Unfunded Mandates and Patient Safety

Last week, several New Jersey state legislators convened a press conference to announce a legislative package intended to stem the tide of opioid and heroin overdoses in the Garden State.  And quite a package it turned out to be: 21 bills are included, covering everything from mandatory insurance coverage for behavioral health to the use of naloxone to prevent overdoses.  There appears to be enough in the package that everyone has something they like... and everyone has something they don't like.  Should make for interesting politics.

One key piece of legislation in the package caught my eye.

The bill requires the mandatory registration and use of the Prescription Monitoring Program (PMP) among New Jersey physicians.  Everyone likes the concept of the PMP, but the Medical Society of New Jersey has an issue with requiring doctors to consult the database prior to writing prescriptions. Should this bill pass, New Jersey would join Oklahoma, Kentucky, New York, Tennessee, and Massachusetts as the only states that require doctors to consult the database prior to writing prescriptions for pain management medications.  If New Jersey legislators are smart, they'll include provisions (like Oklahoma did) creating exemptions for hospice and other end-of-life care situations.  Additionally, they'll prohibit lawsuits against physicians for not checking the database.  While a patient can't sue a doctor for not checking the database, the doctor would still be in violation of the law and subject to sanctions, punishment, etc.

Doctors often refer to such requirements as an "unfunded mandate."  By that, they mean additional requirements are being placed on them with no additional remuneration.  But this is fundamentally about patient safety.  Are the pre-surgical verification steps outlined by JCAHO an "unfunded mandate"?  What about the commonly expected best practice of physicians washing their hands between patients?  These are things we do in the healthcare community to protect patients, physicians, and other stakeholders from the unintended consequences of care delivery.  I can't understand how that logic doesn't extend to opioid prescribing.

New Jersey is headed in the right direction.  I hope they don't screw it up.

Michael
On Twitter @PRIUM1