Friday, July 5, 2013

New York State I-STOP law: Obamacare incarnate?

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The New York State Internet System for Tracking Over-Prescribing Act goes into effect at the end of August tasked with monitoring and endding the abuses of controlled substances!

While speaking with an internist about Obamacare and the problems it will pose to his livelihood, the conversation then moved to a subject that I was completely unaware of which is the soon-to-be implemented New York State Internet System for Tracking Over-Prescribing Act or I-STOP.

Intuitively there is no question that the street trafficking in controlled substances, particularly oxycodone, is a serious societal problem evidenced by pharmacy robberies that include deadly use of force by the perps.

Perps who themselves may very well be addicted to the drugs they are stealing.

That said the question is whether the governmental response like the one in New York State is an overreach by politicians who may not understand, or who simply don't care about, the unintended consequences such legislation may have on pharmacies, doctors and patients alike.

I-STOP seems to be very similar to Obamacare on the federal level in that it was concocted by certain politicians for the benefit of politicians with little regard to the impact on the general public and business.

The New York State I-STOP law, while seemingly laudable in terms of desired outcome, appears to be imperfect in terms of structure and proposed implementation. At the same time, given the reality of addiction, it makes one wonder if such a law will truly address the problem anyway.

Ironically a study conducted by the ECRI Institute shows that the actual source of the problem is likely not at the doctor level but the street level meaning that the I-STOP system wouldn't have a large impact.

In a study of 5,000 patients it was found that only .27 percent became addicted through medications prescribed by doctors.

Now, assuming that at the end of August 2013 the I-STOP program will actually be implemented, here are some of my thoughts about some of the unintended consequences that are going to be faced by doctors and their patients.

Some unintended consequences and failings of I-STOP!

As with any legislation that may be conceived without the input of those who will be most directly impacted, I-STOP seems to possess some fairly significant failings.

I list some here and welcome any others I may not have thought of.

I would also welcome dissenting opinions concluding that this law is good in its present form and will accomplish what it is that the politicians seek to accomplish.
  • Not enough input from the medical profession leading to burdens that will adversely affect both the doctors and their patients.
  • Immediate entry of a controlled prescription into an online database while the patient is sitting in the office. This 3-10 minute process can affect the doctors ability to see enough patients daily in an environment where reimbursements are constantly being reduced. Currently doctors have 45 days to report.
  • The severity of the penalty for failing to report may cause doctors to either not prescribe medicines they deem necessary or to force the patient to go to a pain doctor.
  • Patients now may be unable to get prescriptions that they need either on a timely basis or at all.
  • The financial burden for patients who may need to see a pain doctor (specialist) may cause them to avoid taking necessary medicine.
  • There is an additional financial burden for patients who require pain medicine on an ongoing basis (i.e. cancer patients) who may have gotten an extra months prescription during a visit and who now must visit the doctor each month.
  • As with the gun control argument in which the criminals will still acquire guns while the law-abiding public may have difficulty, criminals will continue to steal and sell these drugs while patients who actually need them will have to jump through hoops in order to get them.
  • As it currently stands patients will still be able to go 'doctor shopping' in other states which may not show up in the I-STOP system.
  • Forces doctors to treat a long-time patient with chronic pain issues in the same way that they treat a first-time patient complaining of back pain.
Thoughts and opinions welcome below.

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