The implementation of opioid prescribing report cards in Medicaid managed care: a community quality collaborative.

Philadelphia, Pennsylvania, is an urban epicenter of the opioid epidemic, and inappropriate opioid prescribing remains a top concern. To help address this issue, the Philadelphia Medicaid Opioid Prescribing Initiative, a type of community quality collaborative, mailed thousands of local Medicaid providers an individualized prescribing report card in 2017 and 2018. The report card featured details of providers' opioid prescribing, including peer comparison measures and inappropriate prescribing measures like concomitant opioid and benzodiazepine prescribing. This case study describes the unique process of developing and distributing the opioid prescribing report cards, with a particular focus on the role of Medicaid managed care organizations. Using Medicaid pharmacy claims, the extensive variation in prescribing measures within and across specialties is also illustrated. The report card's implementation points to the potential value of collaborations between public health departments and Medicaid managed care organizations and can provide insight for other locally grown policies.

Treating Fentanyl Withdrawal.

Fentanyl withdrawal is common, but pharmacological management has largely mirrored traditional approaches to opioid withdrawal. Observations in a large urban center suggest alternative approaches, including the need for dose modification, should be considered.

Boundary violation.

Regulation of the interstate practice of medicine represents a challenge to state medical boards. Although laws prohibiting the unlicensed practice of medicine were originally enacted to protect the public from unqualified practitioners, they could be invoked in a whole host of common clinical situations such as calling in prescriptions to a patient in another state, giving expert testimony in another jurisdiction, or reviewing radiology films on the internet, with potentially serious criminal ramifications. In this article a recent case describing a physician's being prosecuted for the illegal practice of medicine across state lines is presented and followed by a discussion of the numerous ways in which contemporary practitioners are likely to engage in such acts. The function of state medical legislation is explored as it relates to prohibitions on interstate practice. It is suggested that states, and possibly the federal government, should devise legislative solutions to allow for the good faith intermittent practice of interstate medicine.