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http://healthcare.zdnet.com/?p=3265
How e-prescribing stops doctor shopping (Posted by Dana Blankenhorn @ 10:36 am) Doctor shopping is part of the dark underbelly of medicine.Addicts go from doctor-to-doctor, describing phony symptoms, and getting real prescriptions for dangerous painkillers or stimulants.
Q: is that the correct use of Doctor Shopping ? Isn't doctor shopping when you are looking around for a new doctor vs. looking for narcotics ?
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I don't know, maybe I'm missing something, but that story doesn't make sense.
If an addict would succeed in securing multiple scripts for the same drug, the insurer would certainly do something about it before the doctor found out.
If they pay cash for the drugs, without having the pharmacy bill the PBM, surescripts would have no record of that transaction. They only have what the PBM has based on claim data. And they only display data if the patient insurance is current.
Maybe the guy in the story had multiple insurances and got one script for each, or something else that is unusual....
Margalit Gur-Arie
My brand new Blog: On Healthcare Technology
elidan:but that story doesn't make sense
Another mindless time waster post from ijaguar - ijaguar if you had posted some comment about it maybe you would have seen how useless it was - we are not patients or consumers on the forum - we are providers and their assistants! a much higher level.
I object to this kind of post because they bury more important discussions as SPAM.
Medscribbler Getting you there sooner!
Scriptnetics
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I wonder if the ePrescribing modules could be tied in to a State's narcotic prescription registry.
Mike, I object to your objection.
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
I object to your objection of Mikes objection. The article doesnt even post the right picture unless that is the picture of an addict.
To Margeries point, I think the story is fabricated from disparate facts.
I actually think this is a pretty good little article. Medication history comes both from the payors (Surescripts MN, formerly RxHub) and the pharmacies (Surescripts VA, formerly SureScripts - note that second upper case "s"!) and many users do in fact find patients who are receiving multiple prescriptions from different doctors--and stop them from doing so. This could improve with ePrescribing of controlled substances (EPCS) with tie-ins to state PMPs (prescription monitoring programs). In Massachusetts, where the Department of Health, DrFirst, and Berkshire Medical System are running a pilot program for secure EPCS (under a DEA waiver), the Schedule II scripts sent and received are matched with the state database. Not quite the same as seeing that data in your ePrescribing or EMR application, but still useful in the long run. Please refer to my blog that touches on this topic: http://blog.drfirst.com/eprescribing/say-no-to-drug-abuse-by-saying-yes-to-e-prescribing/ [note to admin - if this is inappropriate on your site, please delete the blog reference]
Peter N. Kaufman, MD
Chief Medical Officer
DrFirst, Inc
pkaufman: Medication history comes both from the payors (Surescripts MN, formerly RxHub) and the pharmacies (Surescripts VA, formerly SureScripts
Medication history comes both from the payors (Surescripts MN, formerly RxHub) and the pharmacies (Surescripts VA, formerly SureScripts
Peter,
Are you sure about that? As far as I know, the med history comes only from the PBMs and it is based on the insurance eligibility ID. Basically, if I pay cash at Walmart, there's no way for the PBM to know that. I thought there was a disclaimer saying that OTC, low cost drugs and cash (or non par payers) are not included. Did they fix that?
Yes, I am sure, but history from the PBMs is more mature and more complete than the history from the pharmacies (which I believe is still limited to the chains, which may or may not currently include Wal-Mart). Peter N Kaufman
This is phase 1, next phase is to track cash payments also.
How does e-prescribing stop drug seeking behaviour when, thanks to our "all wise" politicians, we cannot use e-prescribing for controlled substances?
Since we cannot even print out Medicaid prescriptions without using special more expensive paper on dedicated printers, I have gone back to handwriting prescriptions so that my expensive EMR does not always accurately reflect the prescription actually handed to the patient.
We frequently reference the state controlled substance web site, but this is a very time consuming process since the software is very inefficient and I find the issue prescriptions list is frequently incomplete.
All patients have to do to avoid the insurance issue, is pay in cash at different pharmacies and since most of these narcotics are cheap and they are then sold for huge profits, it is easy money.
Keith Stafford, MD
While e-prescribing stops doctor shopping, it ALSO stops pharmacy shopping.
Since you send the script to say, Walgreens, the patient is now rendered incapable to shopping at CVS, Walmart, or any mom & pop stores.
You have locked them into Walgreens.
We are now getting requests to NOT eprescribe from patients, because they want to shop for the best deal.
William "Reddy" Biggs, MD
Managing Partner, 22 physician Internal Medicine group
"Live on eClinicalWorks since 2/1/2007" http://tinyurl.com/reddybiggs
That's a great point Reddy. I didn't think about that.
What would be nice to do is to have the doctor queue the prescription for electronic transmission and let the patient select the pharmacy and complete the transmission from the portal, ideally available on their iPhone. It could also be tied into the various price lists of the pharmacy chains, so they can shop from home. Probably very few would use that though and the mom & pop guys would be left out in the cold, but it would still be a cool feature....
reddybiggs: While e-prescribing stops doctor shopping, it ALSO stops pharmacy shopping.
Apparently that is why Ontario is slow in getting ePrescribing. The pharmacies want to try to compete for business.
However, educating patients that pharmacists play a role in Medication Safety and that having all your prescriptions in one place saves lives .... should be enough to convince them. The couple of bucks here or there saved does not outweigh the risk of medication problems.
Here's the rub.
Wal-Mart has a lot of our popular diabetes meds, such as metformin, lisinopril, lovastatin for $4 a month.
But they are more expensive than other pharmacies for meds like Januvia or Actos.
Patients go to Wal-Mart for groceries, power tools, light bulbs, etc, so it's not an extra trip to get pharmacy items as well.
So they often consider their local pharmacy to be their 'Main Pharmacy' but pick up the $4 offerings at Wal-Mart.
While I agree pharmacists play a role in medication safety, do we have any objective evidence that the 'saving lives' by shopping at only one pharmacy is actually true? Any studies that show that?