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VCSQI SAN 2.0 Opioid Management Workgroup (OMW)Minutes – June 28, 2018 -1- 2 P.M. ESTYouTube Recording Link: (about 30” long) Invited Attendees: (See attachment A for names/emails of practices’ primary contacts included in this meeting invitation)VCSQI Staff: Ivan Berkel, Jayna Eller, Eddie Fonner, Rick Koss, Debbie Melnyk, Dr. Jeff Rich, Sherri WhiteObjectives of this workgroup include:-To commit to review opioid prescribing practices within each participating practice -To review, understand, and adapt several tools already available toward improving opioid prescribing practices (e.g. the CDC Opioid Prescribing Guidelines for Chronic Pain, opioid risk assessment tools/methods, opioid treatment agreement, monitoring and follow up with patients) -To implement an opioid prescribing protocol in each participating practice and encourage clinicians to “take the pledge” share resources and learn from each other (see Appendix B for links to relevant resources), including sharing of stories within VCSQI and TCPi.Appendix D lists the 3 metrics VCSQI is using to monitor overall progress with opioid prescribing practices.Agenda/Discussion ItemDiscussion PointsActionReview of Agenda Debbie added one agenda item related to the new CMS roadmap (see below and document attached to email with minutes)Review and discussion of changes across the country in various laws, practices and guidelines (20”)Debbie reviewed the links’ material listed in Attachment B. Both the U.S. Senate and House are taking action toward requiring e-prescribing for controlled substances. A new ad campaign targeting youth will soon begin; some examples show up in some of the links. Several states are also planning for e-prescribing of controlled substances, as well as revising regulations related to dosing and duration of opioids. for some news links. What’s happening in your state?It’s easy enough to learn what is happening in your state. Google “(your State)’s Opioid Prescribing Regulations”Thank you, Myriam Barakat for sending information that you have posted for First Coast Surgical practice’s staff to keep in mind re: Florida’s new regulations (sent in email with minutes).Do you have any updates about your practice’s work in this area?Susan Warriner, NP from Winchester Medical Center in VA shared that she follows cardiothoracic surgery patients post-op in the outpatient setting and has noticed that they are being discharged now with either no narcotic or only 10-12 tabs.Beth Hart from Mary Washington Hospital in VA shared that she is seeing the same trend. Myriam Barakat stated that they are working to comply with the new Florida regulations; they recently had an HCA presentation about the new regulations and flyers were made available to post in staff areas. Florida prescribers are required to check the PDMP every time they prescribe. Many states are taking this same action.CMS Roadmap to Address the Opioid EpidemicDebbie highlighted a new road map developed by CMS that summarizes the opioid statistics, areas for action, successes to date, and continuing future plans for addressing the opioid crisis.Review this roadmap; consider posting it in an area for your staff to see.Plan for next meetingJuly 26th, 1-2 PM ET Please forward to Debbie any topics you’d like discussed, or stories you want to share.Attachment AVCSQI 2.0 Participating PracticesPrimary Contact Persons Invited to This MeetingSteve Dickson <sdickson@>, Kimberly.Bell@Dr. Pankaj Kulshrestha <pkulsh51@>Dr. Denise Cox <DCCOX@>, John Honey <jjhoney@>Dr. Vince Wood <cedaredgechiro@>Mrs. Monk <opamedical@>Tari Higgins <THIGGINS@>Wakeeda Morgan <amosmedical1@>Maria Ramirez <macombids@>Stephanie Dresback <stephaniebkc@>, Rhonda Byerly <rbyerly_bkc@>Suzanne King <fixmyfeet@>Samara Clurman <nventcenter@>Andrea Moreno <Andrea@>Richard Boyd <ichard.boyd@>Dr. Gary McLeod <dr.gary.mcleod@>Dr. Tim Frost <timfrost@>Janet Rodriguez <jrodriguez@>Thang Tran <ttran@>Victoria Betz <victoriabetz3@>Dianne Garino <dgarino@>Debbie McNamara <debtieni@>Darleen Sutcliffe <darcea@>John Pispidikis <john.src@>Trish Richardson <om@>Dr. Frederick Hasty <drhasty2012@>Maureen Moldovan and Dr. John Gump <drgumpdc@>Rosemary Donald <rdonald.performanceortho@>Cathy Picillo <cathyp.dch@>, Cathy Picillo <cpicillo@>Lauren Raabe <wriburgess@>Amy Davis <premierintegrated4350@>Dawn Fitzgerald <dfitzgerald@>Billie Jo Robbins <socasteeeyeclinic@>Bakula K. Dave <bakoo@>David Salonga <dsalonga@>Roberta Killeen <aak324@>Janelle Cox <jcox@kcbc->Dr. Jeffrey Hurwitz <j.hurwitz7576@>Tammie Robinette <tduncan@>Dr. Sam Kahlam <skahlam@>Dr. Alan Pradillo <hammondeyeclinic@>Ginny Elzinga <melzinga@>Nicolette Shameer <associatedcardiology99@>Dr. John Morris <ergerm67@>Denise Zahares <denise@>Dr. Julie Chao <julie.y.chao@>Mariam Bashkoei <bheyeinstitute@>Geri Hing <pbm9202@>Dr. John Douglas <john_antoni@>Ann Tran <potomacmedctr@>Doris Barzas imrm@Shawn Borchert shawn@, Dr. Randall Shaffer <spine911@>Lisa Shock <lisa.shock@>Dr. Hong Yu <hongyu66@>Goutami Mikkilineni <sapulmonary@>Dr. Rao Mikkilineni <sapulmonary@>Dr. Cynthia Thaik <cthaik@>Renee Tetreault <reneetetreault3@>Dr. Sabeen Chaudry schaudry74@Carol Kelley <kelleyclynn@>Nena Keller <metrorenal@>Dr. Rajiv Aggarwal <docs@>Melinda Byers <vineyarddermatology@>Juli Taylor <jtaylor@>Sammie Ross <jrossfootankle@>Dr. Purvi Shah <purvi.s.shah04@>Dr. Mafutaga Tagaloa-Tulifau <drtulifau1@>Dr. Grigor Harutunian <gmd@>Dr. Darryl Burns <darrylburns@>Dr. Julie Hartl <Julie@chronic-> Donna Stinson lodgechiropractic1@Patricia Stevens <pstevens@>Myriam Barakat <mbarakat@>Claudia Knickerbocker <Claudia@>Dr. Cynthia Chin <chiefchinmd@>Dr. Shruti Shah <shruti.shah@>Allison Murdock <a.murdock@>Zachary Holt <zholt@>Lady Snyder <gw06172016@>JoAnn Reichling <jreichling@>Caroline Naddeo <drsaraperinbasekar@>Marietta Lomboy <mariettalomboy2013@>Catherine Rose <crose08@>Kelly Sigers <ksigers@>Talesh Freeman <talesh_freeman14@>Catherine Rose <crose08@>Brittney Clark <bclark@>Taly Drai <MA@>Stacie Browning <stacie.browning@>Lisa Franco <Lfranco@>Patricia Morand <deerfieldmedical@> VCSQI Original Members Invited:April Howell <AAH8F@hscmail.mcc.virginia.edu>, Beth Hart <beth.hart@>, Cathy Fisher <csfisher@>, Cathy Jennings <cdjennings@>, Chris Sytsma <csytsma@>, David Sugrue <djsugrue@>, Denise Cox <dccox@>, Donna Lou Edwards <edwardsdo@ecu.edu>, Hunter Choate <hchoate@>, Jennifer Whaley <jlwhaley@>, Judy Smith <jgs9m@hscmail.mcc.virginia.edu>, Larissa Rodriguez <LARISSA_Rodriguez@>, Linda Kindell <kindelll@ecu.edu>, Lisa Bowers <lisa.bowers@>, Liza Szelkowski <liza.szelkowski@>, Marian Lawson <mmb3y@hscmail.mcc.virginia.edu>, Mike Brown <mike.brown@>, Robbin Shifflett <rwc8k@hscmail.mcc.virginia.edu>, Scott Oen <scott.oen@>, Susan Warriner <swarrine@>Attachment BLinks to Various News Items RE: Law and Policy ChangesSummary of states’ actions site with reference to various states new or pending legislation: Florida law recently passed by U.S. House of Representatives Senate Bill – Every Prescription Conveyed Securely (EPCS) Act national ad campaign Walmart opioid policy: e-prescribing for controlled substances Michigan laws primer on new actions and e-prescribing law for controlled substances plans to revise opioid prescribing recommendations Guidelines companies encouraging physicians to prescribe their products resources: C ResourcesGUIDELINESFrom Centers for Disease Control (full guidelines document) (brief summary)Chou et al. Clinical Guidelines for Use of Opioids in Chronic Noncancer Pain. The Journal of Pain, Vol 10, No 2 (February), 2009: pp 113-130. - Comprehensive article that also discusses and includes risk assessment tools and treatment agreements. Full pdf of article posted on VCSQI website in “Resources” tab. Also sent with this agenda.Jamison, Serraillier,and Michna. Assessment and Treatment of Abuse Risk in Opioid Prescribing for Chronic Pain. Pain Res Treat. 2011; 2011: 941808. Published online 2011 Oct 11. doi: 10.1155/2011/941808 – General article. Includes list of risk tools and samples of treatment agreement and monitoring tool. ASSESSMENTCopies of Opioid Risk Tool (ORT) – online tool and calculator - article about various risk tools.TREATMENT AGREEMENTS - article about treatment agreements with samplesAppendix C[PDF]Sample Patient Agreement Forms resource includes two sample patient agreement forms that can be used with patients who are beginning long-term treatment with opioid analgesics or other controlled substances. These documents contain statements to help ensure patients understand their role and responsibilities regarding their treatment (e.g., how?...[PDF]sample opioid treatment agreement - (L&I), Washington Statelni.ClaimsIns/Files/OMD/agreement.pdfCachedSimilarOpioid (narcotic) treatment for chronic pain is used to reduce pain and improve what you are able to do each day. Along with opioid treatment, other medical care may be prescribed to help improve your ability to do daily activities. This may include exercise, use of non-narcotic analgesics, physical therapy, psychological?...[DOC]Sample Patient - Provider Agreement for Opioid Treatmenthealth.forms/agreements/SamplePrescriberPatientAgreementOpioidTreat...CachedSimilarPATIENT‐PROVIDER AGREEMENT (PPA) for Opioid Treatment. The use of opioids (morphine-like drugs) is only one part of pain treatment. Opioids can be very useful, but can also cause serious problems and are not always effective in the treatment of pain. The purpose of this agreement is to outline the safest manner to?...[PDF]Sample Opioid Medication Treatment Agreement - CPSAcpsa.ca/wp-content/uploads/2015/04/TPP_Sample_Patient_Contract.pdfCachedSample Opioid Medication Treatment Agreement. I understand that I am receiving opioid medication from Dr. condition. I agree to the following: to treat my pain. Dr. 1. I will not seek opioid medications from another physician. Only. _will prescribe opioids for me. 2. I will not take opioid medications in larger amounts or more?...Appendix DOpioid Management Metrics- For quarterly monitoring by VCSQI Practice has standardized opioid prescribing protocol (yes/no/in development)Evaluation or Interview for Risk of Opioid Misuse (QPP quality measure 414)All patients 18 and older prescribed opiates for longer than six weeks duration evaluated for risk of opioid misuse using a brief validated instrument (e.g. Opioid Risk Tool, SOAPP-R) or patient interview documented at least once during Opioid Therapy in the medical record NOTE: this measure will be tracked as yes/no for VCSQI SAN 2.0 quality data monitoring purposes. A practice can use it to measure their rate of evaluation of risk and use this as one of their QPP/MIPS measures.HYPERLINK ""Opioid Therapy Follow-up Evaluation (QPP quality measure 408)All patients 18 and older prescribed opiates for longer than six weeks duration who had a follow-up evaluation conducted at least every three months during Opioid Therapy documented in the medical recordNOTE: this measure will be tracked as yes/no for VCSQI SAN 2.0 quality data monitoring purposes. A practice can use it to measure their rate of evaluation of risk and use this as one of their QPP/MIPS measures.HYPERLINK ""Documentation of Signed Opioid Treatment Agreement (QPP quality measure 412)All patients 18 and older prescribed opiates for longer than six weeks duration who signed an opioid treatment agreement at least once during Opioid Therapy documented in the medical record.NOTE: this measure will be tracked as yes/no for VCSQI SAN 2.0 quality data monitoring purposes. A practice can use it to measure their rate of evaluation of risk and use this as one of their QPP/MIPS measures. ................
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