Bold Steps to End the Opioid Epidemic – The Physician Contribution to the Solution

Posted in Drug Abuse, opioids on May 21st, 2015 by MMS – 3 Comments

Dr. Dennis Dimitri By Dennis M. Dimitri, MD
President, Massachusetts Medical Society

An epidemic of opioid use and the associated overdose deaths has been slowly building across the nation and Massachusetts for the last decade, and has now reached a crisis point. It is affecting nearly every city and town in the Commonwealth. In some communities, the crisis is unprecedented.

State officials estimate that more than 1,000 Massachusetts residents died of opioid overdoses last year – 33% percent more than in 2012, and nearly three times more than in 2000.

A Harvard School of Public Health survey found that nearly 4 in 10 state residents personally know someone who has abused prescription pain medications.

While the total numbers may be startling, we should also remember that each individual overdose death has a human face. Each tragedy has changed a family forever. It has to stop, and the time for action is now.

Physicians must step forward immediately to do everything we can to help bring this devastating problem under control. How can we do this? It starts with education.

According to the Centers for Disease Control and Prevention, more than 80% of people who misuse prescription pain medications are using drugs prescribed to someone else. These drugs are most often obtained from a friend or relative – for free, purchased, or stolen.

This tells me that there are too many doses of opioid medications in circulation. By limiting this supply and ensuring that opioids are available only to patients who truly need them, we can make a big impact on the Commonwealth’s opioid crisis.

That is why the Massachusetts Medical Society is launching a comprehensive campaign to educate prescribers and the public about the safe and responsible prescribing and handling of these medications.

The campaign has three components:

  • Guidelines to help physicians make the right decisions for their patients
  • Free education resources for prescribers to help inform their judgments
  • Storage and disposal information for patients and their families

Prescribing Guidelines

We have reviewed guidelines already developed by many states and medical specialty societies on this topic. There has been a lot of good work done in the area already – it is, after all, a national epidemic. We are recommending this set of guidelines for use by all physicians.

They are not designed to micromanage care, but to provide guidance and information based on evidence that will improve the care of our patients and lessen the risks associated with opioid prescribing. At the same time we recognize that each patient is different, and in all cases, a prescriber’s sound clinical judgment is important. However, we also believe that several principles should govern the exercise of this clinical judgment.

First, the guidelines emphasize that physicians and patients should discuss family and personal histories of substance abuse disorders and behavioral health concerns, before the prescription is written.

Second, patients and physicians are encouraged to mutually develop agreements that outline the expectations and goals of the treatment, along with the conditions for continuing opioid therapy for chronic pain after initial treatment.

Third, there are exceptions for hospitalized patients, those in hospice and palliative care, and for those being treated for cancer. These patients have special circumstances that do not yield readily to hard and fast rules. Their care must be based upon the long held medical principles of relief of suffering.

We’re offering these guidelines with the hope that they will be adopted by physician practices throughout the state. We are also sharing them with the state Board of Registration in Medicine, in the event that the Board will consider incorporating them into its prescribing guidelines for physicians.

You can see the details of our recommendations here.

Prescriber Education

The Massachusetts Medical Society has long been a leader in providing continuing medical education to physicians and other clinicians about pain management. Today, we are announcing that we are making these pain management courses available to all prescribers – for free, until further notice. This includes not only our current suite of courses, but those currently in the pipeline that are due to be released in the coming weeks and months.

The urgent interests of the community are paramount, and we will remove as many barriers to this prescriber education information as possible.

Public Education

An effective first step to reduce non-medical opioid use is through education. Therefore, in an effort to curb the supply of prescription opioids in the community, we are partnering with the Partnership for Drug Free Kids and its Medicine Abuse Project to broadly disseminate information about the safe storage and proper disposal of opioid medications.

Most people are probably unaware that their medicine cabinets are attractive targets for those who would misuse opioids, and that they could be an unwitting supplier. Our education program will provide guidance on how to safely store and secure medications, and how to get rid of them when they are no longer needed.

In early June, our website will host all of these materials. We will make these materials available to anyone, including physicians, who wish to put them in their offices or share them electronically.

There is no more important public health issue today than the opioid epidemic. It is devastating communities, families, men, women, rich and poor, and most tragically, children and adolescents. It has to stop – and we are ready to do our part.

Medical Injury Alternative to Malpractice Litigation Continues to Expand Across Mass.

Posted in Malpractice, medical liability reform, patient safety on May 19th, 2015 by Erica Noonan – Be the first to comment

Thcommunicatione Massachusetts Alliance for Communication and Resolution following Medical Injury, or MACRMI, continues to increase the numbers of patient cases and sites across Massachusetts and the nation. where health care providers and patients can cooperatively resolve medical injury situations.

MACRMI, formed in 2012, is an alliance of Massachusetts patient advocacy groups, teaching hospitals and their insurers, and health care providers.  It mission is prompt recognition of – and response to – medical injury, along with appropriate compensation to the patient or family, with the goals of improving patient safety and reducing medical costs.

MACRMI, through its Communication, Apology, and Resolution, or CARe program, has so far handled more than 850 patient cases at eight sites around the state, said co-founder Alan Woodward, MD., MMS Past President and Chair of the MMS Committee on Professional Liability.  More than 75 percent of those CARe cases were resolved by the program and not referred to an insurer.

More than 150 health care leaders, physicians and insurers gathered at the organization’s third annual forum this week at Massachusetts Medical Society headquarters.  Much progress has been made in offering an alternative to the “deny and defend” culture that typically surrounds malpractice cases, said Melinda Van Niel, Health Care Quality Manager at Beth Israel Deaconess Medical Center.

Several more medical providers are preparing to formally enter the program in the coming year, she said.

CARe focuses on communication between patient and doctor after an incident of medical harm. The program also investigates the issue thoroughly and determines if something can be done to prevent the error from happening again in the future.

Over the past year, MACRMI has updated and clarified its guidelines, worked with the National Patient Safety Foundation, and  have produced educational programs  to help guide providers, attorneys and patients through the CARe program.

Leaders said the organization hopes to expand awareness in Massachusetts and broaden its reach on a national level within the next few years.

“CARe is the first step in changing the culture of our institutions,” said Allen Kachalia, MD, Associate Chief Quality Officer, Brigham and Women’s Hospital. Read more about MACRMI here.

– Katherine Schauer

 

Website Service Restored

Posted in website on May 18th, 2015 by MMS – Be the first to comment

UPDATE: 7:16 A.M.

The maintenance work has been completed, and all services are back on line. Thank you for your understanding.

Questions? Contact us at webmaster@mms.org.

From 5:30 a.m. to approximately 7:30 a.m. on Tuesday, May 19, most online transactions on the MMS website will be disabled in order to complete a site upgrade.

During that time period, the following functions will unavailable:

  • Register online for MMS events
  • Take online CME exams
  • Download CME certificates
  • Track CME credits
  • View online events calendar
  • Pay dues online
  • View leadership voucher balance
  • Change contact information online
  • Read members-only content

We expect that all other content on the MMS site will be available on that date.

Also not affected: The massmed.org member email service, or access to the New England Journal of Medicine or Journal Watch websites.

Please plan your website activity accordingly!

 

The President’s Podium: “Physicians Really Are Different”

Posted in Annual Meeting 2015, Leadership, workforce on May 8th, 2015 by MMS Communications – Be the first to comment

Dr. Dennis Dimitri 300 ppiBy Dennis Dimitri, M.D., President, Massachusetts Medical Society

Editor’s Note: On Friday, May 1, 2015, Dennis Dimitri, M.D. was installed as the 133rd president of the Massachusetts Medical Society. His inauguration address, while reflecting on personal experiences and acknowledging the help and support of those closest to him, also carried an important message for physicians, as they practice in a dramatically changing and increasingly burdensome health care system. Here are excerpts of his inauguration speech.

“There is really no other career that for most of us could have brought so much personal reward while doing so much professional good.

“We’re very privileged in the sense that our patients come to us, sharing openly all of their own difficult circumstances, be they medical, personal, social, or economic issues that created their difficulties. They look to us to help them overcome these problems, yet over and over lately, we hear about physician burnout and the loss the joy in practice.

“Yes, it can be stressful and overwhelming to be faced by our professional demands at times. Often, the healthcare delivery system seems to add more roadblocks rather than make it easier for us.

“Yet we must not lose sight of the privilege we are afforded in return for our willingness and our professional mandate to put our patients’ interests before ours. Many of us often decry the loss of some types of physician autonomy, as well as the sense of the loss of respect for the profession, yet, over and over, polls of the public indicate that they want a physician to be the provider of their health care, and that medicine remains at the top of the list of respected professions.

“So, yes, we now practice more and more often as part of a team or in an integrated system, but the unique role of physician leadership of that team and physician impact on those systems remains fundamental to our patients’ well-being.

“And as to that loss of joy in practice…. Well, recent studies of physicians indicate, not surprisingly, that what gives us the greatest satisfaction is providing good care to our patients.

“When we feel burned out by dealing with our EMR’s, the prior authorization forms, and the delays in payments from insurers … when we have to stop to check the prescription monitoring program, or search for a course to fulfill our risk management CME’s, we should try to remember this: We helped some patients today.

“We should think for a moment about the impact we have on our patients’ lives, how much we become a part of their families, often without even realizing it.

“My point is that physicians really are different. Every day we have the potential to be involved in awesome life-and-death decision-making. We do our best to make those decisions, based not just on the whimsy of the day, but on scientific evidence, and then we take the feedback of the outcome of those decisions and use it to improve the quality of our next decision, be it for the current patient or the one we might see the next time.

“It’s what our patients expect, it’s what we like to be able to do, and it’s what we should remember on those days when the frustration mounts.

“So in this coming year, I plan to try to remember we are here to take care of patients, to improve the quality of care we deliver, to husband the resources needed to provide that quality of care, and to pay attention to … improving the work life of physicians and their staffs.

“I believe such an effort is reflected in the time-honored mission statement of the Medical Society: Maintaining the highest professional and ethical standards, while promoting medical institutions that are formed on liberal principles for the health, benefit, and welfare of the citizens of the Commonwealth. I shall endeavor to continue to make it so with the help of all of you.”

Watch Dr. Dimitri’s remarks here:

2015 Shattuck Lecture: CDC’s Dr. Tom Frieden on the Current and Future States of Public Health

Posted in Annual Meeting 2015, Drug Abuse, HIV, opioids, Public Health on May 2nd, 2015 by MMS Communications – Be the first to comment

Describing public health as the means that will “account for most of our health progress in the years to come,” Director of the U.S. Centers for Disease Control Dr. Tom Frieden spoke of the achievements and challenges in public health in delivering the 2015 Shattuck Lecture at the Massachusetts Medical Society’s annual meeting on Friday, May 1.

In a talk that was both entertaining and instructive and supported with statistical data, Dr. Frieden touched on a myriad of subjects, including antibiotic resistance, the opioid epidemic, the state of HIV care, tuberculosis, the impact of vaccines, the threats and improvements in cardiovascular care and hypertension, the continuing and new dangers of tobacco and nicotine delivery systems such as e-cigarettes, and the public health actions of a responsive government.

Among the highlights from his address:

On infection and the spread of drug-resistant bacteria: “The obsession to increase the population impact of our efforts is routinely complicated by infection, which could eventually undermine much of modern medicine. Our Antibiotic Resistance Initiative could reduce many infections over the next five years.”

On clinical care working with public health: “The intersection of clinical health care and public health is one of the essential concepts that underlie public health, and all too often they are going in different directions. There’s a lot we can learn from each other.”

On the Ebola crisis: “We learned two big lessons from the Ebola crisis. Every country needs to have a core public health capacity and the world has to move faster with outbreaks and epidemics.”

On the role of government: “The appropriate role of government is getting people to make healthy choices, with free and open information, by protecting individuals from harm caused by others, and by taking societal action to protect and promote health. These are the public health actions of a responsive government.”

On the responsibilities of individuals, providers, and government: “Until we have a collective responsibility for health-inducing environments, we will continue to have challenges.”

On the main goal of the CDC: “The goal of the CDC is a safer U.S and a safer world, to prevent avoidable catastrophes, to detect threats early, and to respond rapidly and effectively.”

Slides from Dr. Frieden’s presentation are available here.

A video of the full talk is available here:

May Physician Focus: Diabetes: Persistent Epidemic

Posted in Health, Physician Focus, Public Health on May 1st, 2015 by MMS Communications – Be the first to comment

Diabetes continues to be one of the most prevalent chronic conditions affecting Americans. Since 1980, the incidence of the disease has tripled; it now affects nearly 20 million adults 18 and older, according to the U.S. Centers for Disease Control and Prevention. And its spread is likely to continue: another 86 million Americans are living with pre-diabetes, and 90 percent of those are unaware of their condition.

The May episode of Physician Focus examines the current state of diabetes in the U.S., how and why it’s become so prevalent, and treatments for the condition. Guest is Michael Thompson, M.D., (right, photo) Ambulatory Physician Leader for the Diabetes Center of Excellence at UMass Memorial Health Care and Chief of Adult Diabetes Clinical Research at UMass Memorial Medical Center. Hosting this edition is primary care physician Bruce Karlin, M.D. (left, photo).

Among the topics of discussions are the risk factors, symptoms, and complications of the disease; how it is diagnosed; the importance of the hemoglobin A1C test; weight-loss surgery as a cure for diabetes; specific treatments for the disease; and the differences between Type 1 and Type 2 diabetes.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on YouTube.

MMS Ethics Forum Examines Pain Management

Posted in Annual Meeting 2015, opioids on April 30th, 2015 by MMS – Be the first to comment

The opioid epidemic continues to grow, here in Massachusetts as well as the nation.  In its latest tally, the state has recorded more than 1,000 opioid-related deaths in 2014, 33 percent higher than just two years earlier.

In announcing the figure on Wednesday, Governor Charlie Baker cited research showing that four out of every five heroin addicts got hooked on opioids through pain medications, many starting with legally prescribed medicine, according to a report by The Boston Globe.

While some point to the overprescribing by physicians as part of the problem, the opioid epidemic – and what can be done to reduce the abuse – has been a priority topic for physicians. The MMS’s 2015 Public Health Forum focused on the topic, and Dr. Richard Pieters’ President’s Report to MMS members delivered earlier today recounted some of the Society’s accomplishments in addressing the issue.

Today’s MMS Ethics Forum continued the Society’s emphasis on the topic. Presented by the Committee on Ethics, Grievances, and Professional Standards, the 2015 forum explored the ethical and legal consideration in pain management. Among the topics included were responsible prescribing, the complexity of pain as a clinical issue , and the ethical problems associated with undertreatment and overtreatment, and the balance between a physician’s obligations to the patient and obligations to public health.

Participants include Seven Adelman, M.D., director of Physician Health Service; Dr. Richard Pels, Director of Graduate Medical Education at Cambridge Health Associates; and Mark Eisenberg, M.D., Unit Chief of Adult Medicine at Massachusetts General Hospital-Charlestown Health care Center.

Visuals from the presentations may be viewed here.

Physicians Again Targeted by Income Tax Fraud

Posted in taxes on April 24th, 2015 by MMS – 1 Comment

form-1040For the second year in a row, physicians are reporting that they may have been victimized by an income tax scam. In some cases, fraudulent tax returns have been filed by stealing a physician’s personal information, such as his or her name, address and Social Security number. Often, it’s not discovered until the taxpayer tries to electronically file a return, and is told it was already filed.

If you believe you’ve been the victim of a fraudulent tax filing, visit the IRS’ Taxpayer Guide to Identity Theft. It provides an overview of warning signs, along with steps to take if you believe you’re a victim.

We also urge physicians to contact the MMS, so we can monitor the problem and convey the scope to the proper authorities. Contact Charles T. Alagero, MMS General Counsel, at calagero@mms.org.

Caution

One of the most common methods that hackers have used to steal Social Security information is to send emails posing as the Social Security Administration, asking you to verify your personal information.

The IRS states, “The IRS does not initiate contact with taxpayers by email to request personal or financial information. This includes any type of electronic communication, such as text messages and social media channels.”

Kiss the SGR Goodbye: Senate Repeals Medicare Payment Formula

Posted in Medicare on April 14th, 2015 by MMS – 1 Comment

US Capitol 1In an historic vote Tuesday night, the U.S. Senate finally repealed the flawed Medicare payment formula that has been plaguing physicians for more than 17 years. The final vote was 92-8. Senators Markey and Warren voted in favor.

To get there, the Senate spent more than two hours trudging through votes on six different amendments from both Republicans and Democrats. Only one vote was close – it would have removed caps on therapy services. If any single amendment had passed, the bill would have returned to the House, whose leaders had already said they would not agree to any more amendments.

The vote came just hours before Medicare would have been forced to cut payments by 21% for all services provided after March 31. But that’s not going to happen – President Obama will sign the bill.

The legislation guarantees physicians a 0.5% rate increase every year through 2019, when a series of quality incentive payments become available. The first 0.5% increase takes effect July 1, 2015, followed by another 0.5% increase on Jan. 1, 2016.

Medicare Initiates Plans to Pay Claims With 21% Cut

Posted in Medicare on April 14th, 2015 by MMS – 1 Comment

Photo by frankleleon, via flickrUPDATE: 10:30 a.m., 4/16/15

The Senate repealed the SGR on the evening of April 14.  However, because the bill has not yet been signed, a small number of claims are being processed at the reduced rate, on a rolling basis.

When the bill is signed, Medicare’s contractors will automatically reprocess those claims at the higher rate.

With the Senate’s vote on the SGR repeal legislation still up in the air,

Medicare’s billing contractor announced that on April 15, it will start processing April claims at reduced rates, on a first-in, first-out basis.

Medicare payment rates were cut by 21% on April 1, following the expiration of the latest SGR payment “patch.” CMS routinely holds claims for 10 business days, so until now, practices’ cash flow was not affected. This “rolling hold” is designed to minimize the impact on practices to greatest extent possible.

There’s still a chance the repeal will pass by April 15. But if Congress acts after April 15, the new rate would be retroactive to April 1.

If there’s any positive news here, it’s that practices will NOT be required to resubmit claims initially paid at the lower rate. National Government Services said it will automatically reprocess those claims and issue checks for the difference.

Claims for services provided before April 1 are not affected by the payment cut.

For more information, visit the National Government Services website.