Copy
View this email in your browser
Rhode Island Department of Health logoDecember 2016
Health Connections
Public health news, advisories, and updates for licensed providers

                     James McDonald                Utpala Bandy                Dr. Clyne 

From the Director...


Dear Colleagues,
Earlier this month, RIDOH hosted the second annual Health Equity Summit, and I am excited to share some of the things we learned and outline some of our next steps.
 
The theme of this year’s Summit was Health Equity in Action: Justice and Equity for All. Our keynote speaker, David Williams, PhD, MPH; Professor of African American Studies and Sociology at Harvard University in Florence and Professor of Public Health at Harvard’s School of Public Health, discussed structures in our society that result in social inequities and their impact on health beginning in early childhood. He also presented a cadre of solutions such as increasing “Cores of Champions” (i.e. community leaders or healthcare providers) that can bring attention to the impact of these concerns, and building up more placed-based initiatives that address transportation, housing, education, and neighborhood environment such as the Rhode Island Health Equity Zones Initiative.
 
His presentation helped to frame discussions in many of the smaller breakout sessions. In the United States, we spend more on healthcare than any other developed nation; yet we do not have the longest average life expectancy. Other developed countries who have higher average life expectancies spend twice as much money on social services such as transportation, housing, education, and safe neighborhood environments compared to healthcare services. In the US, that spending ratio is inverted—we spend half as much on social services as we do on healthcare expenses.
 
Simply stated, we need to think about spending smarter on resources and services that help to address things like employment opportunities, transportation, housing, education, food availability, , and mental health. If a patient does not have a car or easy access to public transportation, it is easy to understand why keeping regular medical appointments can be a challenge. If a patient has difficulty satisfying the basic human needs of food and shelter, preparing healthy meals becomes increasingly unlikely.
 
In order to achieve justice and equity for all, we need to be fully informed by the data, we need to advocate for those who don't have a voice for themselves, and we need action steps to get the work done in our communities.  In partnership with all providers and all of our community partners, we will work to advance health equity by:
  • Expanding high-quality, trauma-informed, accessible mental health and behavioral health services which meet the needs of all Rhode Islanders,
  • Including assessment of and referral to behavioral health, physical health, and oral healthcare in the primary care setting,
  • Identifying individuals who may be at risk for poor health outcomes before the individual’s healthcare needs are urgent or emergent,
  • Streamlining and improving provider-to-provider communication about a patient’s care coordination and compliance; and
  • Creating safe spaces in more communities for patients; regardless of race, gender, ethnicity, or sexual orientation; to get the services they need to achieve optimal health.
 
I am committed, along with all of you, to doing what’s needed to uphold and promote the values of teamwork, encouragement, and inclusion that the 2016 Rhode Island Health Equity Summit exemplified. I have full confidence in our future as a State because of these values we fight to uphold. Together, our eyes are on the prize that really matters: health equity in action.


Nicole Alexander-Scott, MD, MPH
Director of Health

 

Notice Of Annual Adjustment To Medical Record Fees

By Rhode Island Law, the Board of Medical Licensure and Discipline will adjust for inflation the allowable fees providers can charge for duplicating medical records. The Board uses the United States Bureau of Labor Statistics calculator to figure the fees. The fees listed are the maximum allowable fees—lower fees are acceptable.

Fees for When Providing Copies of Medical Records to Patients
  2015 2016
Per page fee for first 50 paper pages $0.75 $0.76
Per page fee for paper page(s) 51-225 $0.50 $0.51
Maximum allowable total fee, per patient, per unique request $125 $127.49
Handling fee for records delivered within 48 hours $20 $20.40
Family discount (records for multiple patients from same household requested at one time) $25 $25.50
Copying fee for x-rays or other documents not reproducible by photocopy $25 $25.50
 
Fees for Providing Copies of Medical Records to Authorized Third Parties
  2015 2016
Per page fee for first 10 paper pages $2.50 $2.55
Per page fee for paper pages 11-50 $0.75 $0.76
Per page fee for paper pages 51+ $0.50 $0.51
Maximum allowable fee none none
 
Please note:
  • No fees can be charged for copies of immunization records that are required for school entry.
  • No fees can be charged for copies of records that will be used to support a claim or appeal for Social Security, medical assistance, Rite Care, Temporary Disability Insurance, unemployment compensation, or any other federal or state needs-based benefits program.
  • No fees can be charged for copies of records that will be used in a civil court certification proceeding or for a Worker’s Compensation claim.
  • No fees can be charged for copies of medical records that are being sent to another consulting provider.
 

Reimbursement Update From Women’s Cancer Screening Program

RIDOH received notification from the Centers for Disease Control and Prevention (CDC) that effective November 1, 2016, the Women’s Cancer Screening Program (WCSP) can provide reimbursement for 3D mammography (tomosynthesis). For patients who qualify for the WCSP, please use CPT codes 77063 and G0279. In addition:
  • CPT code 77063 should be listed in addition to the primary mammogram code (77057).
  • Do not use CPT code 77063 with either 77055 or 77056.
  • CPT code G0279 should be listed as a separate code in addition to primary mammogram code G0204 or G0206.
  • CPT codes 77061 and 77062 are not approved by Medicare and therefore, are not allowed on WCSP reimbursement forms.
Any questions about these CPT codes can be directed to Melissa LaCasse at 401-222-7641.

 

CDC: Updated HPV Vaccine Recommendations

CDC now recommends that 11 and 12-year-olds receive just two doses of HPV vaccine, at least six months apart, to protect against cancers caused by human papillomavirus (HPV) infections. The report includes new recommendations for use of a two-dose schedule for girls and boys who start the vaccination series between ages 9 and 14. Any patient who starts the HPV vaccination series between ages 15 and 26 or has a weakened immune system should still receive three doses of the HPV vaccine.
 

Welcome To New Member of BMLD 

Dr. David Kroessler joined the Board of Medical Licensure and Discipline in September and serves as the representative for allopathic medicine. He founded Angell Street Psychiatry, a multi-site private practice and currently teaches at the Boston University School of Medicine, serves as the Psychiatry Clerkship Director at Roger Williams Medical Center, and is a Fellow of the American Psychiatric Association. After completing his psychiatry residency at SUNY/Stony Brook, Dr. Kroessler did a psychiatry fellowship at Rhode Island Hospital and Brown University. He was a faculty member at Brown before starting his private practice. He has been voted a “Top Doc” in Rhode Island Monthly by his peers on five occasions. Outside of work, he has been working to develop a habitat for the endangered New England Cottontail rabbit on 20 acres in Exeter. His term on the Board is for three years, and can be renewed.

 

Bradley Hospital Starts Pediatric Psychiatry Resource Network

On December 15, Bradley Hospital unveiled the Pediatric Psychiatry Resource Network (PediPRN), an innovative model of consultation and collaboration between pediatric primary care and child psychiatry providers. This free service offers all pediatric primary care providers assistance with mental healthcare needs of their patients and is led by a team that includes a psychiatrist, a clinical social worker, and a care coordinator. A provider can contact the PediPRN team with a diagnostic or therapeutic question and receive a return call within 30 minutes from the psychiatrist, and the team can assist in developing a care plan for children with various psychiatric diagnoses and complex clinical presentations. Care plans can include psychopharmacologic recommendations, therapeutic treatment, and support services in the community. In addition to telephonic consultations, PediPRN will be sponsoring continuing education opportunities. For additional information or to register your practice, email the PediPRN team.

 

A Message From HealthFacts RI

Providers are now able to request information about a specific individual and about an individual’s specific health insurance claim from HealthFacts RI. HealthFacts RI is the state’s All-Payer Claims Database (APCD), and this type of request is called a level 3 extract. APCD is a de-identified database that collects healthcare enrollment and claims data for Rhode Islanders from most private insurers, Medicare, and Medicaid. The data can be used to measure provider performance, understand patterns of care, and conduct risk-adjusted peer comparisons for practice improvement and transformation.
 
Any requests for this data require a full review and approval. Providers who are interested in requesting a level 3 extract can download and complete an application online. More detailed application materials and more information about the APCD are available on RIDOH’s website or by emailing the HealthFacts RI team.
 

Healthcare Workforce Development Update

The Rhode Island Executive Office of Health and Human Services (EOHHS) and the Rhode Island State Innovation Model (SIM) are providing statewide leadership to develop plans, policies, programs, and resources that align Rhode Island’s healthcare workforce education and training programs with health system transformation and population health goals. One of SIM’s main priorities is infrastructure investments that bring about lasting change, including funding projects for practice transformation and the development of the healthcare workforce. Such investments include a variety of training opportunities for providers at all levels, engaging patients in healthy behaviors, and improving data collection and analysis software and skills.
For information or to participate in Rhode Island’s healthcare workforce transformation initiative, contact Rick Brooks.
 

CDC Falls Prevention Study Needs Feedback

The Centers for Disease Control and Prevention (CDC) and Altarum Institute want to support providers in preventing falls among older adult patients as part of the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative. Your perspective as a provider will inform STEADI program messaging, including how to raise awareness of the STEADI program, the importance of managing medications to reduce falls, and clinical guidelines and recommendations. CDC is looking for primary care providers who see patients in an outpatient setting and who has patients who are 65 or older. The 30-minute phone interview to give feedback can be scheduled in December or January. Phone interview participants will receive a $25 gift card. Any provider who is interested should email STEADI and submit full name, phone number, and availability (best day of week/time of day).
 

KIDSNET Now Has Asthma Page

Providers who use the KIDSNET registry will now be able to add information about patients with asthma. Rhode Island’s asthma rates for children are 40% higher than the national average. An estimated 24,000 children have asthma, and an additional 13,500 were diagnosed with asthma at some point in their lives. The Asthma section of KIDSNET has two important features for providers to access and use:
  • Asthma Action Plans: Patients with asthma can prevent asthma attacks and achieve better health through effective asthma self-management. Asthma Action Plans are an essential tool to help people with asthma and their caregivers understand what medications to take, which symptoms to watch for, which triggers to avoid, and what steps to take to maintain good control of the condition. Healthcare providers should create and update Asthma Action Plans for all children with asthma, and share the plans with families, caregivers, and School Nurse Teachers.
  • Breathe Easy at Home Screening Tool: BEAH is an initiative of RIDOH’s Asthma Control Program, and providers can utilize the screening tool (for patients who live in Providence, Pawtucket, Central Falls, or Woonsocket) when they suspect substandard housing conditions (code violations) are preventing good control of a child's asthma. BEAH referrals are sent to municipal housing code inspectors and allows the provider to communicate directly with the inspector about housing conditions. Asthma Control Program Staff can coordinate additional available support services. For more information about BEAH, visit RIDOH’s website or email the BEAH program.

Self-Management Programs Available For Arthritis Patients

Arthritis is the leading cause of disability in the United States, and an estimated 23% of adults have been diagnosed with it. Severe Joint Pain (SJP) affects more than one quarter of adults (27.2%) who have arthritis. SJP can limit basic daily functions, cause work place limitations, and compromise an individual’s quality of life. The CDC has found that low-impact physical activity is a non-pharmaceutical alternative that can help patients who suffer from SJP. RIDOH’s Chronic Disease Self-Management Program is now available in all five Rhode Island counties and is free for all Rhode Islanders. The community-based programs ensure individuals safely increase physical activity and develop a peer support system. Programs such as Walk with Ease and EnhanceFitness are proven to help symptoms of chronic pain due to arthritis or SJP. For information on how to refer patients to these and other programs, call the Community Health Network line at 401-222-3600 or email.
 

Are You Checking The PDMP?

A message from James McDonald, MD, MPH; Chief Administrative Officer for the Board of Medical Licensure and Discipline
As part of its mission, the Board of Medical Licensure and Discipline recently asked RIDOH’s Prescription Drug Overdose Prevention Program staff to conduct an evaluation of compliance for utilization of the Prescription Drug Monitoring Program (PDMP). Specifically, the PDMP database will be reviewed to identify any providers who have prescribed more than 100 opioid prescriptions and checked the PDMP fewer than 10 times in the past 90 days. Results will be reviewed by the Board’s Investigative Committee to determine if a formal complaint and investigation is warranted.

Physicians are reminded that review of the PDMP is addressed in, section 3.5 of the regulations related to controlled substances. It states “The prescription monitoring program (PMP) shall be reviewed prior to starting any opioid.” Review of the PDMP is also addressed in statute and adds an additional requirement to review the PDMP when patients are on continuous opioids for more than three months. The PDMP review must be documented in the patient’s medical record.
Reviewing the PDMP is also an accepted community standard of care as well as part of the legal requirement to “maintain minimum standards to prevent diversion.”

Physicians should adjust their workflow and professional practice to ensure compliance with these regulations. This will help promote consistent practice in keeping with patient safety principles and professional standards.

 

Upcoming Educational Opportunities

  • January 19: 8:30 a.m. – 9:30 a.m.; Learn about RIDOH’s Women’s Cancer Screening Program. RIDOH Auditorium, 3 Capitol Hill, Providence or via webinar.
  • January 20: 7:30 a.m. – 11:30 a.m.; Sugar Rush: The Not So Sweet Truth About How Much Diabetes Costs Rhode Island Businesses presented the Rhode Island Business Group on Health; Join local experts in a discussion about increasing awareness, promoting prevention programs, and reducing costs. Providence Downtown Marriott, 1 Orms St., Register online.
 
 

FOR ORAL HEALTH PROFESSIONALS

 

Welcome To New State Dental Director 

Samuel Zwetchkenbaum, DDS, MPH, has joined RIDOH and the Rhode Island Executive Office of Health and Human Services (EOHHS) as the State Dental Director. Dr. Zwetchkenbaum will be responsible for clinical quality of RIDOH’s Oral Health Program and will collaborate with state and federal agencies that incorporate oral health into policies addressing the needs of Rhode Island's diverse population. He also will provide clinical oversight and monitoring of the Medicaid-funded oral health services to ensure timely, accurate, and superior program performance, plan/provider problem solving, and technical assistance.
 
Dr. Zwetchkenbaum is a native Rhode Islander and received his bachelor’s degree from Brown University, his dental degree from the University of North Carolina, and his MPH in health management from the University of Michigan. He completed a General Practice Residency and has received Certificates in Prosthodontics, Maxillofacial Prosthodontics, and Geriatric Dentistry. Dr. Zwetchkenbaum was on the faculty of the University of Michigan School of Dentistry and achieved the rank of Clinical Associate Professor. As part of his work there, he directed the Hospital Dentistry Program and General Practice Residency and provided clinical care to medically complex patients, adults with disabilities, and patients who required maxillofacial prosthetic rehabilitation. Dr. Zwetchkenbaum is excited to be back in Rhode Island and working with outstanding teams at RIDOH and EOHHS and with committed external stakeholders and health professionals on reaching the goal of optimum oral health for all Rhode Islanders.

 

Feedback Wanted: Oral Health Commission

The Rhode Island Oral Health Commission (RIOHC) invites all medical and dental providers to participate in and provide input at upcoming quarterly meetings and at the annual Summit. The RIOHC is a diverse group of stakeholder organizations and individuals who are dedicated to sharing expertise, best practices, and collaborative solutions designed to improve the oral health of all Rhode Islanders. Additionally, the RIOHC seeks to foster partnerships to advance oral health goals and strategies, including those identified in the Rhode Island Oral Health Plan. Mark your calendars for the 2017 meetings:
  • February 8: 8:30 a.m. – 10 a.m.; quarterly meeting
  • May 10: 8:30 a.m. – noon; Annual Oral Health Summit
  • September 13: 8:30 a.m. – 10 a.m.; quarterly meeting
  • December 12: 8:30 a.m. – 10 a.m.; quarterly meeting
For information about the RIOHC contact the Commission’s Communications Coordinator, Travis Vendetti


 

FOR NURSES

 

School Nurses Are A Great Community Resource 

School nursing practice is centered in community and public health and focuses on health promotion and disease prevention. School nurses are members of two very different communities (education and medical/nursing) and are able to collaborate with practitioners from both fields. The school nurse coordinates student healthcare among the medical home, family, and school. RIDOH encourages providers to reach out to school nurses in the community to help close the gap and provide the best care possible for Rhode Island’s children.
 
Linda Mendonca, RN, MSN, MEd, NCSN, APHN-BC, recently joined RIDOH as a part-time school nurse consultant. She will provide guidance for school health services program development and planning and will serve as a liaison and resource expert in school nursing practice and school health programming related to children with special healthcare needs, chronic and/or infectious disease, and mental and behavioral health. Linda has been a registered nurse for 35 years, and has been a school nurse for 22 years. Her school nursing career has included experience with pre-K to high school students, and the last 13 years she has focused on adolescents in middle and high school. She has vast experience with current best practice and new initiatives and has served as Rhode Island’s representative on the board of the National Association of School Nurses. She is a past president of the state’s Certified School Nurse Teachers Association. Email Linda with questions or concerns. linda.mendonca@health.ri.gov
 
 

FOR PHARMACISTS

 

DEA Schedules Street Drug U-47700

Effective November 14, 2016, the Drug Enforcement Agency (DEA) has declared U-47700 as a Schedule I controlled substance. This declaration is temporary and will be in place for 24 months and was made in response to 46 confirmed fatalities associated with U-47700 from October 2015 to September 2016. Thirty one of the fatalities occurred in New York and 10 were in North Carolina. DEA states that U-47700 is a novel synthetic opioid and its abuse parallels that of heroin, prescription opioids, and other novel opioids. The U-47700 that has been seized has been in powder form and in counterfeit tablets that look like pharmaceutical opioids. U-47700 can be used by itself or in combination with heroin or fentanyls. Read the complete notice from DEA about U-47700 online.

 
 

FOR EMERGENCY MEDICAL SERVICES PROFESSIONALS

 

New EMS Protocols Take Effect In 2017

RIDOH’s Center for Emergency Medical Services (CEMS) has released a full revision of the Statewide Emergency Medical Services Protocols, which will officially be effective March 1, 2017. As EMS agencies and medical directors educate personnel, new protocols can be implemented before March 1. CEMS would like the majority of services to utilize the new protocols by January 1, 2017. There are two key changes that emergency medical service providers should know about:
  • Performing CPR in the field: In accordance with recommendations from the American Heart Association, EMTs and paramedics are now directed to perform CPR for medically related cardiac arrest in the place the patient was stricken for at least 30 minutes before moving the patient to the ambulance and bringing them to the hospital. Continuous, high-quality chest compressions maintain adequate coronary perfusion pressure (CPP) and give a patient the best chance for a good outcome. Even minimal interruptions to position and move the patient result in the loss of adequate CPP. In addition, quality chest compressions cannot be delivered on a moving cot or in a moving ambulance. Other states that have adopted this protocol have seen an increased rate for return of spontaneous circulation (ROSC) because remaining in one location allows EMS practitioners to think critically and act in a more organized and calculated manner. CEMS is working with RIDOH’s communications staff to educate the public on the importance of this protocol change.
  • Pre-hospital stroke care: In addition to using the Cincinnati Stroke Scale to help recognize stroke, EMTs and paramedics will now also perform the Los Angeles Motor Scale (LAMS) to differentiate between potential large vessel occlusions and smaller vascular occlusions. A patient with a high LAMS score will be transported to a comprehensive stroke center (if one is within 30 minutes) where invasive interventions can be performed.
The overarching goal of the revisions is to enhance the scope of practice for all EMS practitioners and to align the protocols with national-level, evidence-based, peer-reviewed standards. Special thanks are extended to the Rhode Island Ambulance Service Coordinating Advisory Board, the Board’s Rules and Regulation Committee, and the Rhode Island Stroke Task Force for input and feedback during the process to update the protocols.
 

In Case You Missed It...

Top 10 Stories of 2016: A Changing Health Care Landscape
RIPR.org, December 23
URI graduates first class from innovative nursing program
Providence Journal, December 23
Editorial: Drug crisis demands vigilance
The Independent- Opinion, December 22
First Rhode Island baby born with Zika virus
ABC6.com, December 21
Infant born in RI with travel-related Zika virus
Channel 12, December 21
Health department: 1st baby born with Zika in Rhode Island
WPRO , December 21
First responders now deliver 30 minutes CPR
Warwick Beacon, December 20
Neighbors Health appoints new CFO
Becker's Hospital Review, December 20
Your Weekly Briefing: Health In Rhode Island, Dec. 20
Rhode Island Public Radio, December 20
Primary care providers are well-suited to treat patients with opioid addictions
Providence Business News, December 19
Community breakfast to celebrate 40th anniversary of health service
Westerly Sun, December 18
Woonsocket water shows capitalism and environmental justice cannot coexist
RI Future, December 16
Time to enact marijuana legislation
Providence Business News, December 16
 

Quick Links

  
Health Connections is brought to you by the Rhode Island Department of Health. Our physician community includes:

Nicole Alexander-Scott, MD, MPH; Director of Health
James McDonald, MD, MPH; Chief Administrative Officer for the Board of Medical Licensure and Discipline
Utpala Bandy, MD, MPH; Director, Division of Preparedness, Response, Infectious Disease, and Emergency Medical Services
Ailis Clyne, MD, MPH; Medical Director, Division of Community Health and Equity

The Health Connections editor is Annemarie Beardsworth.  

facebook icon Like us on Facebook   twitter icon Follow us on Twitter   mail icon Order educational materials

Manage your RIDOH news and alerts: