CURES 2.0: Part 2

by Bruce Silver, MD

Since the last article about CURES 2.0, numerous questions have arisen, particularly as to what is a “facility.” Therefore, I will try to answer that question first.

The CURES 2.0 Program in California is mandatory beginning October 2, 2018.  The following are some of the regulations and policies that must be followed.  

Exceptions in Situations:  There are numerous exceptions to these rules including patients within the facility and certain exceptions for emergency room physicians.  A facility is defined per California regulations and appears to include most hospitals and nursing homes. A recent conference with the California Board noted that as far as nursing homes go, that while most of these may qualify as facilities, one needs to check the specifics of the nursing home.  Please check with the California Board to ascertain if the facility in which you are working is exempted.

Innovations in Care Transitions and Dementia Care

by Heather D’Adamo, MD

CALTCM continues to partner with you and your team to bring up-to-date strategies for addressing common and challenging problems in Post-Acute and Long-Term Care.

This year, we are pleased to collaborate with the Northern CA Gerontological Advanced Practice Nurses Association (NorCal GAPNA) to bring you a series of “best practices” that are designed to help you achieve better survey readiness by improving the quality of dementia care of older adults in your nursing home as well as strategizing patient-centered discharge planning and readmission reduction.

Reducing Unnecessary Hospitalizations of NH Residents

by Timothy Gieseke, MD, CMD

One of the blessings of being a Senior Clinician and long standing Medical Director of SNFs has been the luxury of having more time for exploring resources that may improve care in my facilities while spending less time on the direct patient care.  As a member of AMDA, The Society for Post-Acute and Long Term Care, I look forward to the free monthly webinars (  In August, the webinar was a very practical one on the Utilization of Civil Monetary Penalties to improve the quality of life of residents in LTC facilities.  In California, we have experienced the use of these funds through the Partnership to Improve Dementia Care in California and the Music and Memory Implementation program (attend CALTCM Fall CME program for the latest on this innovation).


by Bruce Silver, MD

The CURES 2.0 Program in California is mandatory beginning October 2, 2018.  The following are some of the regulations and policies that must be followed.

CURES stands for Controlled Substance Utilization Review and Evaluation System

        Controlled Substance

CURES is the prescription drug monitoring program for the State of California. CURES database contains information about schedule II, III, and IV controlled substance prescription dispensed to patients as reported by those dispensers.

CURES data reflects dispensing information as it is reported to the Department of Justice.  The reporting dispenser creates and owns the prescription records submitted. The Department of Justice does not hold the prescription.

Is Good Geriatric Care Affordable?

by Timothy Gieseke, MD                                                                         

As an internist trained in the ’70s, the common mantra was “the patient’s interests always come first.” This was far easier to provide at that time with no limits on work hours, very limited personal educational and start-up debt, and a low-overhead, fee-for-service system.  As I became more involved in the post-acute and long-term care sector in the ’80s & ’90s, my knowledge and expertise expanded through educational offerings of CAMD (California Medical Directors Association, the precursor to CALTCM), AMDA, and AGS. I found great fulfillment in applying this developing expertise on behalf of my patients and facilities.  However, I also found my work efficiency (# of patients seen each day) progressively declined while office overhead rapidly increased. Because of the latter, I gave up my office practice in 2005 to focus full -time on post-acute and SNF care. However, I have been able to continue servicing a geriatric clinic at my CCRC in large part due to a generous contract from this facility for my group’s provider services.   Here, my usual patient is > 85 y/o and medically complex and routine appointments are 25 min. to allow for team-based care and teaching. In this setting, I commonly bill higher-level codes for my services and have the documentation to support those codes built into my EMR notes. In fact, Blue Cross recently sent me a letter informing I was billing higher-level office based codes then most of my IM colleagues, which did not surprise me.

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