International Overdose Awareness Day
To some, this day may not mean much, but to others, it is a day to commemorate and remember loved ones that we lost as a result of overdose. Unfortunately, these fatal occurrences are in large part due to a horrible, stigmatized and chronic illness: addiction.
While there has been widespread media attention for how addiction “should†be categorized as outlined in the latest New York Times article, addiction, specifically with opioids, is still viewed as a moral failing, a flaw, even. The associated stigma often deters patients from receiving proper rehabilitation treatment and even if they do seek treatment, the government currently limits the number of patients a single provider may treat with drugs such as buprenorphine or methadone, which are both proven to reduce cravings and save lives. This leads to many patients relapsing.
Physicians, internists, and dentists are collectively responsible for providing 81.6% of opioid prescriptions in the United States and because of this, they have a very unique role in mitigating the impact of this opioid epidemic. Opioid addiction often starts at the hands of healthcare professionals simply trying to do their job, prescribing pain medications to relieve their patients of painful woes, especially during post-operative recovery.
While many prescriptions are meant for initial, short-term treatment, some doctors and dentists authorize refills time and time again because they want to help patients whom claim that they are still in pain. However, when the pill bottle and refills run out, these patients are left high and dry; looking for alternatives to create that euphoric escape they’ve become so accustomed to. This could mean an endless search of several different doctors to prescribe more substances (also known as doctor shopping), purchasing pills on the black market, or worse, turning to heroin as a cheaper and more readily available alternative.
As the Surgeon General, Dr. Vivek Murthy, reiterates in his recent letter to all of America’s doctors, many prescribers don’t realize how dangerous the drugs can be, or even how addictive they are because many were incorrectly taught that opioids are not addictive when prescribed for legitimate pain. Dr. Murthy further points out that overdose deaths from opioids have quadrupled since 1999 and pain medication prescriptions have risen to the point that there’s enough for every American adult to have their own bottle of pills. It’s a fair statement that the majority of clinicians do not enter the healthcare industry with intent to harm their patients, yet it’s also fair to say that lack of proper education has further fueled these prescribing patterns.
So, who’s to blame here? Is it the prescribers? The pharmaceutical companies’ aggressive marketing tactics in the 1990’s? Learned behaviors? The demands and expectations from patients?
The truth of the matter is: no one is to blame. Blaming only diverts the necessary explication of collectively coming together as a nation to address this epidemic. The imperative solution is education.
Dr. Murthy also addresses in his letter that now is the time for clinicians to properly educate themselves on how to treat pain safely and effectively and screen patients for opioid use disorder and provide them with helpful resources and evidence-based treatment options. Furthermore, to shape how the rest of the country sees addiction, clinicians should shamelessly speak about it and start treating it as a chronic illness.
As a part of this ongoing education initiative, DoseSpot will be hosting a webinar in regards to the opioid epidemic that will include helpful tips and resources to stay ahead of this crisis. Stay tuned for more details.
Sources: Time; CNN; Time; Aetna; Surgeon General Letter; Shatterproof; CBS News
About DoseSpot:
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.
In our last installment of the Insider Threat series, we look to fellow dentists within a dental practice as a potential risk for prescription fraud. How, or better yet why, would a dentist commit such a crime if they are lawfully allowed to authorize prescriptions for their patients? With the opioid epidemic upon us, it’s an unfortunate reality that individuals dealing with a substance abuse issue will go to great lengths to obtain such substances. These drugs do not discriminate regardless of one’s socioeconomic status and sadly, that includes those whom are meant to help combat this crisis: dentists and doctors.
Dr. Joseph Gorfien, a partner at a dental practice in Florida, utilized a fellow dentist’s professional license information and paper prescription pad to forge and fill prescriptions for Oxycodone without his partner’s knowledge. Gorfien took advantage of not only his own position’s authority, but his partner’s as well.
Dr. Mark Horowitz, although being investigated for a multitude of bad behaviors, had a suspended license and decided to utilize a fellow dentist’s prescription pad to obtain 130 pills of Oxycodone for personal use. The dentist in which he stole from only worked in that particular office one day per week and left his prescription pad readily available for anyone to swipe. Horowitz forged the prescriptions as well as the other dentist’s signature.
If a dentist is not utilizing another dentist’s DEA number for their own personal or financial gain, they may be abusing the professional relationships with those that they employ. Dr. Maurice Zybler, a dentist in Massachusetts, was recently accused of fraud because he was using his employees to acquire pain medications for more than a decade. He used his ability as a dentist to prescribe pain killers for his own personal use and wrote fraudulent prescriptions in his employee’s names in which they would fill and return back to him. If they didn’t fill the prescriptions, they expected to be fired.
 Click here to learn more about e-Prescribing and start saving time and money today!
While most dentists are generally aware of potential theft of DEA numbers or prescription pads from patients or staff, they may not question their equivalent peers. A recent survey conducted by Dentist’s Money Digest, further proves this state of ignorance. Nearly one in three dentists claim that they are personally aware of a dentist colleague with a painkiller problem and 65% said they see opioid abuse as a “minor†problem, while another 28% said it is a “significant, but not pressing†issue.
“However, dentists’ roles in the opioid epidemic extend beyond the prescription pad. Many dentists end up addicted themselves. Addiction can stem from stress, personal issues, or simply the access healthcare workers have to such drugs.â€Â Dentist Money Digest
The role of dentists, or any healthcare provider for that matter, within this opioid epidemic is crucial to the success of overcoming this crisis. Not only should dentists consider establishing office policies that can prevent or mitigate the diversion of opioids, but should also partake in ongoing education initiatives regarding responsible practices for prescribing such substances. With colleagues suffering from their own substance abuse issues, assistance, respect and understanding should be of utmost priority, regardless of any role within a dental practice and especially with the perceived stigma associated with addiction.
As part of these policies, dentists should consider e-Prescribing as a beneficial tool to safeguard their prescriptions from patients, staff and fellow dentists. Since e-Prescribing requires the entry of two unique passcodes for controlled substances, it will diminish the element of risk pertaining to stolen prescription pads and DEA numbers that are left out in the open for anyone to take. Furthermore, e-Prescribing is a proven method to help curb the opioid dilemma relative to doctor shopping and places a checks and balances system on prescribing behaviors. The benefits are exceedingly visible and with 3-9% of opioid abusers using forged written prescriptions, it’s a commonsense solution.
We hope you enjoyed our Insider Threat series and that it has given you informative, yet eye-opening insight into the potential threats your dental practice may harbor. This is not to say that employees or dentists cannot be trusted, but with 58% of dentists falling victim to prescription fraud, a change must occur for the safety and wellbeing of a dental practice, as well as their patients.
Sources: University of Kentucky; Boston.com; SunSentinel; prweb; Dentist’s Money Digest
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com
As we continue our Insider Threat series, we look to the role of the assistants within a dental practice. Specifically, the office assistant and the dental assistant. Though their responsibilities may vary from one practice to another, as well as from each other, assistants are often tasked with a myriad of similar duties, including having access to a dentist’s prescription pad or prescription software. The dental assistant, in particular, serves as a direct extension to the dentist and typically writes or calls in prescriptions on the dentist’s behalf.
Though the perceived trusting relationship between a dentist and their assistant(s) may alleviate the daily mundane tasks for the dentist, how much trust is too much? Should a dentist’s prescription pad or prescription software really be that accessible to anyone within the office? Let’s take a deeper dive and review three cases of prescription fraud committed by an office or dental assistant.
First up, in a West Michigan dental office, an office assistant decided to stay after hours and throw a party for some friends. Not only were multiple items stolen, but her friends utilized the dentist’s DEA number to call in and obtain unauthorized prescriptions from multiple pharmacies. Of the items stolen were the dentist’s prescription pad and signature stamp, of which, both were laying around in plain sight and available for anyone to take.
Another office assistant in Bethlehem, PA, whom had free access to a dentist’s prescription pad, admitted to taking two prescription slips, filling them out in the dentist’s name and authorizing 10 Percocet tablets on each for a family member. Not only were the unauthorized prescriptions filled, but the quantity dispensed was altered from 10 to 20 pills, which is easy to do given that they were paper prescriptions.
Lastly, a dental assistant in Alaska was found guilty of prescription fraud for phoning in numerous prescriptions for Vicodin on behalf of the dentist for a non-patient. In her capacity working in the dental office, she was allowed to call in prescriptions for patients, but took complete advantage of that authority. The pharmacist found the situation to be suspicious and contacted the dentist, whom confirmed that he had never authorized such prescriptions.
While the saying “any publicity is good publicity†may work in certain situations, bad press for a local dentist can be extremely detrimental. All three articles pertaining to the stories above include the dentist’s name and practice location, therefore there is no real way to hide from such unfortunate circumstances and stories like these have the potential to deter both current and prospective patients from a dental practice.
Luckily with e-Prescribing, there is no more need for paper prescriptions, therefore no more altered dispense quantities and no more stolen prescription pads. Furthermore, prescriptions will no longer need to be phoned in since it’s a simple click to send a prescription on its way to the pharmacy with no intermediary. A significant decline will also occur relative to the rate of fraud, resale and abuse of controlled substances because e-Prescribing secures all information exchanges from diversion.
 Click here to learn more about e-Prescribing and start saving time and money today!
This is not to say that assistants cannot aid a dentist with their patient’s prescriptions, quite the opposite in fact. When utilizing DoseSpot and with a dentist’s permission, office and dental assistants can receive their own e-Prescribing account and create prescriptions on behalf of the dentist. However, the dentist must utilize their own unique security passcodes to authorize and send the prescriptions along to the pharmacy, which is especially important when prescribing controlled substances.
To complete our Insider Threat series, we will be discussing how it’s not only office staff, but also fellow dentists, who can be a potential risk for prescription fraud within a dental practice. Look out for our next installment coming to you on Thursday, August 25th!
Sources: Juneau Empire; Wood TV; WFMZ
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com
To kick off our Insider Threat series, we shine light on dental practice Office Managers and the trusting relationship they share with dentists. After all, the office manager is meant to be the dentists’ point person who relieves them of administrative and financial duties within the office. Therefore, when it comes to the clinical management of patients, how much control should office managers have? Should office managers have access to the dentist’s prescription pad or prescription software?
Let’s take a look at Nicole Allenton, a now ex dental practice office manager in Washington state whom is serving one year in county jail for forging numerous prescriptions. Utilizing the office’s practice management software, Allenton took advantage of her position of trust and authority to print and fill 15 unauthorized pain medication prescriptions for herself and family members. None of whom were the dentist’s patients and sadly, this wasn’t her first time committing prescription fraud. She previously worked as a dental hygienist in another dental office and pulled off another non-sophisticated scheme to receive pain medication prescriptions simply by phoning the pharmacy “on behalf†of the dentist.
How could this possibly happen, you ask? Regardless of the trust factor, or lack thereof, the computer software in which the dental office deployed was not equipped to handle e-Prescribing. Although prescriptions were entered into the computer system, they could not be transmitted electronically to the pharmacy – they had to be printed, thus giving Allenton a perfect opportunity to take advantage of her superior’s handy DEA number and signature.
 Click here to learn more about e-Prescribing and start saving time and money today!
With written, printed or phoned in prescriptions, there are no checks and balances in place. Since e-Prescribing requires two-factors of authentication for controlled substances, Allenton wouldn’t have been able to forge any prescriptions since a dentist must enter two unique passcodes, including a 6 digit passcode that changes every 30 seconds. Furthermore, e-Prescribing provides a fully electronic audit trail which gives dentists complete insight into all of their prescription activity.
The aftermath pertaining to this case is substantial and it’s safe to say that the price to pay for not controlling prescription access is no laughing matter. Not only did Allenton end up behind bars, but as a result of her actions the two offices in which she was employed experienced severe financial repercussions and one office had to close its doors altogether.
Unfortunately, there are many instances in which a dental office employee has committed prescription fraud. As we will uncover in our next two cases, the office manager isn’t the only potential Insider Threat. Stay tuned for our next case, The Assistants, coming to you on Tuesday, August 23rd!
Sources:Â Tri-City Herald; News Talk
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com
In recent years the trusting relationship between dentists and their staff has come under scrutiny. Questions such as ‘how much control should my staff have?’ or ‘can my staff have access to my prescription pad?’ are questions posed in a dental office on a day-to-day basis, or so we hope. With 58% of dentists falling victim to prescription fraud, an issue that seems to be hitting dentists is Identity Theft. Not identity theft in the usual sense, but specifically the misuse of a dentist’s DEA number, forged signatures and stolen prescription pads.
The culprit? The Insider Threat comprised of office staff and fellow dentists. As the opioid epidemic kicks into full gear, dental offices are seeing the highest rate of fraud yet with forged prescriptions, specifically for controlled substances, and unfortunately staff members with access to the dentists’ prescription pads are at fault. However, as you will read in Case 3 which will be posted on Thursday August 25th, dentists also need to safeguard their prescription pads from other dentists! This is not to say that office staff and peers cannot be trusted or that they’re the sole cause of prescription fraud, not at all. However, how much trust is TOO much without proper protocols in place to ensure checks and balances for every prescription being written?
In 2016 alone, there have been numerous cases where an employee of a dental office has been behind the forged prescriptions and stolen prescription pads, which has ultimately led to dentists hanging the good old closed sign on the front door of the office. This is the type of financial implications such a crime can impose.
Over the next week, we will be discussing specific cases in which a staff member has taken advantage of their employment to receive or distribute unauthorized prescriptions, as well as useful tools to help combat your potential Insider Threat. Stay tuned!
Case 1 – The Office Manager. Thursday, August 18th
Case 2 – The Assistants. Tuesday, August 23rd
Case 3 – The Dentist. Thursday, August 25th
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.
Improving the U.S. healthcare system requires the simultaneous pursuit of three ideals: improving the experience of care, improving the health of populations and reducing per capita costs of healthcare. “Value-based care†after all, does have its reasons behind the term. In keeping up with this new delivery model, it’s important to understand how behavioral health attributes to population health, its effects on the healthcare system and the nation’s bottom line. This is where technology can play a major role.
In a given year, nearly 44 million adults experience mental illness, with a quarter of them living with a substance use co-disorder. Increasing access to mental health professionals via technology is simply a smart solution as more and more individuals grapple with suicide, addiction, and other mental health issues. Unfortunately, the stigma often associated with mental illness is creating a barrier to treatment, but telehealth companies are realizing this enormous growth opportunity and are remaining at the forefront by providing a more convenient and less expensive medical consultation.
Click here to learn more about e-Prescribing and start saving time and money today!
Since counseling really only requires the ability for patients and providers to speak via video or phone, utilizing telehealth applications allows patients to receive treatment without judgement in the comfort of their own home. It creates a safe space for mental health dialogue, thus aiming to reduce hospital admissions and its associated costs. Therefore, behavioral health must embrace technology and its ability to bridge the gaps in care to the benefit of patients nationwide.
To expand upon the evolving increase in technological access to care, it’s important to note that less than 50% of Americans who are prescribed medications to treat mental health conditions take them as directed, if at all, according to industry reports. Marrying telehealth and efforts such as medication adherence programs can assist a patient’s road to recovery while reducing the $193.2 billion in lost earnings per year associated with serious mental illness in America.
Sources:Â Health Affairs; HealthcareDIVE; National Alliance on Mental Illness; Forbes
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.
With a nationwide opioid epidemic upon us, states are starting to insist that prescribers conduct a bit of research before writing prescriptions for addictive medications like pain medications or benzodiazepines. States have therefore created statewide Prescription Drug Monitoring Programs (PDMPs) to monitor an individuals’ controlled substance dispense trends which are meant to assist a prescriber in making smarter treatment decisions. The goal here is to check a patient’s medication history to determine if the patient is doctor shopping or if they may have potential complications with medication(s) they are taking or have taken. Ultimately, PDMPs aid a prescriber in understanding the risks involved in prescribing these powerful medications for their patients.
“Databases known as Prescription Drug Monitoring Programs show doctors all controlled-substance prescriptions patients get and should be linked with the electronic health records (EHRs) that allow doctors to e-Prescribe.†USA Today
In most states, healthcare professionals who prescribe at least one controlled substance are encouraged, not required, to use PDMPs. The USA Today article addresses the fact that only five states promote the use of PDMPs and less than 20% of doctors use the databases when it isn’t required. On the other hand, e-Prescribing of controlled substances has proven to be an effective tool in combating this crisis, yet only three states have mandated the use of e-Prescribing, and one doesn’t enforce its own law.
Click here to learn more about e-Prescribing and how to stay ahead of this opioid crisis
All 50 States (and D.C) have now passed legislation allowing the e-Prescribing of both controlled and non-controlled substances, which is a drastic change from only a few years ago with federal regulations prohibiting the e-Prescribing of controlled substances.
Let’s take a look at the states that have mandated e-Prescribing:
New York: The first state to mandate and enforce its e-Prescribing laws as of March 2016, New York requires prescribers to check their state PDMP database and prescribers who continue to write paper prescriptions are subject to fines, jail time, or both. Since implementing, total numbers of opioid analgesics prescribed fell by 78%.
Minnesota: Technically the first state to deploy mandatory e-Prescribing, they currently do not enforce the use of such technology. The MN Department of Health recently reported that drug overdose deaths jumped 11% between 2014 and 2015 and more than half were related to prescription drugs, specifically opioid pain relievers, rather than illegal street drugs. Minnesota Health Commissioner Dr. Ed Ehlinger said, “The new data show the need for a broader approach to addressing the root causes of drug addiction and overdoses.†Stay tuned.
Maine: Experiencing one of the highest death rates in the country due to opioid overdose, Maine recently mandated e-Prescribing for schedule II controlled substances and will be put into effect come June 2017. Similar to New York, prescribers will face fines, jail time, or both if they choose to utilize paper prescription pads.
New Jersey is also on the horizon to mandate e-Prescribing in due time. As a collective nation, we can no longer sit back and overlook the link between opioid overprescribing and opioid overdose. E-Prescribing and PDMPs should work hand in hand; the benefits are exceedingly visible and with 3-9% of opioid abusers using forged written prescriptions, it’s a commonsense solution. Protect your company, protect your providers, but more importantly, protect your patients. They depend on it.
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.
Transport yourself to medical care bliss.
Virtual reality is changing the game, literally, for our healthcare landscape and AppliedVR, a virtual reality company based in Los Angeles, CA, proves to do just that. Their therapeutic technology provides patients of all ages drug-free alternatives for managing pain and anxiety before, during, and after medical procedures. Utilizing Samsung’s Gear VR, patients can be transported to Ireland, watch the Nature Channel, or even play “Bear Blast,” a simple, fun game that promises no death or injury. Their technology is doing more than just distracting a patient – it is dramatically decreasing patients’ acute pain.
Though their clinical research thus far has proven the technology to be extremely effective, they are currently conducting further research to demonstrate how their products may decrease patient anxiety, minimize the need for sedation, reduce the risk of drug complications and shorten postoperative stays. With partners such as Cedars-Sinai Medical Center and Children’s Hospital Los Angeles, they are already seeing immense value and improvement in patient outcomes, while challenging the typical use of narcotics and maximizing healthcare value for all involved.
While this type of technology may not be suited for every patient, it does serve a very strategic purpose in the medical environment. Kudos, AppliedVR!
Sources: AppliedVR; Fox LA; Seeker; MIT Technology Review
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.
A study recently published by The New England Journal of Medicine stated that telehealth is positioned to revolutionize medical care. It’s fair to say that technologies are making a lot of things possible that wouldn’t have happened even a few years ago, but it’s also fair to say that this new age of telemedicine poses new risks and a few hurdles to overcome for the healthcare industry, providers, and patients alike.
One limitation that the industry is currently experiencing is the adoption of reimbursement for medical delivery systems by payers across the country, specifically the lack of coverage and “unequal†treatment of receiving care via technological advances. Luckily, certain states have put telehealth parity laws into place, thus requiring coverage and reimbursement for telehealth under private insurance, Medicaid, and workers compensation as though services were provided in person. Medicare, on the other hand, seems to be last to join the party which makes sense considering the population it serves.
Want to learn more? Download our free telehealth whitepaper!
Throughout the article, the biggest issue rings loudly: the digital divide between the industry and the populations they serve, whether that be the elderly, lower income individuals, or the less educated. These groups are less likely to have the means to participate in telehealth options. No computer or smartphone = no digital health adoption.
While there are a few bumps in the road, telehealth does serve up some benefits as well:
Ultimately, telehealth is meant to be an extension of the provider’s office, not a replacement. It will enable medical professionals to meet the growing burden of chronic disease, while enhancing the patient-centric, value-based care model the United States is currently trying to implement.
What do you think of this shift to digital health? Exciting or nerve-wracking? Share your thoughts with me below!
Sources: The New England Journal of Medicine
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.
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