09 January 2018

New Legislation Impacts How Physicians Prescribe Opioids & More Confusion About Text Messages and PHI

The Pulse Newsletter header

The Michigan Legislature and Governor Snyder rang in the New Year by passing a package of bills aimed at battling the opioid epidemic.  The package of bills was signed into law by Lieutenant Governor Brian Calley on December 17, 2017 and is a response to the increase in heroin and prescription opioid overdose deaths seen in Michigan and across the country.  The number of heroin and prescription opioid deaths in Michigan has doubled over the last five years.

The Michigan Automated Prescription System, commonly called “MAPS” has been in place since 2002 and was revamped earlier this year.  MAPS allowed the state to monitor prescription practices and generally allowed prescribers to see what medications a patient was taking. However, historically physicians and other prescribers were not required to review a MAPS report before writing a prescription.  In perhaps the biggest change made by the bills, prescribers are now required to review MAPS before prescribing opioids to a patient. Prescribers who fail to use MAPS may be subject to disciplinary action.

The bill also requires prescribers to establish a bona fide doctor-patient relationship before they can prescribe opioids and limits the number of pills that can be dispensed to a patient with acute pain.  Under such circumstances, prescribers can only prescribe a 7-day supply within any 7-day period.  Prescribers are also required to provide patients with information about the dangers of opioid addiction and obtain acknowledgement that the patient received the information about substance abuse treatment services to patients who have previously overdosed.

Here are a few recommendations on how to respond to the set of bills:

  • Hospitals, medical groups and pharmacies should revise medical staff bylaws, policies and procedures to require all prescribers to consult MAPS prior to prescribing opioids.
  • Health care providers should consider revising collaboration agreements with nurses and physician assistants to emphasize these new requirements.
  • Health care providers should consider revising discharge paperwork or work with their electronic medical records vendor to ensure patient records properly document that patients were informed about the risks of opioid addiction.

More Confusion About Text Messages and PHI

The end of the year saw conflicting reports about the already confusing issue of text messaging and HIPAA compliance. Shortly before Christmas, news reports began circulating that CMS was telling providers to stop all texting.  Initial reports indicated CMS had said texting is prohibited even if it occurs over a secure text messaging application.  As the news began to spread, CMS decided it needed to clarify its position.  On December 28, 2017, CMS clarified that texting among health care providers is permitted provided the text messages are sent using a secure, encrypted system.  However, CMS did state that patient orders sent by text are prohibited regardless of whether the text message is part of a secure, encrypted system. While CMS did not provide clarification regarding text messaging patients, health care providers should use secured emails and text messages whenever possible and must get consent before they are permitted to send text message to patients.