Opioid CME for license renewal

Have you completed your opioid requirement yet? The biennium attestation deadline is October 31, 2023. The Wisconsin Medical Society (WisMed) offers a series of on-demand webinars approved by the Medical Examining Board (MEB) to meet the Opioid Prescribing Guideline. All have been approved for AMA PRA Category 1 Credit™ and Maintenance of Certification Part II points for certain specialties. Additionally, WisMed members receive discounts for many of our courses.

MEB-approved Opioid Prescribing Courses*

• Alternatives to Opioids in Treating Acute and Chronic Pain
• Drug Testing in Clinical Practice: The Science and Art of Drug Monitoring
• How to Decrease Prescription Drug Abuse: The What, Why and How
• How to Talk to Patients About Opioids
• Interventional Approaches to Treating Acute and Chronic Pain
• The Opioid Epidemic and the Clinical Practitioner: Responses to Opioid Over-Prescribing

Click here to learn about the MEB’s Opioid Prescribing Guideline and here to learn about the DEA requirements.

Visit our Education Center to view our entire catalogue of programs. Interested in having in-person education? Email [email protected] for details or assistance logging in.
*Some of these courses may need to be combined with additional education to meet the credit requirement. 

Back to top

A mission to provide care in La Crosse

On a recent visit to St. Clare Health Mission in La Crosse, Wisconsin Medical Society Foundation (Foundation) Program Coordinator, Jaime Craig, was given the opportunity to tour the clinic and see the mobile health clinic in action. St. Clare Health Mission is a free clinic and pharmacy. Their purpose is to provide free expansive health care and medications to the poor, uninsured and immigrant individuals and families. Through a Foundation grant made possible by the La Crosse County Medical Society Fund, they were able to purchase medications for patients with type-2 diabetes.

In 1993, St. Clare Health Mission in La Crosse was started by Sister LeClare Beres, a Franciscan Sisters of Perpetual Adoration contemporary of Saint Francis. She renounced all of her possessions, even giving away her shoes, as she devoted her life to the care of disadvantaged people. Partaking in her vision, representatives of health and social service organizations throughout the community began a collaborative effort to address health care access for low-income and uninsured people. Today the clinic holds eight exam rooms, a pharmacy and mental health care offices.

Through St. Clare Health Mission, volunteer health care professionals join together to provide free health care to those who had gone without due to a lack of financial resources. The term “health mission” describes not only the program, but the motivation that guides it. Through the years, volunteers have served more than 18,000 people on over 80,000 visits, which are increasingly through their Rotary Mobile Clinic. 

After visiting, Jaime commented, “It was wonderful to see the comfort level of clients speaking with staff and utilizing the treatment options. The local park in La Crosse had a large gathering of individuals looking for treatment.” With many people losing their Forward Health benefits in recent months, extra time and effort has been used to help obtain coverage and investigate other options for treatment and medication. Through volunteer medical staff and translators there has been the additional commitment to help Latino patients with diabetes better understand lifestyle changes and medication usage to improve their lives.

Between the mobile clinic, pharmacy and clinic there is always a need for volunteers and financial help. The clinic’s website also has a list of medical supplies that can be donated.

If you would like to support important community health programs that increase health equity and access in Wisconsin, please consider donating to the Wisconsin Medical Society Foundation’s Mission Fund. Please reach out to Jaime Craig at [email protected] if you would like to nominate a local community organization to be invited to apply for a Foundation grant.

Back to top

AMA Congressional update: action needed to fix Medicare

The need for Congress to act quickly and decisively to fix a broken Medicare payment system cannot be overstated. The fiscal stability of physician practices and the long-term viability of our nation’s entire health care system hang in the balance.

Medicare payment reform is the first pillar of the American Medical Association (AMA) Recovery Plan for America’s Physicians. This includes immediate relief from annual funding cuts and fundamental changes to Medicare reimbursement centered on simplicity, predictability, relevance and alignment, principles first outlined in reform principles issued last fall.

The current Medicare physician system reflects none of those principles, which needs to change. The government’s own Medicare Economic Index (MEI), which gauges the inflation in medical practice costs, will hit 4.5% in 2024, its highest level in two decades.

When combined with the 3.8% hike in the MEI recorded in 2023, that means medical practice cost increases will have exceeded 8% over just two years. Many individual and group physician practices have experienced cost increases well beyond this level, while still seeking full recovery from pandemic-related setbacks.

However, provisions in current law required the Centers for Medicare & Medicaid Services to implement a 2%, across-the-board reduction in Medicare physician payment rates this year, with another 3.36% cut to the conversion factor scheduled for 2024. In stark contrast to the annual payment increases tied to inflation given to hospitals, skilled nursing facilities and other entities that bill Medicare, physician practices have fought to reduce or delay payment cuts nearly every year.

Taking inflation into account, Medicare physician payment rates fell 26% from 2001 to 2023, while practice costs rose by 47% over the same period. We must place physician practices on sound financial ground through Congressional action to fix the Medicare physician payment system.

Legislative relief

The AMA is strongly supporting the Strengthening Medicare for Patients and Providers Act (H.R. 2474), a bipartisan measure now pending in the 118^th Congress, which would provide the crucial link between the Medicare physician payment schedule and the MEI, and finally put physicians on an equal fiscal footing with other entities drawing Medicare payment. Physicians can contact their representatives in Congress through this AMA portal to urge passage of H.R. 2474.

For physicians who are meeting virtually or in person with their legislators and staff, a variety of resource material is available on a dedicated web site, FixMedicareNow.org, including plain language explanations of the need for automatic, annual inflation-based payment updates, reforms to budget neutrality policies and simplifying the Merit-Based Incentive Payment System (MIPS).

The Wisconsin Medical Society and the AMA intend to fight tirelessly for a financially stable and wholly predictable Medicare physician reimbursement model that protects both physicians and the patients they serve. We ask you to join us in urging Congress to ensure that Medicare continues to fulfill its crucial role in safeguarding both the health and financial well-being of tens of millions of Americans.

Back to top

Maximizing retirement income: physician benefits of Roth conversions

As retirement approaches, many physicians face a highly taxed retirement caused by a lifetime of tax deferred retirement savings. One powerful tool that has gained popularity in recent years is the Roth conversion. A Roth conversion involves transferring funds from a traditional retirement account, such as a 401(k) or traditional IRA, into a Roth IRA. While this process can trigger taxable income in the year of conversion, it offers unique advantages that can prove invaluable during retirement. Let’s explore the benefits of Roth conversions and why they should be considered as part of a comprehensive retirement plan.

One of the primary attractions of Roth conversions is the ability to achieve tax-free withdrawals during retirement. Unlike traditional retirement accounts, Roth IRAs allow you to withdraw your contributions and earnings tax-free, if you are age 59½ or older and have held the Roth IRA for at least five years. By converting a portion of your traditional retirement savings to a Roth IRA, you create a tax-free source of income in retirement, which can be particularly advantageous if you anticipate higher tax rates in the future or if you want to reduce your taxable income during retirement.

Upon reaching age 73, traditional retirement account holders are required to take minimum distributions from their accounts each year. These required minimum distributions (RMD) are taxed at your ordinary income tax rate and can potentially push you into higher tax brackets. Roth IRAs, on the other hand, do not have RMD during the account holder's lifetime. By converting some or all of your traditional retirement funds to a Roth IRA, you can effectively eliminate RMD, giving you greater control over your tax liabilities and the flexibility to manage your withdrawals as needed.

Roth conversions can also provide significant estate planning advantages. Unlike traditional retirement accounts, Roth IRAs are not subject to income tax when inherited by a non-spouse beneficiary. This means that your heirs can receive the funds tax-free and continue to benefit from tax-free growth over time. By converting to a Roth IRA, you can potentially leave a tax-free legacy for your loved ones, providing them with a valuable financial resource without the burden of taxation.

Retirement planning is not only about maximizing your current income but also about understanding and managing your future tax liability. Roth conversions can be a strategic way to diversify your retirement income streams and create flexibility for tax planning during your retirement years. By holding both traditional and Roth accounts, you can have the option to choose which account to withdraw from based on your tax situation, allowing you to optimize your tax position and minimize your overall tax burden.

While Roth conversions offer compelling benefits, they may not be suitable for everyone. Here are some factors to consider before deciding to convert:

• Current Tax Bracket: If you are in a high tax bracket now and expect to be in a lower bracket during retirement, a Roth conversion may not be advantageous until you are in a lower bracket.
• Ability to Pay Taxes: Converting to a Roth IRA triggers taxable income, so you must have sufficient funds outside of the retirement account to pay the associated taxes.
• Time Horizon: The longer the time horizon before you need to access the converted funds, the greater the potential tax-free growth in the Roth IRA.
• Risk of Future Tax Law Changes: Future changes to tax laws could impact the benefits of Roth conversions.

Roth conversions can be a powerful tool for maximizing retirement income and providing flexibility in tax planning during your golden years. By strategically converting traditional retirement funds to a Roth IRA, you can create a tax-free income stream, eliminate RMD and potentially leave a tax-free legacy for your heirs. However, it is crucial to carefully assess your individual financial situation and consult with a qualified financial advisor to determine if Roth conversions align with your long-term retirement goals. Remember, a well-considered and comprehensive retirement plan is the key to achieving financial security and peace of mind in your retirement journey.

Note: This article is for informational purposes only and should not be considered as financial or tax advice. Please consult with a qualified financial advisor or tax professional before making any financial decisions.

For personalized help eliminating debt, investing smart and securing retirement, please contact Mark Ziety, CFP®, AIF® 608.442.3750.

Mark Ziety, CFP®, AIF®
WisMed Financial, Inc. part of the Wisconsin Medical Society.  

Back to top

CBD, hemp and delta-8 usage and drug screening considerations for physicians

Guest article by Mary Jo Capodice, DO, MPH, MBA, FACOEM, FAAFP, MRO for i3screen

This article is intended to educate medical professionals regarding Cannabidiol (CBD), hemp and Delta-8 tetrahydrocannabinol (delta-8) use recommendations and how the use can affect a patient’s employment.

As an Occupational Medicine physician and Medical Review Officer, on a routine day I speak to many people who have had drug screens for a variety of reasons (preemployment, random testing, post-accident, follow up, for cause, school sports and other reasons).

Years ago, a positive tetrahydrocannabinol (THC) result on a drug screen was solely due to consuming marijuana, which was illegal. Today marijuana is legal in many states. Now a positive drug screen for THC can be due to use of marijuana or due to the use of other marijuana related substances. These substances are legal in all states and sold at gas stations and other retail settings!

Federal drug testing does not recognize marijuana as legal anywhere. Federal drug testing includes DOT (FMCSA, FRA, USCG, PMHSA, FTA, FAA), military and civilian employees in safety or security sensitive positions as prescribed by the Drug Free Federal Workplace, Executive Order 12564. Medical marijuana is now legal in several states and patients are able to get medical marijuana cards from these states. Medical marijuana users will not be able to pass a federal drug screen.

For drug testing not done under the federal regulations, an employer’s policies govern what a drug screen positive for marijuana means for employment.

The most well-studied cannabinoids extracted from the cannabis plant include delta-9-tetrahydrocannabinol, or delta-9 THC, which is psychoactive. Delta-9 THC is the main cannabinoid responsible for the high associated with marijuana. Cannabidiol (CBD), in contrast, is non-psychoactive.

Marijuana and hemp are two different varieties of the cannabis plant. In the U.S., federal regulations stipulate that cannabis plants containing greater than 0.3% delta-9 THC should be classified as marijuana, while plants containing less should be classified as hemp. The marijuana grown today has high levels – from 10% to 30% – of delta-9 THC, while hemp plants contain 5% to 15% CBD.

CBD (Cannabidiol), hemp (cannabis sativa) and Delta-8 tetrahydrocannabinol products legally can contain up to 0.3% THC. These products come in varying forms: oils, creams, lotions, gummies, hookah shisha and vape pens. The THC amount is not regulated by the FDA so the amount of THC from product to product can vary. The THC in these products does not induce a “high” in the user but it does get stored in the user’s fat cells and eliminated slowly through the urine. The general public is not aware that THC is in CBD, hemp or delta-8 products.

Delta-8 THC is found in very small quantities in the cannabis plant. The delta-8 THC that is widely marketed in the U.S. is a derivative of hemp CBD.

Delta-8 THC binds to CB1 receptors less strongly than delta-9 THC, which is what makes it less psychoactive than delta-9 THC. People who seek delta-8 THC for medicinal benefits seem to prefer it over delta-9 THC because delta-8 THC does not cause them to get very high. Delta-8 THC binds to CB2 receptors with a similar strength as delta-9 THC. Delta-8 THC could potentially be preferable over delta-9 THC for treating inflammation since it is less psychoactive.

There are no published clinical studies thus far on whether delta-8 THC can be used to treat clinical disorders, such as chemotherapy-induced nausea or weight loss due to HIV/AIDS, that are responsive to delta-9 THC.

At present, the drug testing laboratories cannot differentiate between THC (weed) use and THC solely from CBD, hemp or delta-8 usage in urine drug screens.

Advice for medical providers and employers

Employers should advise their existing and potential employees that CBD, hemp and delta-8 do contain THC which can affect drug screen results. These products can contain up to 0.3% THC.

Medical professionals should inquire as to a patient’s occupation and their potential to be drug screened. If the patient is in an occupation which is under the federal drug testing rules, medical marijuana, CBD, hemp and delta-8 products should not be advised for treatment. If these products are recommended for treatment, the patient should be made aware that the products can cause a positive drug test for THC.

WisMed member Dr. Mary Jo Capodice is a Medical Review Officer for i3screen, which offers technology that provides drug and alcohol testing program management, random selection and occupational health screening services.

Note: This article is intended to help medical professionals. The science in this field is always changing.

References:

U.S. Department of Transportation - DOT "CBD" Notice, National Library of Medicine - Clinicians' Guide to Cannabidiol and Hemp Oils, Mayo Clinic Proceedings - Clinicians’ Guide to Cannabidiol and Hemp Oils, American College of Clinical Pharmacology - A Review of Human Studies Assessing Cannabidiol's (CBD) Therapeutic Actions and Potential, American College of Clinical Pharmacology - A Review of Human Studies Assessing Cannabidiol's (CBD) Therapeutic Actions and Potential, Johns Hopkins Medicine - Some CBD Products May Yield Cannabis-Positive Urine Drug Tests, Harvard Health Publishing - Cannabidiol (CBD): What we know and what we don't, Journal of Analytical Toxicology - Urinary Pharmacokinetic Profile of Cannabinoids Following Administration of Vaporized and Oral Cannabidiol and Vaporized CBD-Dominant Cannabis, Centers for Disease Control and Prevention - CBD: What You Need to Know, Substance Abuse and Mental Health Services Administration - Frequently Asked Questions About Federal Workplace Drug Testing, U.S. Food and Drug Administration - 5 Things to Know about Delta-8 Tetrahydrocannabinol – Delta-8 THC, National Center for Complementary and Integrative Health - Cannabis (Marijuana) and Cannabinoids: What You Need To Know, StatPearls - Cannabinoids, Banner Health - When it comes to drug testing, CBD may not be A-OK, Medical News Today - CBD, Centers for Disease Control and Prevention - Marijuana FAQs, Healthline - What Is Pure CBD? The Best CBD Isolate Products for 2023

Back to top

Leadership Academy – business-focused CME for physicians

Wisconsin Medical Society Members taking on new leadership roles or responsibilities within their practice or system or transitioning from a patient care role to an administrative role in leadership are invited to join the virtual leadership academy. Courses focusing on Emotional Intelligence and Impression Management cover cornerstones of emotional intelligence, provide tools to assess and improve EQ skills and will help you evaluate aspects of emotional intelligence and executive presence as it applies to leadership roles.

The Wisconsin Medical Society has partnered with Pennsylvania Medical Society to offer this program to help members achieve the foundational leadership skills you need to succeed in your new role. Enroll in these completely virtual mini courses focused on critical business acumen to set yourself up to be an effective leader and earn up to 14 credits of CME.

Courses include Ethical Decision Making, Health Care Finance 101, Project Management for Physicians, Strategic Thinking, and more.

This exclusive, member-only program has limited space available. Register today by emailing [email protected] or calling 866.442.3800.

*The Pennsylvania Medical Society (PAMED) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. PAMED designates these enduring materials for a maximum of 14 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in these activities.

Back to top