Saturday Conference News

Exhibit News

Stop By the ASAM Booth (No. 9) to check out ASAM-branded merchandise for purchase, update your member profile, learn how to enter your CME credit hours online, see additional courses available for purchase and CME credit through our e-Live Learning Center, register for the Review Course in September, and enter in a raffle to win an Amazon Kindle preloaded with Principles of Addiction Medicine.

Meet ASAM board members at the ASAM booth (No. 9) during the following hours:

  • 9:30 to 10 a.m. today
  • 2:30 to 3 p.m. today

The following exhibitors are having drawings during the Med-Sci Conference:

  • Creative Care Malibu booth (No. 91) will be giving away an iPad 2 (wi-fi) as a grand prize and throughout the conference. CCM also will be giving out 12 of Dr. Khaleghi’s book, “The Anatomy of Addiction,” as well 12 of the pen/laser pointer/ USB drive combos.
  • Fisher Wallace Laboratories booth (No. 80) will be raffling off a free Fisher Wallace Cranial Stimulator. Cranial Electrotherapy Stimulation has been used to effectively treat addiction and related symptoms such as anxiety and insomnia since 1991, as an FDA cleared methodology.
  • Stop by the Aton Center booth (No. 64) to drop off a business card and be entered to win a $50 Starbucks card.

Member Profile: Driving Force Behind Chapter Comeback

Xiulu Ruan, M.D.

Xiulu Ruan, M.D.

Four-year ASAM member Xiulu Ruan, M.D., has served as the motivating force in bringing back the Alabama Society of Addiction Medicine to full activity and service.

“I want to continue to be active, and the first step was to bring our chapter back to life,” says Dr. Ruan, who now serves as Interim Vice President of the Alabama Society of Addiction Medicine. He worked toward reactivating his state’s chapter after a period of inactivity.

He is currently Co-Medical Director and Co-Owner, Physicians’ Pain Specialists of Alabama (PPSA), Mobile, Ala., where he serves as the Director of Clinical Research and Director of the Fellowship Program at PPSA. Dr. Ruan has earned seven board/subspecialty board certifications, including Physical Medicine, Pain Medicine, Interventional Pain Medicine, Electrodiagnostic Medicine, Addiction Medicine, and subspecialty certifications in Neuromuscular Medicine and Pain Management by the American Board of Physical Medicine and Rehabilitation.

He relies on the services of ASAM, particularly the Annual Medical-Scientific Conference, to stay abreast of advances and issues in addiction medicine.

“Specifically, I have really benefitted from ASAM’s board review course and the annual conference,” Dr. Ruan says. “Undoubtedly, both were some of the best attended and organized professional events I’ve ever seen.”

Member Profile: ASAM Opens Heart, Mind, Practice

Jason Powers, M.D.

Jason Powers, M.D.

Involvement in ASAM for Jason Powers, M.D., has opened his “heart and mind to different ways of treating patients.”

He is the Chief Medical Officer of Spirit Lodge, San Cristobal, and The Right Step, which are chemical dependency treatment centers in Houston, Dallas/Ft. Worth, Austin, Texas, and Taos, N.M. A member of ASAM since 2005, he is President-Elect of the Texas Society of Addiction Medicine for 2014 and currently serves as the chapter’s Secretary/Treasurer. He is also author of the upcoming comprehensive addiction resource book, When the Servant Becomes the Master, due to be published in May by Central Recovery Press.

“Bottom line: I want to support the professional organization that advocates on behalf of my patients, their rights to receive effective treatment, and the physicians from every background imaginable who treat them,” Dr. Powers says. “Membership is a great way to network, bounce ideas off other professionals, and learn how to be more effective in treating addicts.”

Member Profile: Educating Non-Addiction Specialists

Norman W. Wetterau, M.D., FAAFP, FASAM

Norman W. Wetterau, M.D., FAAFP, FASAM

ASAM membership has served as a springboard for Norman W. Wetterau, M.D., FAAFP, FASAM, to inform and educate other specialists about the value of the addiction medicine specialty. He currently serves as a specialist in addiction medicine, Tricounty Family Medicine, Dansville, N.Y., and Clinical Assistant Professor of Family Medicine, the University of Rochester School of Medicine, Rochester, N.Y.

“I am very concerned about the importance and need to educate primary care physicians and other non-addiction specialists treating individuals diagnosed with substance abuse,” Dr. Wetterau says.

An ASAM member since 1985, Dr. Wetterau is President of the New York Society of Addiction Medicine. He currently serves as ASAM’s Chairman of the Family Practice Workgroup, ASAM Liaison to the American Academy of Family Physicians, ASAM Representative to the Patient Centered Primary Care Collaborative, Program Committee Member for the Annual Medical-Scientific Conference, and a past member of ASAM’s Strategic Planning Task Force.

Through his involvement in an ASAM chapter, Dr. Wetterau has contributed to a number of legislative changes in New York laws, including preventing the passage of a bill supporting medical marijuana usage and achieving the passage of legislation that prevents individuals from being arrested for possession when they call 911 for a drug overdose.

He is clearly dedicated to serving ASAM, but he also relies on ASAM, too, specifically for continuing medical education.

“The Annual Medical-Scientific Conference, in particular, gives me an opportunity to learn new things that will help my patients,” Dr. Wetterau says.

Software Helps Improve Treatment Selection

The ASAM Criteria Software, based on the ASAM Patient Placement Criteria-2nd Edition Revised (PPC-2R), assists addiction counselors in assessing patients in a consistent and comprehensive manner, producing a level of care recommended by the PPC that until now only existed on paper, says David Gastfriend, M.D., a Newton, Mass., addiction psychiatrist who led the software’s development.

After 15 years of research and more than $7 million in federal and international funding, the system is now ready for evaluation by commercial health information technology companies in U.S. treatment programs, he says. After the Harvard Business School conducted a yearlong study that determined the software was commercially viable and defined a strategy for adoption, ASAM now has a business plan to guide creation of system licenses.

The first software firm to implement the system is Sigmund Software, LLC, Brewster, N. Y., (booth No. 93) and the first U.S. treatment program to commit to evaluating the ASAM Criteria Software is Addiction Recovery Resources Inc., New Orleans. Dr. Gastfriend is discussing the ASAM Criteria Software with other programs, including the Caron Foundation, a multi-state treatment system based in Wernerville, Pa.

He has also been negotiating with the federal Substance Abuse and Mental Health Services Administration (SAMSHA) for six months, “to incorporate the ASAM Criteria Software into the SAMHSA Open Behavioral Health Information Technology Architecture (OBHITA). This has far-reaching implications, and we are excited about its prospects,” Dr. Gastfriend says. “ASAM is being asked to provide the question items and screen sequence for single-patient evaluations, which would be offered nationally, free-of-charge, to end-user systems,” including states and treatment programs.

This is the only ASAM-endorsed software for patient placement, he says. Whether the decision is to prescribe outpatient counseling, detoxification, rehabilitation, or other interventions, each course of action requires a different level of services, intensity or restrictiveness, he says. The PPC-2R involves 380 textbook pages, “full of intricate rules,” that comprehensively consider how to manage, for example, a patient with high blood pressure worsened by withdrawal, plus depression, plus poor motivation, in an abusive marriage, Dr. Gastfriend says.

The software presents a computer-guided interview to help the counselor assess the patient, with a computer algorithm covering 150 pages of Excel spreadsheets—in eight-point font. In a clinically logical order, the software assists the interviewer to ask a particular sequence of questions that are individualized for the patient and can probe more deeply as needed based on the patient’s answers, he says.

Following three years of testing in Norway, with funding by the Norwegian government, the PPC-2R software will next be tested in the U.S. by Addiction Recovery Resources Inc., says A. Kenison Roy III, M.D., FASAM, the facility’s founder and Medical Director.

That program will be a beta-testing site, providing a trial of the ASAM Criteria Software before it goes into commercial use.

The testing will help establish the value of the software in helping the provider tailor the selected treatment to the condition of the particular patient, Dr. Roy says, with all concerned being comfortable with that selection and not selecting a treatment “just because that treatment needs patients.”

ASAM is on the cutting edge in developing measurable criteria for services and levels of structure for treatment of addiction—the first to develop these kinds of guidelines for mental health or brain-related health conditions, he says. This will provide criteria for the appropriate level of treatment, especially for the benefit of communication with insurance companies.

The ASAM PPC-2R software will define the various parts of the spectrum of services for addiction, the types of treatment, whether ambulatory or residential, for example. This will help select the type of treatments that are needed and define the types of treatment that are available, Dr. Roy says.

ASAM Helps State Chapters by Hosting Web Pages

State chapters may rely on a new resource to inform and educate their members—a web page for state chapters hosted by ASAM. Thanks to the redesign of the ASAM website, these state chapter web pages offer the opportunity to deliver helpful chapter and member information, from event listings to news of hot topics and trends related to their states and the practice of addiction medicine.

ASAM provides training and technical support in guiding chapter presidents and administrators through the process of building web pages. The process is simple, and Hiranthie Stanford, ASAM Manager of Membership and Chapter Relations, can walk chapter administrators or presidents through the process in a short amount of time.

The South Carolina chapter became of one of the first ASAM chapters to take advantage of this service to develop a web page.

“Our chapter is small, and we’ve struggled with putting together an entire website over the last few years,” says Roy E. Smith, M.D., the ASAM South Carolina Chapter President. “Unfortunately, we don’t have the financial resources to hire a professional to design and maintain a website, so when this resource became available through ASAM, it really helped us.”

Dr. Smith says the web page is a valuable new resource for his state’s members, providing them with access to meeting dates, reports, and links to continuing medical education opportunities.

Hiranthie says some chapters are large enough and have the financial resources to host their own websites. But even in those cases, or in the case of a chapter that is small and just getting started, this resource can help with simple tasks, including downloading member lists.

The Massachusetts Society of Addiction Medicine (MASAM) currently hosts its own website, but the chapter has used ASAM’s resources to download member lists and may eventually switch to ASAM’s individual web page in the future, says Lynda Layer, MASAM Administrator.

“It is something we will probably consider in the future because right now, MASAM utilizes a Yahoo website and it might like the connection to the ASAM website,” Layer says.

Anticipating more chapters will take advantage of this ASAM resource, Hiranthie will provide administrators with 30 minutes of training by phone to get started and will be available to answer questions beyond that initial tutorial. Because of his busy schedule, Dr. Smith did not receive training through the initial session, preferring instead to navigate his way on his own after business hours. Yet, he says the support from Hiranthie has been extremely helpful.

“Right now, I am working on learning to post photos, and it is something I enjoy doing after hours,” Dr. Smith says. “But Hiranthie has been great about answering my questions and teaching me what I need to know to move forward.”

Hiranthie says it is easy for chapters to get started; simply contact her at hstanford@asam.org to schedule an initial training session. She also encourages all members to log on to the new ASAM website. The redesigned website allows members to select what specific information they wish to display to the public, to members only, and to keep private.

e-Live Learning Center Features Leading Addiction Medicine Content

The ASAM e-Live Learning Center was introduced last year and continues to accommodate the busy lives of members by giving another opportunity for earning continuing medical education (CME) credit and obtaining valuable addiction medicine information.

“The e-Live Learning Center is notable because it offers more than 100 recorded sessions including content from the 2011 Med-Sci Conference, 2011 State of the Art Conference, 2011 Ruth Fox Course, and 2011 Pain and Addiction Course, as well as offerings on SBIRT and Opioid Dependence Practice Management,” says Arlene C. Deverman, ASAM Senior Director, Professional Development. “That content is captured digitally, and presented as a slide deck synced with the audio from the presentations at the conference.”

All registrants of the ASAM 43rd Annual Medical-Scientific Conference will be given free access to material from the conference by the end of May, when it will also become available for purchase to those that were unable to attend the conference.

“Courses are offered 24 hours a day, seven days a week in order to provide members the opportunity to learn on their own schedules and at whatever location suits them best,” Deverman says. “Conference attendees may obtain more information during the Med-Sci Conference on how to access and use the e-Live Learning Center, as well as how to claim CME. Simply visit the MultiView Demo Desk by the registration area or discuss the e-Live Learning Center with ASAM staff members at the ASAM exhibit booth (No. 9).

To access the e-Live Learning Center and claim CME certificates from Med-Sci, visit the ASAM website, click the “Education” tab, and select, “e-Live Learning Center.”

ASAM Confers Fellow Status for Demonstrated Achievement

Earning the designation of an ASAM Fellow demonstrates notable accomplishment. An honor granted only every other year, the FASAM title is bestowed on those ASAM members who have provided significant contributions in three different areas related to addiction medicine, says Paul H. Earley, M.D., FASAM, of Earley Consultancy, Atlanta.

“Fellows of the Society have worked for years, sometimes decades, for ASAM and its pursuits,” he says.

Dr. Earley says the criteria to become a Fellow includes being a member for at least five consecutive years, giving significant service to ASAM, and making considerable contributions in specific areas. Those areas include serving:

  • On the ASAM Board of Directors
  • As a chair or member of an ASAM committee, task force, or work group
  • As an ASAM delegate or alternate to the American Medical Association (AMA)
  • As an officer of a state society or chapter of ASAM
  • Through other noteworthy contributions

“It is important to show you have made a contribution to academic medicine or training, either by publishing papers or speaking to groups to train other physicians about addictive illnesses,” Dr. Earley says.

Participation in other medical and professional organizations can include service as an officer, committee member, or representative in medical societies or organizations such as the AMA, the American Osteopathic Association, and the American Psychiatric Association, as well as state and local medical societies.

Giving back to the surrounding community is also an important aspect for qualifying as a Fellow, Dr. Earley says.

“Candidates must show they are contributing to their communities, maybe through a nonprofit board that has to do with addiction services, supervising a free clinic, or working in a church or a local ministry—anything that shows you are giving back and promoting addiction awareness education or health,” he says. “A Fellow has to meet all of these areas over years or decades to be given the FASAM title.”

Dr. Earley says the awarding of Fellowships is important for ASAM.

“It is a great way for us to recognize members who have really given of themselves, sometimes tirelessly, to the care of patients who suffer from addictive diseases to the addiction research or treatment community and to ASAM itself,” he says. “ASAM Fellows are individuals who give their time to help others understand addiction is an illness that needs to be addressed with science and compassion.”

Opioid Practice Management Comes to e-Live Learning

Two ASAM members are bringing their expertise in the billing and coding functions of opioid practice management to ASAM’s e-Live Learning Center. The session, “Opioid Dependence Practice Management,” will cover both an overview of opioid dependence and tips for health insurance reimbursement through proper billing and coding.

The session was developed by John Femino, M.D., FASAM, MRO, Medical Director and President, Meadows Edge Recovery Center in North Kingstown, RI, ASAM Northeast Regional Director, and Immediate Past President of the Rhode Island Society of Addiction Medicine, and Stuart Gitlow, M.D., M.P.H., M.B.A., Executive Director, Annenberg Physician Training Program in Addictive Disease, Associate Clinical Professor, Mount Sinai School of Medicine in New York, ASAM Acting President and ASAM Delegate to AMA.

ASAM’s e-Live Learning Center provides members with an easy method of earning CME credits, whether it’s from the office or home, and now features an array of educational sessions. This newest session is timely because many physicians delegate the financial aspects of practice management to non-physician staff and may be missing opportunities for reimbursement. Both Dr. Femino and Dr. Gitlow concur that with a better understanding of opioid dependence and treatment within a practice, improved billing and coding will follow.

“The first half of this session begins by exploring the larger issue of defining opioid dependence and how it differs from opioid use,” Dr. Gitlow says. “Not all patients who use opioids have opioid dependence and not all patients with opioid dependence use opioids.”

Effective opioid practice management begins with thorough patient screenings and reliance on what literature has demonstrated as being a successful intervention for a substance use disorder, he notes. Addiction specialists must differentiate between patients who use opioids illicitly, but without related dysfunction, from patients who have a physiologic dependence to prescribed opioids. Likewise, he says it is important to screen for patients who have an addictive disease, but have never been exposed opioids, and those individuals who are in recovery and abstain from illicit opioid use.

Additionally, interventions often covered by health insurance providers include routine visits with an addiction specialist physician, routine urine drug screens, ongoing participation in AA/NA or comparable 12-step programming, potential use of buprenorphine-naloxone, a full medical workup (including a psychiatric workup after an appropriate period of abstinence), and increased intensity of treatment if symptoms worsen.

The second-half of this new e-Live Learning Center session focuses on the practical aspects of coding, billing, and using office-based treatments for addiction and medications related to addiction. This particular series focuses on the use of buprenorphine. Both medical and behavioral health providers must understand the scope of their practices and insurance benefits by provider type, Dr. Femino says.

“If you are a medical provider, you might not be accessing the behavioral side of the health insurance benefit,” he says. “Conversely, as a behavioral health provider, you may have reciprocal exclusions.”

The learning objective for this session is for physicians to understand how insurance providers process medical and behavioral health claims, Dr. Femino says. It’s only when physicians and counselors understand the system that they can take a “whole treatment” approach.

“What this session does is prepare providers to be proactive rather than reactive,” he says. “This better understanding not only helps in reimbursement, it also reduces claim denials for the patient and the resulting frustration and anger that go along.”

To access the ASAM’s e-Live Learning Center, visit www.asam.org and select the “Education” tab.

PIPMAG Designs Evidence-Based Future of Addiction Medicine

To improve continuously, a specialty must set a baseline from which to measure any advances. The Practice Improvement and Performance Measurement Action Group (PIPMAG) is working to establish that starting point for addiction medicine practice. Learn the latest progress with this endeavor by attending Component Session 7, “Performance Measures and Addiction Medicine” from 8 to 10 a.m., Sunday, in Grand Salon East, Salon B.

Speakers will include PIPMAG Chair Michael M. Miller, M.D., FASAM, FAPA, Associate Clinical Professor, the University of Wisconsin-Madison, and Assistant Clinical Professor, the Department of Psychiatry and Behavioral Medicine, the Medical College of Wisconsin, Milwaukee; Mady Chalk, Ph.D., Director, Center for Policy Research and Analysis, the Treatment Research Institute, Washington, D.C.; and Diane Stollenwerk, M.P.P., Vice President, Community Alliances, National Quality Forum, Washington, D.C.

PIPMAG used its 2011 start-up meeting to wrap its collective arms around defining its exact scope of work, and from there outlining how to secure funding for the group to embrace its charge, Dr. Miller says.

“Our challenge is to describe areas of practice in which physicians offering care for addiction patients can be measured to affirm they are engaging in providing quality care and incorporating appropriate, evidence-based aspects of quality into their practices,” he says. “The challenge we face is that there is not a range of practice guidelines for addiction medicine care from which we can draw. Usually, performance measures are developed using a process that designs a metric or algorithm that will measure if physicians do what established guidelines say they should do. We don’t have those yet, and we may decide that we need to create them.”

PIPMAG’s role is an imperative for ASAM and the specialty itself because all of medicine is moving in the direction of defining best practices, Dr. Miller says.

“To show our patients, the medical establishment, and the government that we are generating the best results, we must collect data on our performance to make sure our physicians are improving,” he says. “We need to measure at a baseline to know that we are moving the needle and offering better care. All of medicine is moving this way—from Maintenance of Certification programs of medical specialty boards, such as ABAM, to state licensure boards.”

Dr. Miller says that the action group will perform a literature review of what guidelines and measures already exist. The measures for Substance Use Disorders treatment and for screening developed by the AMA Physician Consortium on Performance Improvement are known examples. The action group will then outline the specific practice activities where performance measures are needed. In developing these measures, extensive literature reviews will be required, a laborious and time-intensive task.

“ASAM developed three practice guidelines in the mid-1990s, but those focused specifically on managing withdrawal symptoms and detoxification, rather than management of addiction,” he says. “At this point we are trying to delineate specific aspects of addiction medicine practice for which baseline performance can be measured via performance measures.”

Dr. Miller says PIPMAG is also looking at the interface between specialty practice and the clinical work of primary care physicians who will need to carry the bulk of responsibility for meeting the needs of this patient population.

“You can never have enough specialists to treat every patient, so transitions of care (clinical ‘handoffs’) between specialists and generalists is important to most people who evaluate medical quality,” he says. “Health care reform will bring a lot of people into the system who haven’t had coverage and who haven’t been able to self-pay. Up to 40 million people will have some mechanism of coverage under the Affordable Care Act. The people who modeled care under that plan are counting on meeting the need through federally qualified health centers staffed by primary care doctors working with specialty care practitioners, as well as through other Patient Centered Medical Home frameworks.