Extremely Potent Drug Carfentanil Detected in Three Philadelphia Drug Overdose Deaths	"Naïve" Opioid User Could Get Hooked in Five Days
PCMS to Host MACRA/MIPS Program	When Your Friend Keeps Banging His Head Against the Wall
We Need You to Help Change Prior Authorization	Pa. Lawmakers Told to Butt out of Tobacco Cessation Funds
Temple Study: Inferior Vena Cava Filter Implantation Rates Too High in U.S.	Pa. Weed Update
Looking for Something to do for Two Hours on September 6?	Dating Service

The Phila. Dept of Public Health (PDPH) has issued a health alert concerning the detection of high-potent fentanyl analogues in the city that caused the deaths of two men and a woman.

Toxicology reports from the Philadelphia Medical Examiner have confirmed the presence of carfentanil in one overdose death in December 2016 and two deaths last month.

The victims were a 59-year-old African American man, a 56-year-old Caucasian man and a 35-year-old Caucasian woman. The victims were not found in the same areas of the city. Carfentanil is an extremely potent fentanyl analogue. It's 100 times more potent than fentanyl and 10,000 times more potent than morphine. It's designed to be used on large animals.

Carfentanil and other fentanyl analogues are often mixed with heroine and/or cocaine, and can be accidentally inhaled or absorbed through the skin.

Naloxone can reverse such an overdose, but sometimes it needs more than one dose to work.

For more information on this health alert, go to: https://hip.phila.gov/EmergentHealthTopics/Opioids.

CDC researchers have concluded that the probability that an opioid-naïve patient would become a chronic opioid user increases sharply after as little as five days of use.

With sobering statistics like these in mind, Independence Blue Cross (IBX) has issued an updated management strategy for the appropriate use of opioids for acute or chronic pain.

IBX calls for prior authorization for the following:

• All opioid products whose standard dosing exceeds 90 milligrams per day.
• All opioid patches as of July 1.
• Most strengths of long-acting opioids.

On July 1, IBX implemented a cumulative five-day supply per 30-day period for members who have not received an opioid within the last 30 days.

IBX noted some good news. Since CMS initiated the Overutilization Monitoring System (OMS) there was a 47% drop from 2011 to 2015, in Part D beneficiaries overusing opioids.

You can get all the details on the new IBX policy on opioid management by going to: https://www.ibx.com/pdfs/providers/pharmacy_information/pharmacy_policies/opioid_management_policy.pdf.

The August 17 program at the PCMS building at noon, will help independent physicians avoid paying MACRA/MIPS penalties, and help them understand how to get incentive payments and bonuses. Details on the PCMS program are in the Dating Service segment of this newsletter.

PAMED also has a broad range of services that can help. You can find them by going to: www.pamedsoc.org/macra.

Tell him there's a better way to handle his professional frustrations. He can take his concerns about practicing medicine to the PCMS delegation that will attend the annual Pa. Medical Society (PAMED) House of Delegates conference.

PAMED wants to know the challenges you face in your daily practice, such as cumbersome regulations and issues involving doctor-patient relationships.

The House of Delegates, PAMED's legislative body, will meet in October to agree on policies to champion to state lawmakers during the coming year.

If you have an issue you want the PCMS delegation to present at the statewide meeting, submit it to PCMS by August 18.

PCMS is committed to serving the needs of Philadelphia's physicians and their patients. For more information on how we can help you, contact PCMS by emailing us at: [email protected], or by calling: 215-563-5342, ext 101.

PAMED says the effort to get a bill through the Pa. legislature that would enact reasonable restraints on prior authorizations is stalled because physicians are not involved in the lobbying effort.

PAMED's chair of the specialty leadership cabinet, Dr. John Gallagher, said emails and tear-off pads have been sent to members and specialties seeking both physician and patient experiences to share with lawmakers, but "to date the response has been disappointing.... We find our membership now missing in action when needed."

PAMED is seeking support for HB 1293, sponsored by Rep. Marguerite Quinn. Dr. Gallagher is urging you to ask your patients who have experienced serious delays from prior authorization decisions from health plans to share their story at www.pamedsoc.org/ShareYourStory.

Legislators are debating whether to try to fill some of the state's $2 billion budget hole with money from the Master Settlement Agreement with the tobacco companies.

The Pa. branch of the American Lung Association says that's a very bad idea. "Tobacco kills more than 22,000 adults in Pa. every year and costs taxpayers over $6 billion in health care costs," said Jazmin Nixon, of the American Lung Association in Pa. "We need to continue funding programs that help smokers quit, prevent young people from ever starting to smoke, and protect Pennsylvanians from the health effects of secondhand smoke."

For more information, go to: www.lung.org.

The filter has been used to help prevent deep vein thrombosis blood clots from reaching the lungs, but in 2010, the U.S. Food and Drug Administration (FDA) questioned its safety, after reviewing more than 900 adverse events.

The Temple research team headed by Dr. Riyaz Bashir, found that there was a significant reduction in the use of the filter after the FDA findings were published, but that implantation rates still remain high in the U.S., especially when compared to use in five large European countries.

"In the United States, the IVC filter implantation rates are 25-fold higher than in Europe," Dr. Bashir said. "The hospitals across this country collectively are spending close to a billion dollars on these devices every year without a known significant benefit. With current level of evidence, we believe that the appropriate implantation rate in the U.S. should be similar or lower than the rate observed in Europe."

Physicians who want to certify patients to receive medical marijuana must undergo a training course and put their names in a registry. The Pa. Dept. of Health (DOH) will post the physician registry this month.

If you want to register, DOH would like you to take a survey by going to: https://www.surveymonkey.com/r/WM72DXX.

You can find answers to frequently asked questions on the Pa. medical marijuana program, by going to the DOH website, at: health.pa.gov.

We have a suggestion. Help PCMS answer phones during the Doctors on Call program at KYW-TV.

This year's program will take place on Wednesday, September 6, from 4:30 to 6:30 PM at the CBS studios at 1555 Hamilton Street, in Philadelphia.

Volunteers will take calls from viewers on any medical topic. Physicians will discuss with callers their concerns in general terms, while not offering a diagnosis or specific medical advice.

PCMS is partnering on the project with other county medical societies and PAMED. If you would like to volunteer, you can learn more and register at: https://philamedsoc.org/pcms-events/doctors-on-call/.

August

17 - How to Succeed With 2017 MACRA Date: Thursday, August 17 Time: Noon - 1:30 PM Place: The Philadelphia County Medical Society, 2100 Spring Garden Street, Philadelphia, PA 19130 To all Philadelphia Practice Managers and Physicians: Join us for a practical review of MACRA/MIPS in 2017. Learn how to create a plan that will avoid penalties and optimize your incentive and potential bonus. Click Here to Register

September

6 - Doctors on Call Date: Wednesday, September 6 Time: 4:30 PM - 6:30 PM Place: KYW- TV 3, 1555 Hamilton Street, Philadelphia, PA 19130 Doctors on Call is a live TV program where viewers in the Philadelphia area can call a toll-free number and ask questions of member physicians on any medical topic. Member volunteers discuss with patients their concerns and answer questions in general terms. (We do not offer diagnoses or specific medical advice.) 12-16 volunteers are needed. Click Here to Register