Tennessee Medical Assn. seeks to curb pain medication abuse

Tennessee Medical Assn. seeks to curb pain medication abuse

MEMPHIS, TN (WMC) - In an effort to curb abuse of addictive pain medication such as OxyContin and hydrocodone, the Tennessee Medical Association has proposed a two signature requirement on certain prescriptions.

"A physician led team based approach says if it's narcotics, weight loss medications, anything that's controlled like that, there needs to be two signatures on there," said Dr. John Hale, Jr., TMA's current President. Dr. Hale told the Memphis Rotary Club. "We have a lot of physicians who are prostituting their licenses who are signing off and not practicing good medicine."

Hale explained  that 80 percent of the top 50 prescribers in Tennessee are nurse practitioners who work in doctors' offices. However, there is not enough coordination and communication between physicians and so-called "physician extenders" or "mid-levels" (nurse practitioners or physician assistants).

"There needs to be agreement on what's being done," Dr. Hale told Rotarians. "We're trying to make sure we get this drug problem under control."

Ending rubber stamping of narcotics and weight loss prescriptions is just one of a long list of initiatives the TMA will carry to its annual "Day on the Hill" at the Tennessee State Capital in Nashville on March 1.

Dr. Hale, a Union City, TN primary care physician, told the Memphis Rotary Club, "I'm a family physician. I stand before you as a dinosaur that's probably going away. We don't have a lot of med students going into primary care."

Hale shared some endearing early childhood memories of growing up in Halls, a small West Tennessee town. A family doctor made regular house calls to Hale's ailing mother.

"I made a tunnel to get through the house with bedspreads and chairs; that's how I went through her bedroom so I would not wake her up when she was asleep," the now 54-year-old physician recalled. "I made that old doctor crawl through that tunnel to see me."

The TMA is asking lawmakers to increase Graduate Medical Education funding in the state this year.

"All of our studies show that if they train in the state, they'll locate in the state; so we're trying to increase that funding so we can get more residency spots," Hale said of the GME fund that has gone without an increase for 20 years. Hale says the state desperately needs primary care physicians to oversee the big picture of each patient's care.

"You ask, who's your primary care doctor and people say 'I don't have one. I have a cardiologist, a pulmonologist, a gastroenterologist, this "ologist" and this"ologist" but I don't have somebody who coordinates my care,'" Hale told Rotarians.

Another TMA focus is TennCare payment reform.

Hale explained that outcome based insurance payment strategies encourage physicians to "cherry pick" healthier patients rather than those who need a doctor's regular care and encouragement.

Hale shared a frequently repeated scenario: "In my practice right now, I have a lot of good patients. They're almost like family. They're almost like children in a way; sometimes I have to scold, especially my diabetics. I see them out in restaurants and they're eating a piece of pie. Sometimes I feel like a preacher. I say, 'What are you doing?' They turn white, get a little nauseated and push the pie away. We bring it up the next time they come in the office. Right now, I can fuss at them and scold them and say you can do better because I love them. But under this reform, if their average sugars are not doing well, and they're going to the hospital too much because of complications from diabetes, they're going to hurt my numbers. Then I'm going to have to say, look, you're still smoking when I told you not to, you're not taking medicine like I told you to, you're going and eating out not just a piece of pie but several pieces of pie, I can't see you anymore and that's going to hurt me," Hale said.

The TMA President said health care cannot be based totally on economics but quality with physician led teams working with patients.

Hale indicated he has no illusions about pushing controversial programs like Insure Tennessee in an election year for lawmakers. Even though a recent TMA poll had 80 percent of its members supporting passage of Insure Tennessee that would help working, uninsured people who need health care, the legislature's Republican super majority remains solidly against it.

Tennessee Governor Bill Haslam, the Tennessee Hospital Association and a wide cross section of state health leaders including the TMA favor the health
care program that would have 90 percent of its funding come from the federal government and the other 10 percent from Tennessee hospitals.

"The taxpayers were not going to be out any money," Hale told Rotarians. "I'm as conservative as anyone in this room but this was a good thing," Hale said of Insure Tennessee.

A legislative committee recently killed a Haslam proposal to use more than $1 billion each year in Affordable Care Act funding to expand Medicaid coverage to help uninsured working Tennesseans. 

The TMA will send a flock of white coated physicians to Capitol Hill March 1 to ask for changes in many other health care issues including telemedicine, the use motorcycle helmets, tort reform, and insurance company accountability.

Hale told Rotarians he knows working with lawmakers will be tough.

"Last Tuesday I was at the state legislature trying to work some of our bills," Hale said. "Closest thing I can tell you what it was like: it was like when the Christians went into the Coliseum. I needed to lose a little weight but not all of my rear end in about 30 minutes."

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