Published 3/1/2014

Second Look

FDA: Limit acetaminophen in combination products
The U.S. Food and Drug Administration (FDA) is asking manufacturers of prescription combination products that contain acetaminophen to limit the amount of acetaminophen to no more than 325 milligrams (mg) in each tablet or capsule. Manufacturers must update labels of all prescription combination acetaminophen products to warn of the potential risk for severe liver injury. The elimination of higher-dose prescription combination acetaminophen products will be phased in over 3 years and should not create a shortage of pain medication. Continued reports of liver injury also prompted the agency to propose boxed warnings for all acetaminophen prescription products.

Penalties for “abusive prescribing”
A proposed rule by the U.S. Centers for Medicare & Medicaid Services (CMS) would allow the agency to revoke Medicare enrollment for “Part D prescribers who engage in abusive prescribing practices.” CMS could take similar action if a provider’s license has been suspended or revoked or if a provider was restricted from prescribing painkillers and other controlled substances. The agency also proposes requiring providers to formally enroll in the Medicare program before prescribing to Medicare Part D patients.

Streamlining multistate licensure
According to Newswise, a bipartisan group of 16 U.S. senators has commended state medical boards and the Federation of State Medical Boards for recent efforts to streamline the licensing process for physicians who wish to practice in multiple states. The senators believe the Interstate Medical Licensure Compact system—a proposed licensing option under which qualified physicians who seek to practice in multiple states would be eligible for expedited licensure in all participating states—retains important patient-protection advantages of the current state-based medical licensing process.

Improving the RAC process
The California Medical Association notes that the federal appropriations bill passed by the U.S. Congress and expected to be signed by President Obama contains language instructing CMS to improve the Medicare Recovery Audit Contractor (RAC) program. Specifically, the bill states that the RACs’ financial incentives cause them to be too aggressive in their retrospective audits of physicians and calls for a plan with a time line, goals, and measurable objectives to improve the RAC process. The American Hospital Association has asked CMS to suspend RAC audits until all pending appeals have been processed. The Office of Medicare Hearings and Appeals will give priority to appeals filed by beneficiaries and suspend action on hearing requests filed by healthcare providers until the current backlog of cases is addressed.

Improving checklist compliance
Data from a pilot study presented at the American Society of Anesthesiologists Practice Management 2014 conference suggest that informing patients about the use of a surgical safety checklist may improve compliance among healthcare providers. The researchers compared provider compliance across 61 patients who were not informed about the World Health Organization Surgical Safety Checklist and 43 patients who were told about the list and given a copy that included a place for providers to sign, agreeing they would follow it. When patients were informed, compliance was higher for all 26 specific checklist items and informed patients felt more comfortable going into their surgeries.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)