Proposed State of Ohio Board of Pharmacy (SOBP) rules that will require a ICD-10 code on all controlled substance prescriptions are moving forward even though the Ohio Academy of Family Physicians has objected to them at every stage of the review process. The last hurdle for the rules was the Joint Commission on Agency Rule Review (JCARR) hearing heard on July 31. That body reviews as to process not policy so the Academy’s letter focuses on process.
On behalf of the 4,900 family physician, family medicine resident, and medical student members of the OAFP, I write to express deep concern with the SOBP draft rule OAC 4729-5-30 that would require physicians to include an ICD-10 code on all controlled substance prescriptions. We ask that JCARR invalidate section (B)(14)(b)(i) of the rule because the pharmacy board failed to provide accurate financial impact information during the Common Sense Initiative (CSI) process. In addition, data gathered under the rule’s newly proposed, very expensive administrative process already exists in other forms which the SOBP board has made no attempt to access.
The SOBP, in the CSI business impact analysis process, provided no monetary figures for the prescribers’ technology costs, administrative burden, and personnel costs – instead vaguely stating that there “might” be some costs to prescribers. While no dollar figures were applied by the SOBP, the Ohio State Medical Association (OSMA) estimates the collective financial burden to prescribers and pharmacies to be at least $87 million annually.
And with regard to data collection, rather than meeting with impacted stakeholders to find ways to utilize ICD-10 data that already exists in other forms, the pharmacy board simply proceeded with creating a new multi-million-dollar process that is incredibly burdensome to physicians and pharmacists. Administrative tasks and paperwork reduce time available for taking care of and interacting with patients. The American Academy of Family Physicians estimates that family physicians spend 1.8 hours per week on prior authorization of insurance coverage, 7.7 hours per week on non face-to-face patient care issues, and 3.8 hours per week on other non-patient care tasks. Meeting requirements of this rule will take more time from direct patient care.
We respectfully ask that the committee invalid section (B)(14)(b)(i) of draft rule OAC 4729-5-30 so that stakeholders can work together to figure up how to use available data that already exists; those stakeholders can identify any gaps and how to rectify them. If this section isn’t invalidated, the rule will add millions of dollars in new expense and regulation to an already burdened system to collect data for which no clear evidence exists that patient care will improve.
Prior to the start of Monday’s hearing, the OSMA and the Ohio Hospital Association reached a compromise with the Kasich administration that they would not continue to object to the ICD-10 requirement as long as a 9-month delay in the requirement for non-opioid controlled substance prescriptions was instituted.