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March 24, 2019

...after Joining

FAQs applicable to active Georgia PHP Participants.

Well-designed research studies show that frequent random witnessed urine drug screens when combined with proper psychotherapy and support group attendance produce an excellent prognosis for recovery in healthcare professionals. Checking in regarding a random urine drug screen is like a daily reminder of your illness. For reasons that we do not understand, individuals with a substance abuse disorder seem to forget that they have a lifelong disease.

The urine screens as well as twelve-step meeting attendance comprise a system that is called “contingency contracting.” By having frequent low grade interventions into your illness through contact with us and the screening process, the probability of long-term recovery is greatly enhanced.

If an individual stops screening or has a single positive urine drug screen, it may mean that the individual is early in the process of relapse. The PHP responds to these events with graded, careful interventions that help get you back onto the road towards recovery.

We understand that this monitoring process may seem at times to be a lot of work. We tend to look at it as a relatively small amount of work when compared with the daily maintenance associated with other chronic diseases such as diabetes mellitus.

Participation with the PHP is confidential but there may be other parties to which you must report your participation because of contractual obligations you’ve assumed.  Check your contracts to see if you have agreed to notify any entity with regards to changes in your practice (e.g. diagnosis/treatment for addiction or mental/physical impairment).  Your hospital bylaws, malpractice insurance policy, and/or health insurance payor contracts may all have notice provisions requiring you to report your participation with the PHP.

Thanks to John Miller, principal and head of Medical Services Practice, Sterling Risk Advisors for this FAQ

Tell them that you are participating in the PHP.  The PHP will confirm your participation but will need your written permission to provide additional information.  The insurer will typically want to know about your treatment plan, dates and location of all treatment/evaluation as well as the name of your supervising and/or monitoring physician(s) and usually requests that they be kept up-to-date with your progress while participating with the PHP.

This FAQ is not legal advice and should not be construed as such. When in doubt, you should consult an attorney. Thanks to John Miller, principal and head of Medical Services Practice, Sterling Risk Advisors for this FAQ.

Affinity is a third-party organization that the Georgia PHP uses to help track drug screen monitoring and behavioral compliance with recovery. Affinity offers an organized and easy to use system that allows our participants to determine if they need to provide a urine screen. Affinity offers more than just that however. If you need help finding a drug screen drop site they have web-based as well as old-fashioned phone support.

We also collect our participant fees through the affinity system. This allows you one portal to cover both the participant fee and the cost of urine drug screens. Finally, we ask all of our participants to track their 12 step and other support group meeting attendance using this simple online tool.

Sometimes we are asked why we have to collect so much information about you. The answer is simple. Compliance with twelve-step meeting attendance as well as negative urine screens help to produce the best possible long-term outcome from the chronic disease of addiction. In this way, the affinity tool is part of your therapy for recovery.

The Georgia Professionals Health Program, unlike most professionals health programs across the United States, relies solely upon participant fees for its work. This means that the monitoring fee for physicians is currently $400 per month. If we obtain grant or other benevolent funding in the future, we hope to decrease this fee. Physician assistants and respiratory therapists pay somewhat less.

Your monitoring fee goes to pay the overhead, computer hardware, office rent, and salaries of its employees. The PHP maintains a database of your drug screens, self-help group and therapy attendance. Tracking these variables has been shown to increase the rate of recovery for healthcare professionals who suffer from addictive disorders.

The staff of the professionals health program will meet with you from time to time to discuss your progress in recovery. We manage a network of providers who have proven expertise in the treatment of addiction among healthcare professionals. We run group therapies and caduceus groups that extend the network of support across the entire state.

Importantly, part of every participant’s fees goes to expanding the care for addicted healthcare providers. At present, we are engaged in discussions with many large hospital systems across the state of Georgia, removing stigma and assisting hospital systems in credentialing and maintaining our participants within the healthcare network.

Everyone misses a check-in from time to time, nobody's perfect. The staff of the Georgia PHP follow trends not a single event. If you continue to miss check-ins or even testing, we begin to worry about your abstinence. We suggest you make a note of why you missed a call in or internet check-in. Use this information to look at your recovery. Is it still solid? Are you ambivalent or angry? Discuss this with your sponsor as well.

If your check-ins are concerning to us, we will contact you and may require you to come in to meet with us to see if anything else should be done. Then make sure you check in tomorrow!

Traditionally, questions are posed as follows on these sorts of documents:

      • Have you ever been evaluated for, recommended for treatment of, diagnosed with, or treated for alcohol, narcotics, or any other substance abuse, sexual addiction, anger management issues, or any mental illness, including but not limited to depression and/or depression and/or chronic fatigue?

     Answer: Typically the response to the above question will be “yes” for someone who has participated with the PHP relative to any of the above items. Be prepared to provide requested details as to your status with the PHP.

     • Have you ever been indicted or, charged with, or convicted of, any act committed in violation of any law or ordinance other that traffic offenses or had your hospital privileges, DEA license, medical license or reimbursement privileges refused, denied, revoked, suspended, restricted, subject to a reprimand, placed on probation or voluntarily surrendered?

     Answer: You are encouraged to consult with your attorney in responding to questions of this nature. But, it is likely that the answer is “no” for PHP participants voluntarily entering the PHP and for whom regulatory or privileging bodies have not taken any action against.

     • Have you ever been or are you currently under a consent order?

     Answer: Participation in the PHP does not mean that you’ve had a consent order. Unless the Georgia Composite Medical Board issued a specific consent order against your license the answer to this question is “no”.

Most Georgia malpractice insurance policies have a “catch all” notice provision that makes it a duty of the insured physician to notify the insurer of any changes in their practice. You need to review your individual insurance policy to see if such a provision exists. According to John Miller at Sterling Risk Advisors, who represents the majority of the malpractice carriers in Georgia, “It is always best to partner with your malpractice insurer to disclose any changes that may affect patient care. It is preferable to proactively volunteer such information as underwriters see this disclosure as a positive step in your road to recovery.

Thanks to John Miller, principal and head of Medical Services Practice, Sterling Risk Advisors for this FAQ. This FAQ is not legal advice and should not be construed as such. When in doubt, you should consult an attorney.

For fairly obvious reasons, it’s a bad idea to use your own laboratory to collect or assess your urine drug screens. There is a particular skill in ensuring the “chain of custody” and proper handling of specimens for healthcare professionals. In addition, the urine screens themselves are different. Just as you shouldn’t provide medical care for your family or yourself, you should not use your own laboratory for independent screening.

The Georgia PHP believes that all who work with healthcare professionals should coordinate and work with the Georgia PHP to ensure the best possible outcome for your addiction disorder. Therefore, we encourage you to select providers who have a known expertise in the management of substance abuse among healthcare professionals. If you’re seeing a provider outside of our network, please consult with us to determine the best course of action.

Most of the time, your provider may be encouraged to join our network and assign proper releases so that we can work as an efficient team in your health and recovery.

When many substance abusing workers return to their practice, their first weeks and months often feel shaky and uncertain. In addition, some of us may have fallen behind in our skills or knowledge base during the course of our addictive disease. A few of us might have had difficulties with interpersonal boundaries, overprescribing, or setting limits in our relationships with our patients.

When this occurs, the Georgia PHP will have you set up a practice or worksite monitor. This individual should know the scope and the knowledge base of your practice. They cannot work for you (i.e., be your employee). Often a partner in the practice or individual at the hospital with your same specialty area is a good choice.

We will help you pick out a proper worksite monitor. You will be required to sign a release of information. This individual will need to write letters that describe your ongoing growth in the areas of concern in your practice. The frequency of these letters will be determined by need. The length of time that this information is needed from a worksite monitor varies from participant to participant.

We do not respond to requests regarding your medical condition or recovery status to any health, disability or life insurance carriers. We are not your treating physicians and thus have no authority to do so. If one of these agencies contacts us, we will deny that we know you for your own protection. Please take such forms to your attending physician.
Note that we do provide information to your malpractice carrier if you request us to do so. Similarly, we will provide information to health insurance carriers regarding your monitoring status if they require this information for you to maintain your provider status in a HMO or other payer network.

Every participant in the Georgia PHP will need to have an ongoing doctor/patient relationship with a physician who is an addiction specialist. If you attended treatment in a nearby treatment center, you may choose (but you are not obligated) to continue seeing the physician from your initial treatment setting.

Why do we have this requirement? The Georgia PHP believes that addiction is a chronic illness and needs chronic disease management. This does not mean that you have to see this individual weekly; however, they need to know you well enough to step in should problems arise in your recovery. If, for example, you have to undergo a surgical procedure and need addictive substances postoperatively, your addiction physician will be available to help you navigate the dangerous waters that occur when a recovering person is administered addictive medications.

Because addiction does not occur in a vacuum, your addiction specialist physician will also help with any needed psychiatric medications. They are also a resource to your primary care physician, helping them work around medications for medical conditions that have the potential to reignite your addictive disorder.

It could.  But, depending on your individual profile, the insurers typically will continue coverage until such time as you are released from the PHP at which point they evaluate your risk relative to practice re-entry.  If your policy is canceled by your insurer, there are plenty of options available from insurers who specialize in non-standard physician liability insurance.  According to John Miller at Sterling Risk Advisors, “There is a vibrant marketplace in Georgia of insurers willing to assume the risk of physicians in transition.  It is rare that a physician in our state does not have a viable option to continue coverage during or post-PHP participation.”

This FAQ is not legal advice and should not be construed as such. When in doubt, you should consult an attorney.