by Timothy Gieseke, MD, CMD

One of the blessings of being a Senior Clinician and long standing Medical Director of SNFs has been the luxury of having more time for exploring resources that may improve care in my facilities while spending less time on the direct patient care.  As a member of AMDA, The Society for Post-Acute and Long Term Care, I look forward to the free monthly webinars (https://paltc.org/product-type/archived-webinars).  In August, the webinar was a very practical one on the Utilization of Civil Monetary Penalties to improve the quality of life of residents in LTC facilities.  In California, we have experienced the use of these funds through the Partnership to Improve Dementia Care in California and the Music and Memory Implementation program (attend CALTCM Fall CME program for the latest on this innovation).

by Bruce Silver, MD

The CURES 2.0 Program in California is mandatory beginning October 2, 2018.  The following are some of the regulations and policies that must be followed.

CURES stands for Controlled Substance Utilization Review and Evaluation System

CURES is the prescription drug monitoring program for the State of California. CURES database contains information about schedule II, III, and IV controlled substance prescription dispensed to patients as reported by those dispensers.

CURES data reflects dispensing information as it is reported to the Department of Justice.  The reporting dispenser creates and owns the prescription records submitted. The Department of Justice does not hold the prescription.

by Timothy Gieseke, MD                                                                         

As an internist trained in the ’70s, the common mantra was “the patient’s interests always come first.” This was far easier to provide at that time with no limits on work hours, very limited personal educational and start-up debt, and a low-overhead, fee-for-service system.  As I became more involved in the post-acute and long-term care sector in the ’80s & ’90s, my knowledge and expertise expanded through educational offerings of CAMD (California Medical Directors Association, the precursor to CALTCM), AMDA, and AGS. I found great fulfillment in applying this developing expertise on behalf of my patients and facilities.  However, I also found my work efficiency (# of patients seen each day) progressively declined while office overhead rapidly increased. Because of the latter, I gave up my office practice in 2005 to focus full -time on post-acute and SNF care. However, I have been able to continue servicing a geriatric clinic at my CCRC in large part due to a generous contract from this facility for my group’s provider services.   Here, my usual patient is > 85 y/o and medically complex and routine appointments are 25 min. to allow for team-based care and teaching. In this setting, I commonly bill higher-level codes for my services and have the documentation to support those codes built into my EMR notes. In fact, Blue Cross recently sent me a letter informing I was billing higher-level office based codes then most of my IM colleagues, which did not surprise me.

by Timothy L. Gieseke, MD, CMD

In California, this Option (physician aid in dying) went live June 9, 2016 for persons with less than 6 months to live and intact decision-making capacity.  By law CDPH reports annually by July 1 of each year data on the previous year’s statewide experience with this option. For the year 2017, 632 persons started the process and 241 unique physicians prescribed 577 aid-in-dying drugs.  62.9% died following ingestion of these drugs, 14.9% died without ingestion of the prescribed drugs, and the outcome of the remaining 22.2% was not reported (some may have taken it in 2018). Most of the individuals taking the drugs were in the 60-89-year-old age range (77%), white (88.9%), had some college education (72.7%), and were enrolled in hospice (83.4%).  The most prevalent illnesses identified were malignancies (68.5%), followed by neurologic disorders (9.4%) like ALS and Parkinson’s. You can read the executive summary on the CDPH web site at: https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/2017EOLADataReport.pdf