Health Policy

Mass. Medical Society supports bill that would end discrimination against gay men wishing to donate blood

Posted in discrimination, Health Policy, HIV, Uncategorized on July 13th, 2017 by MMS Communications – Comments Off on Mass. Medical Society supports bill that would end discrimination against gay men wishing to donate blood

 

Earlier this month, Jimmy Kimmel took to Twitter and leveraged his significant social media profile to encourage blood and platelet donation.

Staff and volunteers attached to blood donation centers across the nation have in recent weeks furiously stepped up donor recruiting efforts.

The summer season – and, specifically, the Fourth of July holiday – is a predictable time in which a blood shortage or “summer slump” may occur.  No matter the season, however, blood supply shortage puts patients’ lives at risk, including those who may need blood after an accident or who are facing treatment for cancer and blood diseases.

The media coverage of the nation’s most recent shortage brings to the forefront the fact that an entire segment of the United States is barred from giving blood, and a shift in that policy would increase the pool of potential donors and likely lessen the shortage and save additional lives.

The Massachusetts Medical Society is proud to support Rep. Daniel Cullinane (D – 12th Suffolk) and of HB 3597, An Act relative to eliminating discrimination in blood donations. This bill would require blood donation facilities not to discriminate against prospective donors on the basis of sex, gender, or sexual orientation, while allowing those facilities to require proof of a negative HIV test prior to accepting donated blood.

Currently, FDA regulations recommend that men who have sex with men be deferred from donating blood.

The MMS has a long history of advocating to remove discrimination based on sexual orientation. MMS policy “strongly supports the rights of individuals to health, happiness, and liberty regardless of sexual orientation…and urges all governments to recognize these rights.” Accordingly, MMS policy favors lifting the FDA deferral of blood donation for men who have sex with men: “The MMS supports a federal policy change to ensure blood donation bans or deferrals are applied to donors according to their individual level of risk and are not based on sexual orientation alone.” Accordingly, we recognize the importance of testing donated blood for HIV/AIDs, and we commend this legislation for stipulating that blood donation facilities may require individuals to provide negative HIV test results prior to donating to ensure the safety of our Commonwealth’s blood supply.

We wish to note that, while our policy refers specifically to enacting policy change on a federal level to address this issue, making this change at the state level is consistent with the MMS’s anti-discriminatory stance. Massachusetts has a chance to be a leader on this important shift in policy, and we as a medical society stand proudly with Rep. Cullinane at the forefront of this change.

Furthermore, this bill would not only combat discrimination based on sexual orientation; it would also save lives by increasing the supply of donor blood. The Commonwealth currently faces a shortage of donated blood: the American Red Cross issued an emergency call for blood and platelet donations this year. This bill would add to the pool of potential donors in Massachusetts.

The MMS urges the Committee on Public Health to report H.3597 out of Committee favorably.

 

 

 

 

 

Public Health Forum: The Social Determinants of Health

Posted in Health, Health Policy, Public Health, Public Health Leadership Forum on March 9th, 2017 by MMS Communications – Comments Off on Public Health Forum: The Social Determinants of Health

MMS President Dr. James S. Gessner

Good health includes much more than access to care. Research has demonstrated that a range of factors – such as environmental conditions, education, employment, and social and economic status – play key roles in a person’s health.

These factors – the “social determinants of health care” – will be the focus of the Medical Society’s 13th annual Public Health Leadership Forum taking place on Tuesday, April 4, 2017 from 1 – 5 p.m.

“Access to care and our health care system are certainly essential to good health,” says James S. Gessner, M.D., President of the Massachusetts Medical Society, “but a host of other factors come into play that contribute to healthy behaviors and prevent premature death. It’s important for the medical community to recognize all those elements and how they affect a patient’s health, and to be prepared to counsel their patients in a way that reflects social factors.”

The forum, entitled Social Determinants of Health: Improving Population Health Through Prevention- Based Care, will examine what policy makers and the medical community can do to acknowledge the impact of these factors on health.

Hosted by Dr. Gessner and Steven Ringer, M.D., chair of the MMS Committee on Public Health, the forum will be moderated by Harold Cox, Associate Dean for Public Health Practice at the Boston University School of Public Health.

Featured Speakers are Thea James, M.D., Vice President of Mission and Associated Chief Medical Officer at Boston Medical Center, who will deliver the keynote address, and Monica Bharel, M.D., M.P.H., Commissioner of the Massachusetts Department of Public Health, who will speak during the second half of the program.  The program also includes panel discussions with local experts on the topic.

For the complete agenda and to register for the event, click here.

 

 

Statement from MMS President on Passage of Question 4

Posted in Drug Abuse, Health Policy, Public Health on November 9th, 2016 by MMS Communications – 1 Comment

“It is disappointing that the commercial interests of marijuana have won out over the health and safety of citizens in the Commonwealth.  Physicians will continue their advocacy to warn citizens about the dangers of recreational marijuana and pledge to work with state officials to ensure that public health oversight, protections for teens and adolescents, and provisions for education, treatment and recovery are included as the law is implemented.”

James S. Gessner, M.D.
President, Massachusetts Medical Society
November 8, 2016

MMS Restates the Risks of Marijuana

Posted in Health, Health Policy, Public Health on November 4th, 2016 by MMS Communications – Comments Off on MMS Restates the Risks of Marijuana

The following statement from MMS President James S. Gessner, M.D. was issued November 4 in response to a press conference held by proponents of Question 4 and featuring physicians who advocate for the legalization of recreational marijuana.  Coverage of the event may be read here.

“Presenting recreational marijuana as something most physicians believe is beneficial to health is deceiving and dishonest.  Massachusetts already has a program for medical marijuana, strictly regulated by the Department of Public Health.  Question 4 provides no public health oversight and directs no revenue to health or substance abuse education or treatment.

The facts are that marijuana presents a real risk of addiction. Its use damages the developing brains of young people, risks pregnancy, and increases the risk of accidents.

We urge voters to read the ballot question carefully.  Question 4 is bad policy and bad for public health.  Those are the reasons why the Massachusetts Medical Society, 11 physician specialty organizations, hospital and nursing associations, and other health care groups in the state are strongly opposed to Question 4.”

The public health dangers of recreational marijuana are further outlined in this commentary by Dr. Gessner and in this essay by five health care professionals from McLean Hospital.  More information on marijuana and the risks it presents is available on the MMS website and at the National Institute of Drug Abuse.

 

 

MMS Responds to Column on Question 4

Posted in Drug Abuse, Health, Health Policy, Public Health on November 3rd, 2016 by MMS Communications – Comments Off on MMS Responds to Column on Question 4

In a column entitled Countering the anti-pot hysterics with a ‘yes’ on Question 4 published October 28 online in The Boston Globe, WGBH’s Margery Eagan took the opponents of recreational marijuana to task, labeling them as “hysterics” who are engaged in “reefer madness.”

In the column, she accuses the MMS of “shameful” behavior in its opposition to marijuana (both medical in 2012 and recreational in 2016).recreationalmarijuana_ballotquestion_image_990x450

MMS responded to the column October 31 in a letter to the editor from MMS President James S. Gessner, M.D. As of this posting, the letter has not appeared, so we publish it here for our members to read.

Marjorie Eagan may believe that opposing marijuana is “shameful” behavior by physicians, but her willingness to ignore the public health effects of legalization and discount the threat to children in favor of having a “really fun time” is simply irresponsible. (Countering the anti-pot hysterics with a ‘yes’ on Question 4, Oct. 28). Marijuana is not the harmless substance she and the proponents of Question 4 claim it to be. 

Today’s marijuana has four times the amount of the mind-altering THC substance it had in years past, and its use can lead to addiction, impair cognition, risk pregnancy, and damage the developing brains of adolescents.  Those are the facts, not reefer madness hysteria. Question 4 also offers no public health oversight and provides no resources for prevention, education, or treatment.  It represents bad policy, and physicians take pride in advocating for public health over the ready access to a substance that can cause harm.

MMS and 11 physician specialty societies in Massachusetts have stated their strong opposition to Question 4 for a host of reasons. We urge voters to visit the National Institute on Drug Abuse and MMS websites for information on recreational marijuana and watch the October 30th CBS 60 Minutes report on the effects of recreational marijuana in Colorado. All three indicate that marijuana is not the harmless substance many people think it is.

 

Senator Markey Headlines MMS Opioid Summit

Posted in Health, Health Policy, opioids, Public Health, Uncategorized on November 1st, 2016 by MMS Communications – Comments Off on Senator Markey Headlines MMS Opioid Summit

On October 31, MMS sponsored a leadership summit on opioid addiction, Medication Assisted Treatment: Improving Access to Evidence-Based Care, an event intended to raise awareness of the need for medication assisted treatment for substance use disorder. The summit was attended by nearly 200 health care professionals at MMS headquarters in Waltham.

U.S. Senator Edward J. Markey, in his keynote address, said, “If we are going to reduce the supply for heroin, fentanyl, and illicit prescription opioids, we have to reduce the demand through treatment.”

“I will not stop fighting for legislative support on this issue,” Sen. Markey added, noting that despite his efforts and those of his colleagues, Congress has repeatedly rejected bills that would financially support addiction recovery programs.

He decried the rising numbers of deaths in Massachusetts due to overdoses  — doubling in number in the Bay State in one year — and warned that due to the potent influx of fentanyl from China and Mexico, “we are poised to lose even more lives.”

Gathered for the Opioid Summit: Dr. Dennis Dimitri, Dr. Monica Bharel, Sheriff Peter Koutoujian, Senator Edward Markey, MMS President Dr. James Gessner, MMS President-Elect Dr. Henry Dorkin, MMS Vice President Dr. Alain Chaoui

Gathered for the Opioid Summit: Dr. Dennis Dimitri, Dr. Monica Bharel, Sheriff Peter Koutoujian, Senator Edward Markey, MMS President Dr. James Gessner, MMS President-Elect Dr. Henry Dorkin, MMS Vice President Dr. Alain Chaoui

“Fentanyl is like a Class 5 hurricane making landfall,” Sen. Markey said. “It is the Godzilla of opioids. It is trending too quickly. It is so dangerous that first responders insist on wearing HazMat suits when they arrive at a scene of an overdose for fear they will become contaminated if exposed to it. We just don’t know how dangerous it is, and it’s coming to every street in America.”

Combatting the opioid epidemic requires vigilance coupled with “aggressive data collection, surveillance, increased prescriber and patient education, and the passage of aggressive new laws,” he said, that are aimed at controlling the influx and consumption of opioid drugs.

Markey alerted attendees to a report by U.S. Surgeon General Dr. Vivek Murthy on opioids due to be released early in 2017.

“The Surgeon General’s report on opioids will have a great societal impact,” Sen. Markey said, “similar to when the former Surgeon General years ago released the report about the health hazards of cigarette smoking. History will judge us, because now is our opportunity to respond to the greatest public health crisis in the 21st century.”

Several speakers, including Massachusetts Public Health Commissioner Monica Bharel, M.D., Middlesex County Sheriff Peter J. Koutoujian, and others called for a unified effort to destigmatize those who struggle with substance abuse.

“Treatment works, recovery is possible,” Koutoujian said. He described treatment programs sponsored by the Bay State’s criminal justice system that are helping inmates to return to society after incarceration better able to control their drug habits.

Dr. Bharel reminded the capacity audience to commit to viewing substance abuse addiction through the lens of the #StateWithoutStigMA campaign, launched last year by Governor Charlie Baker’s Opioid Working Group. The statewide campaign aims to eradicate the negative stereotype of drug misuse by declaring it to be a treatable illness.

MMS gathered more than a dozen national and local experts on the topic for this summit to speak to such topics as the treatment of addiction as a disease, the importance of psychological treatment and behavioral support, models of care, and supporting physicians and providers in treating opioid use disorders. It was hosted by MMS President James S. Gessner, M.D. and moderated by Dennis M. Dimitri, M.D., immediate past president and Chair of the MMS Task Force on Opioid Therapy and Physician Communication.

Presentations by the participants may be viewed here.  For highlights and photos from the event visit the MMS Twitter page.

MMS 2017 State of the State’s Health Care Leadership Forum: The Election’s Impact on Health Care?

Posted in Affordable Care Act, Health Policy, Health Reform, State of State Forum on October 20th, 2016 by MMS Communications – Comments Off on MMS 2017 State of the State’s Health Care Leadership Forum: The Election’s Impact on Health Care?

The outcome of the national election on November 8 and its potential to shape – either positively or negatively — the healthcare agenda in Washington and locally in years to come was on the minds of the moderators and presenters as they addressed nearly 150 attendees at MMS’s 17th annual State of the State’s Healthcare Leadership Forum held at MMS headquarters on October 19.

Moderators James Braude and Margery Eagan, co-hosts of WGBH’s Boston Public Radio, noted during opening remarks that the-white-house-at-dc-thconstructive discussions of healthcare have been largely absent from the presidential debates and during most national campaign appearances by both candidates. Braude said that the candidates seemed bent to “shed blood” rather than to engage in vigorous fisticuffs about how to control the costs of prescription medicines, for example, or how to improve the Affordable Care Act. Yet many voters, if not most, he observed, collectively worry about these issues.

Ray Campbell, the newly appointed executive director of the Massachusetts Center for Health Information and Analysis (CHIA), said that Massachusetts remains a “bright spot” in this dark national political landscape. In the Bay State, he emphasized, “we have strong bi-partisan support that has transcended party lines” when it comes to providing quality health care for all citizens. Unlike the negative rhetoric that has surface nationally during election-year discussions of Obamacare, Campbell remarked, “there is no talk of a repeal or replacement of Massachusetts’ healthcare reform.” Campbell further noted that CHIA and other state agencies must continue to aggregate data and to use it as fodder to better manage spending, which this year is at a 4.1 percent increase, exceeding the previous year’s benchmarks. “We are exploring ways to do a better job to use the data we collect to shed a light on spending in Massachusetts,” he said, “so we can institute statewide efforts to better control it.”

capitol-dcKate Walsh, president and chief executive officer at Boston Medical Center (BMC), said that while BMC has grown “out of adolescence” by celebrating its 20th anniversary this year, “we still need to improve so we can fulfill our mission, namely to provide ‘exceptional care without exception.’” Toward that end, Walsh said, “we have to earn our patients’ trust and invest in a rigorous quality improvement agenda.” Tailoring programs at the hospital to respond to patients’ needs, such as BMC’s program to treat opioid use and abuse, is just one example of how Walsh envisions BMC to be “part of the solution do to a better job because our patients deserve it.” The challenge facing healthcare institutions in Massachusetts is to “remove barriers” and to “empower patients” to take firmer control of their health.

Michael Dowling, president and chief executive officer of Northwell Health, a conglomerate of 21 hospitals and over 450 patient facilities and physician practices in New York and New Jersey, echoed this theme of empowerment, urging the audience to define it as a movement not just for patients but also for health care providers. “Too often,” Dowling said, “we as health care professionals play the victim. We must take pride in our work, to be optimistic, and face the reality that our business is changing. We must not become prisoners of the past, we must embrace change. One way of doing this is by becoming leaders in the digital world. Otherwise, we run the risk of becoming “Uber-ized,” as someone else will find a way of doing what we do better.” Toward this end, Dowling encouraged his listeners to adapt to the needs of the consumer/patient who, he said, are increasingly more educated, with more access to technology than ever before. He concluded: “We must ask ourselves what skills we will need in the next 5 to 10 years, since our world is always changing, and health care is in a transformative stage.”

Robert J. Blendon, professor of health policy and political analysis at Harvard’s Chan School of Public Health, brought the forum full circle by sharing research he and his colleagues have conducted on the 2016 election, revealing strong partisan views with regards to health policy. Harvard researchers asked, “How Has the ACA Impacted the Country?” They found that 66 percent of Democrats responded that Obamacare has had a positive impact, while 72 percent of Republicans responded by saying ACA has a negative impact. Overall, he noted, healthcare surfaced as the third most important policy issue nationally, with the economy/jobs ranking as the primary issues, and terrorism/national security the secondary issues of importance. Blendon concluded that we will all have to wait for the outcome of the impending election to determine where healthcare emerges in our nation’s priorities.  He concluded, “Major changes in health policy only occur when one party holds the presidency and both houses of Congress.”

–Robert Israel

 

 

 

 

The President’s Podium: The Real Issue of Question 4

Posted in Health, Health Policy, Public Health on October 12th, 2016 by MMS Communications – Comments Off on The President’s Podium: The Real Issue of Question 4

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

Citizens thinking about how to vote on Ballot Question 4 – whether or not to legalize recreational marijuana – should ask some important questions before casting their ballot.

How would our health and safety, and especially that of our children, be affected should recreational Dr. James S. Gessner, MMS President '16-'17_editedmarijuana become legal?  What affect will it have on our highway and occupational safety?  Should Massachusetts allow ready access to a substance with a potential for addiction when we are fighting an epidemic of opioid abuse that is already disrupting and destroying too many lives?

These are critical questions, because this referendum, more than anything else, is really about public health and safety.

Marijuana is not harmless. Its main ingredient – tetrahydro-cannabinol (THC) – is a mind-altering substance, and the amount of THC has been increasing steadily over the years. The THC content in marijuana today is four times stronger than it was in the 1980s.

We know that a risk of addiction exists with marijuana. According to the National Institute of Drug Abuse (NIDA), approximately 9 percent of those who use marijuana will become addicted. The rate jumps to 17 percent, or about 1 in 6, for those starting to use it in their teens and rises to 25–50 percent among daily users.

We also know its use contributes to cognitive impairment, presents a risk during pregnancy, poses a threat to highway and occupational safety, and can damage the developing brains of adolescents – the last being one of marijuana’s most troubling effects.

A 2014 article in the New England Journal of Medicine by NIDA Director Dr. Nora D. Volkow and her colleagues reviewed the current state of the science on the adverse health effects of recreational marijuana. Here is part of what they concluded:

Marijuana use has been associated with substantial adverse effects, some of which have been             determined with a high level of confidence…. As policy shifts toward legalization of marijuana, it is   reasonable and probably prudent to hypothesize that its use will increase and that, by extension, so will the number of persons for whom there will be negative health consequences.

In summary: the legalization of marijuana will lead to more marijuana use and more use will lead to more people with poorer health.

Physicians are especially concerned about the impact of this law on children and adolescents, despite a proposed ban on sales to anyone under 21.  An age restriction doesn’t work with tobacco and alcohol; it won’t work with marijuana. In Colorado, where legalization occurred in 2012, the state has seen an increase in marijuana use by youth 12-17 that is now 56 percent higher than the national average.

Adding to the concern is that teen perception of the risks of marijuana has decreased over the past decade, largely due to efforts to legalize medical and recreational marijuana.  The American Academy of Pediatrics has warned that increasing the availability of marijuana for adults, regardless of restrictions, expands access for youth and persuades them that it’s not dangerous – and that’s a wrong message to send to our young people.

Legalization will also likely to lead to greater danger on our highways, because the skills needed for driving – alertness, concentration, coordination, reaction time – are impaired with marijuana use.  In Washington state, where voters approved recreational marijuana in 2012, the number of fatal crashes involving drivers who recently used marijuana doubled in one year, according to a study by the AAA Foundation for Traffic Safety. Colorado has likewise seen a jump – 48 percent – in marijuana-related traffic deaths.

Those are compelling reasons against legalization. But the ballot question itself gives us more reasons to vote no on Question 4.

First, the referendum permits the sale of marijuana edibles, such as cookies, candies, snack foods, and drinks, which are especially appealing to children.

Second, it lacks any provision for public health oversight or authority in the development of regulations that would guide implementation of the law. And third, it has no allowance for any revenue from the sale of the drug to be earmarked for health education, prevention, or treatment programs.  These are serious failings.

A careful read of this ballot question reveals that this was created by and for the marijuana industry, without regard for public health in the Commonwealth.

The Massachusetts Medical Society and 10 physician specialty groups, representing a wide variety of medical specialties, including pediatrics, primary care, emergency medicine, obstetrics, and psychiatry, have stated their opposition to Question 4 for the reasons listed above.

We think preventing possible addiction, guarding our public health and safety, and protecting children and adolescents are far more important and valuable than the commercialization of marijuana and the “recreational” use of a substance capable of causing harm. We hope our patients think so, too.

The President’s Podium appears periodically on the MMS blog, offering Dr. Gessner’s commentary on a range of issues in health and medicine.  Versions of the above have been distributed to newspapers across the Commonwealth for publication as commentary. 

 

 

 

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 – Comments Off on CMS’s Andrew Slavitt talks with MMS about MACRA

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: Engaged in the battle? Yes!

Posted in Department of Public Health, Drug Abuse, Health Policy, opioids, Public Health on November 3rd, 2015 by MMS Communications – 1 Comment

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

The voices of the media are becoming more frequent and more pointed about the nation’s opioid epidemic, and the Dr. Dennis Dimitri, MMS Presidentnarrative that physicians are part of the problem continues.

The suggestion that physicians are lax in addressing the opioid epidemic or are reluctant to work toward solutions has been espoused by national and local media. A November 2 editorial in The Boston Globe takes our medical society to task, suggesting that we are reluctant to work with public officials and are even obstructing progress because we believe there needs to be more flexibility in the Governor’s proposed limit of a 72-hour supply of opioids for first-time prescriptions.

The idea that physicians are standing on the sideline or hindering progress toward solutions to the opioid epidemic is simply wrong. The fact is that MMS officers and staff have been meeting and working with Governor Baker, Health and Human Services Secretary Sudders, Attorney General Healey, and Public Health Commissioner Bharel for some months in order to address this crisis and develop strategies and responses. There has been nothing casual about the MMS response to this crisis.

Our opioid prescribing guidelines, issued in May, were in fact a response to the Governor’s request for assistance in addressing the epidemic. Our guidelines outlining use of the lowest effective dose for the shortest time presaged the Governor’s opioid bill by several months, and were subsequently adopted by the Massachusetts Board of Registration in Medicine and incorporated into its comprehensive advisory to physicians on prescribing issues and practices.

Additionally, the MMS has called for every physician to rethink their prescribing practices with the goal of reducing the number of opioids prescribed. We ‘own’ that part of the problem.

We have worked with members of the Baker administration on several initiatives and have invited them to work with us as we reach out to physician leaders for help. Physicians are firmly committed to working with government leaders, public health officials, and others in the medical community to stem the tide of opioid and prescription drug abuse.

Our other actions speak to that, as well.

Our continuing medical education courses on opioid prescribing and pain management have been taken by nearly 2,000 individuals since we began offering them free in May. Nearly 5,000 courses have been taken.

We have reached out to the medical community and beyond with our annual public health forum and our Opioid Misuse and Addiction Summit, which brought together physicians, pharmacists, law enforcement officials, and government officials to create awareness and discuss strategies to reduce opioid abuse.

We have been engaged for several years in efforts with the Department of Public Health to improve the state’s Prescription Monitoring Program and are now collaborating with the DPH and the deans of the four Massachusetts medical schools to improve education on opioids and pain management for medical students.

Our dedicated website and public service advertising campaign speak to the importance of safe storage and disposal by patients, two critical elements in curbing abuse.

Physician activity in addressing the opioid crisis by the MMS is not something new in 2015. MMS efforts in alerting patients about prescription drug abuse go back nearly five years, and my predecessors Dr. Ron Dunlap and Dr. Rick Pieters were instrumental in bringing the urgency and importance of opioid abuse to our members and the patient population.

As I wrote back in July, physicians have made the commitment to be part of the solution. We will remain so and will continue to work with government and public health officials, our colleagues in the medical community, and our patients to attack this crisis.

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