CMS’s Andrew Slavitt talks with MMS about MACRA

Posted in Electronic Medical Records, Health Policy, Health Reform, Payment Reform, Regulation on May 26th, 2016 by MMS Communications – Be the first to comment

Editor’s Note: On April 27, 2016, the Department of Health and Human Services issued a Notice of Proposed Rulemaking to implement key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), bipartisan legislation that replaced the flawed Sustainable Growth Rate formula with a new approach to paying clinicians for the value and quality of care they provide.  In early May, the Massachusetts Medical Society sat down with Andrew Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services, to talk about the new rule and how it was developed.  More information on the Proposed Rule can be found here.

MMS:  Recently you said that you thought CMS had lost the hearts and minds of America’s doctors, and the new MACRA rule was an opportunity to win them back. Can you tell us how you got to that point and why you think the new proposed rule will change physicians’ perceptions?

CMS Acting Administrator Andrew Slavitt

CMS Acting Administrator Andrew Slavitt

MR. SLAVITT: I want to start with mentioning that the Quality Payment Program that we put out in a proposal comes at a very exciting time in the evolution of Medicare. The implementation of MACRA allows us to take the next transformative step in the Medicare program, by introducing the Quality Payment Program to pay physicians and other clinicians for quality, with a more flexible approach, common-sense approach.  MACRA repealed the SGR and streamlined the patchwork of Medicare programs that currently measure value and quality into a single framework where every physician and clinician has the opportunity to be paid more for providing better care for their patients.  MACRA builds on the important reforms of the Affordable Care Act, which increased the numbers of Medicare clinicians participating in alternative payment models, which are models that reward coordinated, innovative care.

But, there is a lot of fatigue that has come with all the changes over the years. We know it can feel like there are people that sit around thinking of ideas for how to make a physician’s job more difficult; when what is really happening is the accumulation of requirements over time, passed in a series of laws or that come through a series of regulations. If people don’t implement and manage them carefully, we end up in a situation where I think we are now –  where despite all of the best intentions, the burdens add up for those on the front lines where care is given or received.

If people don’t feel like they’re being heard, if they don’t feel like they have a voice, and if they don’t feel like the changes make sense for their practice, it can be incredibly demotivating.

We have approached the implementation of MACRA with the belief that physicians know best how to provide high quality care to our beneficiaries.  And we have taken an unprecedented effort to draft a proposal that is based directly on input from those on the front line of care delivery.  Before drafting the Quality Payment Program proposal, we reached out and listened to over 6,000 stakeholders, including state medical societies, physician groups, and patient groups to understand how the changes we are proposing may positively impact care and how to avoid unintended consequences.

The feedback we received shaped our proposed rule in important ways—and the dialogue is continuing. Based on what we learned, our approach to implementation is being guided by four principles, which I think are also consistent with the goals of the MACRA legislation.

  • One is to keep the patient at the center, always.
  • Two, give physicians more flexibility to control their own destiny and to control what gets measured, how it gets measured and have a little bit more say in how things work, because I think that flexibility is a critical ingredient to some of the issues that we talked about.
  • Three, is simply to do less. Find opportunities wherever we can to reduce the burden. It’s as simple as that.
  • Fourth is simplify, simplify, simplify. That is something we try to take an opportunity to do in every place we could, whether it’s in the use of technology, whether it’s in taking this patchwork of programs and consolidating them and, it will be in how we ultimately implement many of the other components. We have an opportunity to really make a big change. What we’re going to have to do well is continue to listen, provide as much flexibility as possible and simplify.

At the end of the day, after thoughtful and skillful execution, it will be time that tells us how well we have done.

MMS:  You also talk about user-driven policy design. Can you talk about what that means and how it influenced the new Meaningful Use rules now called Advancing Care Information?

MR. SLAVITT: Sure. It’s actually not that radical a concept in the real world. In the real world it might be called “talking to your customers about what they want.” Perhaps in Washington, though, it is a bit of a new concept.

A great example of user-driven policy design would be the visit that you led us on when we were in Massachusetts: Sitting down and listening to what people who deliver care say about the impact of our work at CMS. There is no magic to it: just listen; translate needs into actions; create and deliver; communicate and seek further input; continue to iterate.

In a nutshell the big trap when doing public policy is to do it from your desk. The opportunity we all have – and it’s quite exciting for the people in the agencies – is to really get out there and think about what it feels like at the kitchen table of the American family, what it feels like in the clinics where people get care and how to improve on that. It is a wholesale different way of approaching this work.

When we implemented ICD-10, we used a bit of this approach, I think successfully. We are attempting to roll it out more significantly with the Quality Payment Program. I think you’re exactly right, the Advancing Care Information proponent of MIPS is a critical aspect which we took in a significant amount of input on.

And like I said, continuing to listen and iterate is a very important aspect of user-driven policy design. We are in the phase now of listening to input. And even after we publish the final rule, we will listen and iterate.

MMS:  You’ve also compared the new MACRA proposal to the rollout of an iPhone. So if you’ll forgive me for expanding on that analogy, even in Massachusetts there are physicians who are still using flip phones. You’ve also said, and I’m paraphrasing, that it’s okay to have payment models that aren’t perfect as long as we learn from them. How do you see these perspectives fitting into the implementation of MACRA, e.g., opportunities for physicians who are not used to taking on risk, learning how to bear more risk without fearing that they’re going to lose their practices?

MR. SLAVITT: It’s really important to put in context what payment model and incentives are supposed to do. I have never met a physician, nor do I hope to meet a physician, who makes decisions on patient care based upon how they’re going to get paid. I don’t think that’s how physicians are wired.

The role of payment models and incentives is simply to reinforce what the clinician believes to be the right way to deliver care. If incentives are done well and done right, clinicians will get reinforcement financially; and the payment system gives them the opportunity and the dollars to invest and reinvest in the kinds of things that they believe are right for their practice and for their patients. We have to make sure it is clear that we know it is the clinical and cultural leadership that improves quality, not public policy.

The point I was making about the iPhone is that we are in early generations of some of these payment models. The clinicians who participate should be aware that models are meant to reinforce the good practice of medicine, but the models are not going to be perfect. The models are going to have to get better over time based upon how they get used in the real world and improved upon. For instance, in our second generation models we have made changes, like adding telemedicine or adding patient incentives to make sure that the patient is aligned with their physician in staying healthy.

And where did the changes come from?  They came from listening to physicians and patients. The physicians tell us this model would be better if it could do this, if it could do that. And that’s the thinking that has to continue. So, like any other good, user-driven program, we want an ongoing dialogue so that year over year the program improves for patients and clinicians.

MMS:  So on to interoperability, which I know is one of your concerns. You know it’s one of the physicians’ greatest frustrations. Secretary Burwell has said 90 percent of EMR vendors are committed to interoperability, which is great. I think I can hear physicians nationally groaning because they think they’ve heard this before. So what is it that CMS can do and HHS can do to make it real?

MR. SLAVITT: Let’s talk about what interoperability really is. This is such an important ingredient to improving health care. But interoperability in some respects needs to just be as simple as this: how can we collaborate for the best outcomes when a patient is going to experience different parts of our fragmented health care system? What we want out of interoperability is simple: having a patient referred for other care and understanding what happens at that visit; or communicating with the physician when a patient is discharged from the hospital to make sure they are taken care of and are healing at home.

As you mentioned, Secretary Burwell announced that companies representing 90 percent of EHRs are committing to three vital steps to real interoperability. I thank the many who have made this commitment. It has the potential to set us on a new course, but we all need to be more committed than ever to making sure that the substance of this pledge translates to reality.

And you’re exactly right about physicians groaning; we are not talking sending a man to the moon. We are actually expecting technology to do the things that it already does for us every day. So there must be other reasons why technology and information aren’t flowing in ways that match patient care.

Partly, I believe some of the reasons are actually due to bad business practices. But, I think some of the technology will improve through the better use of standards and compliance. And I think we’ll make significant progress through the implementation of API’s in the next version of EHR’s which will spur innovation by allowing for plug and play capability. But the reason that the pledge is important is because the private sector has to essentially change or evolve their business practices so that they don’t subvert this intent.

In some respects, you can look at me and you can look at the government and say, “Why don’t you just mandate that people do this?”  We have very few higher priorities, but the reality is that if we really want change, we need everybody to put pressure on people in the system to make the technology work. So, if you are a customer of a piece of technology that doesn’t do what you want, it’s time to raise your voice. We’re doing everything we can to make sure that the technology vendors stop focusing on meeting the regulations, so they can start focusing on their customers and their users, and design around the physicians’ needs, the caretakers’ needs, the patients’ needs.

MMS:  We reached out to other medical societies nationally to get some questions for this interview, and they’re all interested in MACRA’s Quality Payment Program, including MIPS and APMs. Many of the questions had a pretty common theme: Physicians are willing to be held accountable for what they’re doing and they know they’re going to be graded on it, so to speak, but they’re concerned about being held accountable for things that are not under their control, whether it’s care that’s not under their control or let’s say a non-compliant patient for whatever reason. The other part of it was registries; how can the medical community be more involved and engaged with CMS in the development of these registries. So your thoughts on those two issues?

MR. SLAVITT: They’re very good questions. First, I’ll just go back to my earlier comment, which is that these payment models are intended to be strong signals about the kind of activities that improve patient care. And so, yes, a physician will feel like there are some things that they’ve got to really influence and pieces of the puzzle that they don’t control; we are interested in hearing about those and making sure that those make sense.

However, patient compliance is a tough but critical part of the process, and efforts to communicate to patients and so forth are obviously part of what physicians do and have been doing for a number of years. At the same time, we’re hearing amazing stories from physicians in small practices and rural, underserved communities.  Motivated and driven with a passion for patient care, they are redesigning their care teams around their patient needs in ways that are having dramatic impacts in patient compliance and health outcomes.  Meaningful impacts, such as significantly improving A1C levels – even as practices expanded to take on sicker, under-insured patients – and significant increases on follow through for referrals on behavioral health and addition referrals.  These are improvements that matter in our communities and in our homes.  And we’re hearing physicians say, “This is incredible! We’re practicing medicine again!”

We work very hard to create what we call a core set of measures, which means that we want to be on the same page with every other payer that’s in a physician’s office so that a physician can focus on one way of doing things.

For specialists, we’ve done a lot of work and a lot of collaboration.  Eighty percent of our measure sets are specialty specific, and the vast majority of those measures come from physician leadership outside of CMS where people are saying this is the evidence-based state of practice, this is what we want. We spent a lot of time engaging the clinical community – medical societies and front-line physicians – to design a program that’s equally meaningful to a wide range of specialties that practice in very different settings.  There’s plenty of ways to be successful within the Quality Payment Program. In addition, for small practices, we’ve designed our proposed rule to provide support and flexibility that match their circumstances, including increased technical assistance, exemptions for small volume practices, allowances for medical home models, and a continued focus on reducing reporting burden.  Our teams are set up to evolve these rules and the clinical community needs to continue to be a strong partner in this process.

MMS:  You are in charge of the most powerful agency in the nation to effect changes in health care in this country at the time of greatest change in health care. So what do you see as your role in this position and the role of CMS in helping shape the future of health care?

MR. SLAVITT: I think it’s really to listen to and absorb the voice of the people that are doing great care every day. We have 140 million consumers that are a part of Medicare, Medicaid and the Children’s Health Insurance Program, and the Marketplace.

If you start with that, let’s talk about what their life is like. They’re increasingly mobile. They’re connecting to an often fragmented system where they’re not anchored. Many of these 140 million, the vast majority are on modest incomes or fixed incomes. They may have family-care needs, both with parents and with children. They worry about how they’re going to pay for the next prescription drug or about missing their bus to their next dialysis appointment. They worry about whether health care is going to become too expensive to manage.

So if you keep it at that fundamental level, it makes, I think, our job pretty clear: represent the needs of the people we serve and to make sure those needs are getting met. CMS will continue to shape health care by making sure these programs are preserved, as well as evolve to meet the needs of the patients.

The wrong way to do that is to put a bunch of policy ideas together in a black box and try to implement them.

The best way – and it is very exciting – is to manage these programs by capturing both the voice of the patients and of the voice of the clinicians, represent those the best we can, and drive towards the delivery of high quality care.

MMS:  Is there anything else you want to say?

MR. SLAVITT: I want to thank you all at the Mass. Medical Society for the visit we had in Boston in the physician’s office. It is so important that we figure out how to connect public policy to what happens on the ground and in the real world. It’s invaluable. And we have to keep it up. It’s not one-off. It must be a cultural commitment. In fact, in the month of May alone, we have 35 scheduled events to hear from a wide range of stakeholders and this outreach will remain an important ongoing part of our work. I personally have been meeting regularly with physician groups, including smaller and rural practices, and have spoken to thousands of physicians in different parts of the country about their work, the opportunities and challenges they face, and what this proposal means for them and their patients.

The second thing I’d say is for physicians who are looking at these new regulations, to please get engaged. There is no possible way, for all the thinking our team can do, that we can anticipate every consequence of what we are working on. And as we aim to provide you with meaningful flexibilities, reduce your burden, and simplify how things get done, please help us think about how these programs can fairly and objectively reward you for the quality of care you delivery.

With all of the work that went into the proposal, it is critical that we receive direct feedback from physicians and other stakeholders. We rely heavily on the feedback for people to say, “I see your intent but what is happening is there’s an unintended consequence or there is a better way to lead us.” If physicians don’t get engaged, then consequentially they will feel the impact of things that they really could have influenced, and we want them to see that we are listening.

I know Washington can feel so distant, policy-making can feel so distant, and I think people are just, sheer exhausted for good reason, so sending in feedback can feel too difficult or pointless. But if this is truly able to be moved forward with all the input of the people who take care of all the beneficiaries (who I like to think actually run Medicare every day), then these new improvements will go so much better, and the Medicare program, the patients in these programs, and the practice of medicine will be the better for it.

I recognize that it’s not the talk, but how we act together, that moves things forward. Which is why I think the change from Meaningful Use to this new, much simpler, much more flexible program of Advancing Care Information is so important because it’s intended to be, among other things, a proof point that we’re not just talk. We are willing to look at things that aren’t working and fix them because it’s for the good of our patients, your patients and for the good of the practice of medicine.

 

The President’s Podium: A Renewed Effort on HIT

Posted in Electronic health records, Electronic Medical Records, Health IT, meaningful use on May 20th, 2016 by MMS Communications – 1 Comment

by James S. Gessner, M.D., President, Massachusetts Medical Society

Physicians well know the rapid advance of information technology in medicine over the last Gessner Cropdecade.  Pushed by federal and state regulations and requirements, the adoption of electronic medical records has been swift. Today, some 90 percent of physicians in Massachusetts use some form of electronic medical records.

While health information technology (HIT) arrived with great promise and adoption has been quick, widespread acceptance has lagged, and EHRs remain a major concern among physicians of all specialties. Among the most contentious issues: interoperability, clinical workflow efficiency, and the myriad demands of reporting patient data as required by Meaningful Use and the Physician Quality Reporting System, among others.

Some physicians have embraced HIT; they see it as a way to reduce medical errors, streamline workloads, and offer a path to improved outcomes.  Others view it as an impediment to the physician-patient relationship, a huge expense, a tool that consumes too much time, and a source of immense frustration.  Some have even stopped practicing medicine because they found the rules and regulations and operations too onerous.

Health information technology has been a major focus of the Massachusetts Medical Society since the establishment of the MMS Committee on Information Technology (CIT) some 20 years ago. The Committee’s Guide to Health Information Technology has provided useful information and direction for physicians as we struggle through the obstacle courses of HIT and EHRs.

The last year has seen a renewed effort by physicians nationally and locally, to share our concerns about the impact of HIT on physician practices and how we deliver patient care.

In September, MMS hosted an AMA Break the Red Tape Town Hall, to voice concerns about Meaningful Use.  More than 100 physicians attended, and the collective message was clear: EHRs are cumbersome, time-consuming, and hurting productivity.

MMS officials have also met with CMS Acting Administrator Andrew Slavitt on multiple occasions, including a visit last fall, at our suggestion, to Massachusetts and the office of a local family physician.  The visit provided Mr. Slavitt with a first-hand, real-world look at the issues affecting physicians as they work with electronic health records and wrestle with interoperability.  The encounter influenced his thinking about Meaningful Use; Mr. Slavitt has made it clear that EHRs should be patient-centered, physician-focused, and simple.

Our most recent effort was the adoption of a new set of principles governing health information technology.  Proposed by the CIT, the principles were adopted unanimously by the House of Delegates at our May annual meeting.

The essence of the new policy is contained in seven statements. It states that information technology available to physicians should accomplish the following:

  • support the physician’s obligation to put the interests of the patient first;
  • support the patient’s autonomy by providing access to that individual’s data;
  • be safe, effective, and efficient;
  • have no institutional or administrative barriers between physicians and their patients’ health data;
  • promote the elimination of health care disparities;
  • support the integrity and autonomy of physicians; and
  • give physicians direct control over choice and management of the information technology used in their practices.

MMS members may read the complete report of the CIT on these new principles here.

Guided by these principles, MMS will continue to work on health information technology issues and how these tools can improve the practice of medicine – and that means first and foremost a focus on patient care.  HIT does indeed hold promise, but its priority should not be on data collection, but on how it can raise the level of patient care – a goal shared by each of us as physicians.

The President’s Podium appears periodically on the MMS Blog, offering commentary on a range of issues in health and medicine.

 

 

 

May Physician Focus: Colorectal Cancer

Posted in Physician Focus on May 12th, 2016 by MMS Communications – Be the first to comment

Colorectal cancer is the second leading cause of cancer-related death for both men and women in the U.S., Colorectal Cancerclaiming more than 50,000 lives each year.  The American Cancer Society estimates that 134,000 cases of the disease are diagnosed every year.

Screening for the disease saves lives, but 23 million American adults – about one in three – do not get screened as recommended.

To raise awareness about the condition and the importance of screening, the May edition of Physician Focus features two physicians from the Massachusetts Gastroenterology Association.  Guests are Francis MacMillan Jr., M.D. (photo, center) president of the Association and owner and president of Merrimack Valley Gastroenterology in Haverhill, and Raj Devarajan, M.D., (right) president of Middlesex Gastroenterology and Endoscopy Center in Acton, a board member of the Association, and President of the Medical Staff at Emerson Hospital in Concord.  Hosting this edition is primary care physician Bruce Karlin, M.D. (left)

The physicians discuss the prevalence of colorectal cancer, the suspected causes of the disease, why so many adults don’t get screened, screening guidelines set by the medical groups, the various screening tests available, and the importance of a colonoscopy as a procedure to prevent cancer.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and online at www.physicianfocus.org, www.massmed.org/physicianfocus, and YouTube.

Shattuck Lecture: A Better Way to Drug Development

Posted in NEJM, Uncategorized on May 6th, 2016 by MMS Communications – Be the first to comment

The pharmaceutical and biomedical research industry have had many successes over many years, curing and eradicating diseases, prolonging and enhancing life. Such success has entailed years of testing and trials and millions and even billions of dollars.

Woodcock_SLL

Dr. Janet Woodcock

Today, however, the development and costs of new drugs have become two of the most difficult – and sometimes controversial – topics in medicine today.  The cost of developing even a single drug can run into the billions of dollars; the cost of one life-saving therapy can erase the life savings of a patient.  Such conditions have brought the pharmaceutical industry under scrutiny and under fire.

However, even with so many triumphs, says Janet Woodcock, M.D., “the biomedical research enterprise is surprisingly ineffective at improving health and treating disease, given our level of investment in it.”

Dr. Woodcock, Director of the Center for Drug Evaluation and Research at the Food and Drug Administration, shared her thoughts on drug development programs as she delivered the 2016 Shattuck Lecture, Lost in Translation: The Path from Scientific Discover to the Clinic, presented by the MMS Committee on Publications and the NEJM Group as part of the MMS annual meeting today.

She offered her perspectives – and some recommended solutions – to improve scientific discovery based on her 30 years of observing thousands of attempted drug development programs, both commercial and academic, while at the FDA.

Dr. Woodcock was clear and direct in her analysis: “Multiple systemic flaws impede generational knowledge,” she stated. “Medicine must take back ownership of clinical evidence development.”

The shortcomings in the system, she says, are the result of three problems in biomedical research: a lack of reliable basic scientific information to support development program; the absence of a robust translational infrastructure to develop and assess tools and drug candidates; and the inability of clinical medicine to create effective systems to generate evidence.

Despite the flaws, Dr. Woodcock believes opportunity for change and improvement exists.  “The system we have successfully operated for many years is under severe stress,” she declares, “and transformative change is needed.  New structures and technologies will provide opportunities.”

“Transformation of clinical research would be challenging with many obstacles,” she notes, “but the payoff might be worth it.” Among the benefits would be rapid and efficient generation of clinical evidence, patients as active participants in the clinical research enterprise, the integration of research into healthcare, and more effective and clinically relevant evaluations of new products and other interventions.

For more observations from Dr. Woodcock and a sampling of her recommendations for a better way forward, view her presentation here.

 

 

Ethics Forum: Patient Experience and Satisfaction

Posted in Ethics Forum, Primary Care on May 5th, 2016 by MMS Communications – Be the first to comment

A growing part of the ever-changing healthcare landscape is measuring patient satisfaction. Hospitals and physicians, more and more, are being rated and ranked based on a patient’s experience – what they think of the care they get from their individual physician, what they think of their stay in a particular hospital. Reputations are at stake, as are reimbursements and payments.

Surveys and publication of patient satisfaction with providers of all kinds are growing in number. And they’re here to stay.

That was part of the message from the MMS Ethics Forum on Thursday, May 5 presented by the Committee on Ethics, Grievances, and Professional Standards as part of the 2016 MMS Annual Meeting.

The Forum, entitled Patient Satisfaction Surveys: Utility and Unintended Consequences, featured presentations from Thomas Lee, M.D., Chief Medical Officer of Press Gainey and former CEO for Partners Community HealthCare, Inc., and Allen Kachalia, M.D., J.D., a general internist and Chief Quality Officer at Brigham & Women’s Hospital. Below, are the main points from their presentations.

Ethics-Thomas-Lee

Dr. Thomas Lee

Dr. Lee recognized that patient measurement can lead to unwanted changes or unintended consequences, but also acknowledged that not measuring patient experience means “giving up on the idea of improvement.” The challenge, he said, was “to invest thought, time and energy in preparing people to receive data [of measurement], and it’s a challenge worth taking on.”

Patients are afraid, he noted, not just of their diseases or the therapies they may have to undergo, but of the lack of coordination by the medical community, that, as he bluntly stated, “we don’t have our act together” in caring for patients.

Dr. Lee, however, ended on a positive note. The keys to proper and well-accepted measurements, he said, are within our control: better care coordination, more empathy, and improved communication with the patient. The good news, he said, is that those drivers of patient satisfaction are consistent with the professional values of physicians.

Ethics-Allen-Kachalia

Dr. Allen Kachalia

Dr. Allen Kachalia said that legitimate issues exist in accurate measurement.  The rankings are based on inexact science, response rates are generally too low, financial incentives are motivating the wrong behaviors, and measurement is one more item for physicians to manage. Yet his message was clear: patient satisfaction and the public reporting of patient experiences are here to stay.  “All of us want to be the best,” he said, “but there’s no way to know if we are the best without measurement.” The key, he said, is to balance patient experience with quality of care. Physicians must “embrace measurement and be transparent,” Dr. Kachalia stressed, and “offer solutions to the poor metrics” that exist in measurement today.

 

The President’s Podium: A Final Message

Posted in Medicine, Physician Health on May 4th, 2016 by MMS Communications – Be the first to comment

By Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

Dr. Dimitri XIn my inaugural address a year ago, I spoke about something I consider to be one of the most important issues facing the medical profession today: physician (dis)satisfaction.

As the end of my presidency approaches, I believe it is important, not only to our colleagues in the profession, but to our patients as well, to reiterate some of what I said.

My remarks last May highlighted the fact that we physicians are privileged to have our patients come to us, sharing openly all of their own difficult circumstances, that they look to us to help them overcome these problems.

I urged my fellow physicians to remember that that privilege means we must put our patients’ interests before ours. I reminded colleagues that we should think for a moment about the impact we have on our patients’ lives.

Still, we hear much about physician burnout and the loss the joy in practice.

“Physician” still rates as one of the most respected professions in every public poll, yet many within the profession are less sure of that.

This increasing dissatisfaction within our profession provided the genesis for the annual education program at the 2016 MMS Annual Meeting – Sustaining Joy in the Practice of Medicine: Compassion, Innovation, and Transformation.

I have the privilege of moderating a program with national experts who share the love of practicing medicine and who are committed to helping physicians overcome these challenges and restore their passion for this profession.

Participants include Jeffrey J. Cain, M.D., Chief of Family Medicine at Children’s Hospital Colorado; M. Bridget Duffy, M.D., Chief Medical Officer of Vocera Communications; and Christine A. Sinsky, M.D., Vice President of Professional Satisfaction for the American Medical Association.

Among the topics to be addressed are lessons we can learn from patients, why caring for the caregiver is so important, how we can transform the practice of medicine, and how physicians can rediscover the joy in the practice of medicine.

My tenure as MMS president has been marked by many issues, most significantly the opioid epidemic, electronic health records, and the search for a new executive vice president of MMS.  Given the urgency of those subjects, I didn’t get as much opportunity as I would have liked to focus on the issue of physician satisfaction.

While I end my presidential year firmly believing that we have established our medical society as a leader in the Commonwealth’s fight against substance abuse, that we made an important contribution in easing the burdensome requirements of information technology, and that we have selected a new executive who will be a great partner of physicians for years to come, I wish to leave colleagues with the same message I imparted when I became president.

And that message is this: Physicians really are different, and what gives us the greatest satisfaction is providing good care to our patients. 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 when you are feeling dissatisfied about regulations, prior authorization, delays in payments, or searching for a course to fulfill your risk management CME’s, remember this: I helped some patients today.

The President’s Podium appears periodically on the MMS Blog, offering commentary on a range of issues in health and medicine.

 

The President’s Podium:  Education Is Key to Opioid Battle       

Posted in Drug Abuse, opioids, Physician Focus, Public Health on April 14th, 2016 by MMS Communications – Comments Off on The President’s Podium:  Education Is Key to Opioid Battle       

by Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

Multiple efforts have been taken by many people all over the Commonwealth during the last year to curtail the state’s opioid epidemic.  We’ve seen Dr.DimitriMMS (4)Governor Charlie Baker’s Opioid Working Group present 65 recommendations to attack the crisis,  law enforcement officials offer treatment instead of arrest, Department of Public Health work on improving the Prescription Monitoring Program, and the deans of the state’s four medical schools establish core competencies in opioids and pain management for medical students.

Our own medical society has been at the forefront of addressing the crisis, with prescribing guidelines, free pain management CME’s to all prescribers, public service campaigns for patients, and collaboration with state and public health officials on a variety of initiatives.

Our latest effort is yet another cooperative endeavor with the Department of Public Health. I am privileged to appear as a guest with Monica Bharel, M.D., M.P.H., Commissioner of the Massachusetts Department of Public Health, on Crisis in the Commonwealth: Opioid and Prescription Drug Abuse, the most recent edition of our monthly patient education television series, Physician Focus, produced in cooperation with HCAM-TV in Hopkinton.

Hosted by Lynda Young, M.D., Professor of Pediatrics at UMass Medical School and a past president of MMS, the show is intended to educate citizens across the Commonwealth, providing perspectives about many aspects of the opioid crisis: the origins of the epidemic, the impact on patients and families; the roles of prescriber and patient; actions taken by medical, state, and public health agencies; and the provisions of the new state law recently signed by Governor Baker to address the epidemic.

The half-hour program is being distributed to public access television stations across the state, within reach of citizens in some 275 communities, and it is also being posted online at several sites. The video also includes a public service announcement and a listing of local and national resources about substance abuse, opioids and pain medicines, and prevention and treatment options.

While the efforts of many have led to some progress over the last year, the opioid epidemic is a difficult one to attack, as evidenced by recent headlines: Middlesex County saw 20 deaths from overdoses in just three weeks, and an analysis by the Massachusetts Health Policy Commission revealed that opioid-related visits to hospitals nearly doubled from 2007 to 2014, reaching 57,000 in 2014.

The opioid crisis has been the Medical Society’s number one priority for the last year, and it will remain at the top of the list.  The video produced with the Department of Public Health is another initiative by physicians and targets what we believe to be one of the keys to success:  education for both patients and prescribers, current and future. As Dr. Bharel states early in the video discussion, “It’s so important that we talk about this and make sure we’re educated and understand the scope of the problem.”

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dimitri’s commentary on a range of issues in health and medicine.

 

April Physician Focus: The Opioid Crisis

Posted in Department of Public Health, Drug Abuse, opioids, Physician Focus, Public Health on April 14th, 2016 by MMS Communications – Comments Off on April Physician Focus: The Opioid Crisis

The Massachusetts Medical Society, in cooperation with the Department of Public Health, has taken another step in its efforts to address the publicOpioids_edited health crisis of opioid and prescription drug abuse affecting residents of the Commonwealth.

The April edition of Physician Focus, Crisis in the Commonwealth: Opioid and Prescription Drug Abuse, examines multiple aspects of the opioid epidemic with MMS President Dennis M. Dimitri, M.D. (photo, center) and DPH Commissioner Monica Bharel, M.D., M.P.H., (right), two physicians who have been at the forefront of addressing the problem over the last year.

Hosted by Lynda Young, M.D., (left) Professor of Pediatrics at UMass Medical School and a past president of MMS, the program represents another initiative by the physician community and seeks to educate prescribers, patients, and citizens about the crisis and what steps they can take to help to curtail the abuse.

Among the topics of conversation are the origins of the opioid crisis; the roles of prescribers and patients; actions taken by medical, state, and public health agencies to reduce the abuse; and the provisions of a new state law created specifically to fight the epidemic.  The video also contains a public service announcement recorded by the guests and a list of local and national resources about substance abuse, opioids and pain medicines, and prevention and treatment options.

Physician Focus is distributed to public access television stations throughout Massachusetts, reaching residents in more than 275 cities and towns. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org/opioids, and on YouTube.

AG Healey: Curbing Gun Violence Requires “Partnership” with Physicians

Posted in gun control, Public Health Leadership Forum on April 5th, 2016 by Erica Noonan – Comments Off on AG Healey: Curbing Gun Violence Requires “Partnership” with Physicians

Curbing the epidemic numbers of deaths and injuries from firearms in the United States  will require a “spirit of partnership” among law enforcement officials, health care providers and community leaders, said Massachusetts Attorney General Maura Healey.

“This is a public health issue, and we are not going to be able to prosecute our way out of this,” she said.  “We need to reframe the conversation and retake the issue for the good of our country.”

Healey was a featured speaker at 12th Annual MMS Public Health Leadership Forum – Firearm Violence: Policy, Prevention & Public Health on April 5 at MMS Headquarters in Waltham.

The forum was convened to discuss the latest information on firearms violence, including how physicians can reframe the debate about firearms in order to encourage strategies that support gun violence prevention policies, research and programs.

Expert faculty includes Georges Benjamin, MD, executive director of the American Public Health Association, David Rosmarin, MD, director of the Forensic Psychiatry Service at McLean Hospital, the Rev. Jeffrey Brown, longtime anti-violence activist and founder of RECAP, and many more distinguished speakers.

Healthy defended the right of physicians to speak to their patients about guns, noting that physicians in Florida were recently prohibited by an appeals court from doing so.

She also urged support for policies that would require gun manufacturers and dealers to be held more accountable for the estimated 33,000 deaths per year across the country.  “Guns are the only consumer products that enjoy full immunity (from lawsuits)” she said.

Healey drew parallels between the guns and the issue of opioid abuse, an issue on which the MMS and state officials have collaborated extensively.  “This crisis requires renewed focus and persistence,” she said. “I hope collectively we can work together and make an impact.”

–Erica Noonan

Public Health Keynote: 91 deaths a day, 33,000 a year

Posted in gun control, Public Health Leadership Forum on April 5th, 2016 by MMS Communications – Comments Off on Public Health Keynote: 91 deaths a day, 33,000 a year

The numbers represent a “true epidemic,” said Georges Benjamin, M.D., as he tallied the number of deaths per day and the number of deaths per year from gun violence in the United States in delivering the keynote address April 5 at the 12th Annual Public Health Leadership Forum, Firearm Violence: Policy, Prevention and Public Health.  The forum was attended by approximately 120 physicians, health care leaders and public health and government officials.

The numbers represent a public health crisis, and the grim statistics prove the point: on an average day, 91 Americans are killed by guns, with more than 33,000 dying every year.  In an average month, 51 women are shot to death by their intimate partners, and seven children and teens each day are killed by guns.

Dr. Benjamin, Executive Director of the American Public Health Association, had three objectives in his keynote: (1) to define the societal toll of firearm injury; (2) to articulate a public health approach to reducing injury and death from firearm violence; and (3) to offer a broad approach to reducing firearm-related injuries and deaths.

“Guns are part of our culture,” said Dr. Benjamin, noting that the U.S. has more guns than people, “and we have the fundamental belief that firearms protect us.” Yet, he said, far too often the result is death and injury. Mass shootings, like the one at Sandy Hook, Connecticut, remain a persistent issue, with the U.S. experiencing more days with mass shootings than without.

“The protective safety of guns is overestimated,” said Dr. Benjamin. “In homes with firearms, homicide is three times more likely and suicide is five times more likely.”

Dr. Benjamin argued that through technology and education we can make guns safer and make people safer with their guns.  And it is an issue, he says, that physicians should embrace.  “Why should physicians care about this?  If it hurts people, if it kills people,” he said, “physicians should care.”

— Richard P. Gulla

Dr. Benjamin’s slide presentation, A Public Health Approach to Reducing Firearm Injury, may be viewed here.