had to be determined on a case by case basis, and depending upon the facts of the case, where a prescription is clearly contraindicated the pharmacist could be held to a duty to take additional measures before dispensing the medication. In the Abrams case, the appellate court held that the record did not show the prescription was so contraindicated as to require the CVS defendants to confirm the prescription, and the appellate court held that summary judgment should be granted in favor of the CVS defendants.