Health Policy

The President’s Podium: Being Part of the Solution

Posted in Drug Abuse, Health Policy, opioids, Public Health on July 31st, 2015 by MMS Communications – Comments Off on The President’s Podium: Being Part of the Solution

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

 In October 2Dr. Dimitri1_edited013, the Trust for America’s Health rated Massachusetts as one of the top six states for developing  strategies to curb prescription drug abuse. Despite that ranking, the Commonwealth recorded more than 1,000 deaths from opioid overdoses in 2014, a jump of 33 percent from 2012.

Today, our state has developed an even firmer resolve in response to this epidemic.

Governor Charlie Baker and Attorney General Maura Healey have made this public health crisis a top priority. The Governor’s Opioid Working Group released an action plan in June that I believe is a smart, comprehensive approach to a complex problem. From the physician’s perspective, the plan has much to like. It reframes addiction as a medical disease, and recognizes the physician’s critical concern: “to ensure access to pain medication for individuals with chronic pain while reducing opportunities for individuals to access and use opioids for nonmedical purposes.”

The plan also supports initiatives that physicians have urged for some time and embrace wholeheartedly: more drug take-back days (an effort the Drug Enforcement Administration is also reviving), increases in the co-prescribing and bulk purchasing of the life-saving drug naloxone, more treatment programs, eliminating insurance barriers to treatment, and improvements in the state’s Prescription Monitoring Program.

The monitoring program is especially significant. The Centers for Disease Control describes such programs as one of “the most promising state-level interventions” to improve prescribing and protect patients at risk.

Changes in the monitoring program will make it easier for physicians to use, and compatible with those in other states. One key improvement: reducing the time for pharmacy reporting of opioid prescriptions from two weeks to 24 hours. This will provide better “real time” information on patient prescriptions and less “doctor shopping” by patients.

Another good sign: government is allotting more resources to fight the epidemic. The new state budget includes $111 million for substance abuse services, and the Governor has requested another $27.8 million in supplemental spending for treatment and prevention. U.S. Health and Human Services has also announced a $100 million effort for medication-assisted treatment, and Massachusetts will share in that program.

Creative new approaches have come from law enforcement as well. Gloucester’s Angels Program has enrolled nearly five dozen people into treatment since it began June 1, and the program has led to similar efforts in other communities.

For our part, the Massachusetts Medical Society has reached out to all prescribers with our Opioid Therapy and Physician Communication Guidelines, offering evidence of best practices for prescribing.

In May, we made our continuing medical education courses on opioids and pain management free to all prescribers, and since then, nearly 2,500 health professionals have taken one or more courses in the first two months. To meet demand, we have added nine courses since last year, when only 400 completed such courses in a comparable period.

We are reaching out to patients, focusing on the critical areas of proper storage and disposal of medications with a dedicated website and an upcoming radio public service campaign that will continue through the end of the year.

The American Medical Association is also taking action, concentrating on physician education in prescribing opioids, use of monitoring programs, and promoting access to treatment and naloxone.

But physicians – and all prescribers – can do better. More than half of enrolled prescribers don’t routinely use the prescription monitoring program, and most patients say their doctors don’t discuss the risks of addiction when prescribing pain medication. One of the best things prescribers can do is raise patient’s awareness of the risks of addiction and their responsibility to properly store and dispose of their medications.

Let’s also remember the public has a critical role to play. More than 75 percent of those 12 and older who use pain relievers for nonmedical reasons are using drugs prescribed to someone else, whether obtained free, purchased, or stolen. As White House Drug Policy Director Michael Botticelli told our membership, the prescription opioid problem is, in one sense, “an epidemic that starts in the medicine cabinet.”

The Opioid Working Group declared that “strong partnerships” will be required to curb this abuse. Many groups are rising to meet the challenge, and physicians have made the commitment to be part of the solution as well. As those closest to the patients, as the ones who prescribe their medicines and treat their pain, we can do no less.

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

CMS, AMA Announce Help with ICD-10 for Physicians

Posted in Electronic health records, Health IT, Health Policy on July 6th, 2015 by MMS Communications – Comments Off on CMS, AMA Announce Help with ICD-10 for Physicians

With the October 1 deadline for the implementation of ICD-10 looming, The Centers for Medicare & Medicaid Services road 1 icd(CMS) and the American Medical Association (AMA) today jointly announced some good news – and relief – for physicians.

The two organizations have reached agreement on important elements of a “grace period” for the implementation of version 10 of the new International Classification of Diseases that includes some 68,000 codes. The medical codes, used for diagnosis and billing, have not been updated in more than 35 years.

Among the major steps announced by CMS and the AMA:

• For a one-year period beginning October 1, Medicare claims will not be denied or audited solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.
• To avoid potential problems with mid-year coding changes in CMS quality programs for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed.
• CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
• CMS will also establish an ICD-10 communications and coordination center, to identify and resolve issues arising from the transition.
• CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The organizations also said they will reach out to providers across the county, with webinars, on-site training, and educational articles to help them learn about the new codes and prepare for the transition. The free help from CMS also includes the Road to 10, The Small Physician Practice’s Route to ICD-10, a website aimed specifically at smaller physician practices to help them with the transition.

Today’s CMS/AMA joint announcement may be read here. More information on ICD-10 is available at this CMS site and from this post by AMA President Steven J. Stack, M.D., which contains links to additional information and resources.

The President’s Podium: Reducing Opiate Abuse

Posted in Department of Public Health, Health Policy, Medicine, opioids on February 18th, 2015 by MMS Communications – Comments Off on The President’s Podium: Reducing Opiate Abuse

By Richard Pieters, M.D., President, Massachusetts Medical Society

Governor Charlie Baker and Attorney General Maura Healey have each made opiate abuse one of their top priorities, and this week they will announce steps they will take to fight this public health crisis. That the state’s top elected official and top law enforcement officer have put this issue at the forefront of their agendas is good news, because even as Massachusetts ranks as one of the top four states in adopting strategies to curb prescription drug abuse by the Trust for America’s Health, prescription and opiate abuse remains a crisis in the Commonwealth.

MMS has reached out to both the Governor and Attorney General to offer our assistance as they address the problem. Their initial responses have been encouraging, and we look forward to hearing the specifics of their plans and working with them.

One of the keys to reducing the abuse, however, is a sustained effort in raising public awareness about the issue, and the Massachusetts Medical Society has long recognized the importance of communicating to both physicians and patients about prescription drug abuse.

We highlighted the topic in 2011 with our patient education television program that reaches communities across the state, and in subsequent shows addressed the topic of substance abuse in young people and how they can be treated.

Our current program revisits the subject of prescription abuse with experts in addiction medicine. Additionally, we have distributed articles to local media, to outline what both physicians and patients can do to prevent prescription abuse. This is especially important, as more than three out of four people who misuse prescription pain medicines use drugs prescribed to someone else.

My predecessor Dr. Ronald Dunlap last year outlined the physician’s perspective on prescription drug abuse and recommended additional steps that can be taken to reduce the abuse.

I have since provided my views and recommended improvements in the state’s prescription monitoring program, which the Society helped to create more than 20 years ago. We believe a well-run, real-time, robust monitoring program is a key element in the fight against prescription abuse and one in which every physician should participate.

MMS will continue its educational effort on opioids and prescription abuse on April 8 with our Annual Public Health Leadership Forum for physicians and health care providers. The Opioid Epidemic: Policy and Public Health, featuring local and national leaders in substance abuse and addiction medicine, will discuss a range of issues, including the basics of pain management, alternatives to opioids, communicating with patients about pain management and treatment, and advocacy for treatment programs for those with addictions. This forum will offer important information for those who prescribed opioids and treat pain and addiction, and I urge those who do so to attend.  Also, the MMS Ethics Forum at our annual meeting in May will explore the ethical and legal considerations in pain management by physicians.

As government and public health officials seek remedies to the opiate crisis, we urge them to recognize that physicians and their patients – the ones who treat the pain and take the medicines – can play critical roles in reducing the abuse.

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

The ACA Really Does Matter This Election Season: Blendon

Posted in Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 8th, 2014 by MMS – Comments Off on The ACA Really Does Matter This Election Season: Blendon

 

The Affordable Care Act is still a major election issue this year, particularly in states whose voters will ultimately decide who controls the next U.S. Senate, according to a leading health policy analyst from the Harvard School of Public Health.

Robert Blendon, ScD., speaking at the MMS” annual State of the State of State’s Healthcare conference, said anti-ACA messaging and advertising is very heavy in the 14 competitive state races, and most of those states tend to be conservative, Republican, or both.

After the ACA: Some Successes, and Lots More Work to Do

Posted in Accountable Care Organizations, Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 8th, 2014 by MMS – Comments Off on After the ACA: Some Successes, and Lots More Work to Do

 

David Blumenthal, MD, president of The Commonwealth Fund, told attendees of the MMS State of the State conference yesterday that while federal health reform has fostered many important improvements in our health care system, there are still big gaps in access to care, affordability, and health status.

Dr. Blumenthal said the U.S. is still “Two Americas,” where on the most metrics, the northern half of the country is generally much better off than the southern half. For example, he asserted that middle income people in the South are in no better a situation than low-income people in the Northeast.

However, the Affordable Care Act has been the primary reason for “historic” improvements on several fronts. In the attached video clip, he outlines some of those changes. Then he reviews the experience so far in Massachusetts.

Transforming Health: The Need for an Innovation Ecosystem

Posted in Accountable Care Organizations, Health Policy, Health Reform, State of the State: 2014 on October 7th, 2014 by MMS – Comments Off on Transforming Health: The Need for an Innovation Ecosystem

 

How do you transform the health care system in mid-flight?

Victor J. Dzau, MD, recently named president of the Institute of Medicine, argues that health care organizations have the ability to create an ecosystem that encourages the creation of ideas, nurtures them through experimentation, and then disseminates them to the rest of the health care system – up to and include commercialization.

His video clip begins with the wry observation that “innovation was not invented in the United States,” and can arise from anywhere.

His comments today were part of the 15th annual MMS  State of the State of Healthcare Leadership Forum.

Cleveland Clinic’s Lessons for Health Care Transformation

Posted in Accountable Care Organizations, Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 7th, 2014 by MMS – Comments Off on Cleveland Clinic’s Lessons for Health Care Transformation

 

The CEO of the Cleveland Clinic provided a persuasive and moving case study today of how a health care organization can tackle the transformation of health care.

Delos M. Cosgrove, MD, said the Cleveland Clinic has made significant improvements in the areas of affordability, access and quality.

But he noted that none of these are important if a fourth critical item is missing: empathy.

Dr. Cosgrove’s presentation was part of the MMS’ 15th annual State of the State’s Healthcare Leadership Forum.

View video clips from the conference’s other presentations.

Mass. Health Care Costs: Evidence, Testimony, and Scrutiny

Posted in Global Payments, Health Policy, Health Reform, Payment Reform, Payment Reform Commission on October 6th, 2014 by MMS Communications – 1 Comment

“We’re not interested in just saving money, we’re also concerned aboutMassachusetts State House quality and access, but we need to do it in a way that we have the capacity to afford it,” said Stuart Altman, chairman of the Massachusetts Health Policy Commission, as he opened two days of hearings on health care cost trends in Massachusetts at Suffolk University Law School this morning.

Billed as an “opportunity to present evidence and testimony to hold the entire health care system accountable,” the Annual Health Care Cost Trends Hearing represents the first review of the state’s performance under the health care costs growth benchmark established in Chapter 224 in 2012. Over two days, the Commission is examining cost trends for public and commercial payers as well as hospitals and other providers.

Along with health care policy experts making detailed presentations, nearly 30 individuals – a list that reads like a “Who’s Who” of Massachusetts health care – are providing testimony on such topics as meeting the health care cost benchmark, transforming the payment system, coordinating behavioral health and post-acute care, and insurance market trends and provider market trends in promoting value-based health care.

The mood among the HPC commissioners and morning’s presenters as the session began was generally upbeat, as the Center for Health Information and Analysis (CHIA) last month released the first report on the Commonwealth’s performance. With the health care cost growth benchmark set at 3.6 percent, CHIA found that total health care expenditures increased by 2.3 percent , 1.3 percent below the benchmark. Total expenditures reach $50 billion statewide.

Governor Deval Patrick, one of the first to speak and declaring that “health is a public good,” said that “by any measure, Massachusetts health care reform is a success,” at the same time cautioning that even after eight years of health reform “there’s plenty of room to innovate” and “constant refinement” will be needed. Patrick added that challenges remain, chief among them the delivery of primary care.

Jeffery Sanchez, Chair of the legislature’s Joint Committee on Public Health, the second public official to speak, was also upbeat but cautious as well. “Let us continue to show the nation we continue to be a leader,” he said, at the same time expressing concern about behavioral health, alternative payment systems, and reaching underserved populations. He noted that minorities have difficulty navigating the health care system, and that it is imperative to “make sure the health care system is accessible and effective for all.”

Morning presentations included those from David Seltz, executive director of the Health Policy Commission; Aron Boros, executive director of CHIA, and Michael E. Chernew, Ph.D., Professor in the Department of Health Care Policy at Harvard Medical School. Other expert speakers scheduled include Alan Weil, J.D., Editor-in-Chief, Health Affairs, and Thomas Lee, M.D., Chief Medical Officer of Press Ganey Associates.

The hearing concluded at the end of the day on Tuesday. Written testimony, agency reports, and expert presentations are available on the HPC’s website at www.mass.gov/hpc. Live streaming of the hearing is also available from the website.

News coverage of hearings:

Health care stakeholders size up cost-control bid
State House News Service via Worcester Business Journal, October 7, 2014

 

 

Perspective: CMS Release of Physician Payments

Posted in Health Policy, Health Reform on May 7th, 2014 by MMS Communications – Comments Off on Perspective: CMS Release of Physician Payments
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MMS President Ronald Dunlap:   perspective needed on Medicare payments.

When the Centers for Medicare and Medicaid Services (CMS) last month  released its physician payment data for 2012, the agency described it as a major step forward for health care transparency, and CMS administrators and Congressional representatives alike extolled the virtues of making such information public.

The proposed action wasn’t without controversy. Prior to its release, nearly 100 national, state, and specialty medical societies signed on to a letter sent in September 2013 to CMS citing physician concerns about the release of raw data and opposing its release, saying it “should be limited for specific purposes and with appropriate safeguards.”

The letter further stated that the societies welcomed “the opportunity to work with CMS to improve meaningful and appropriate access to this information and recognize the potential value and importance of Medicare physician claims data,” and it encouraged CMS to partner with physicians to develop policies that will “promote the reliable and effective use of this information” and cited many concerns physicians had about releasing the data.

CMS released the raw data on April 9, and, predictably, news coverage was widespread across the nation.  The Wall Street Journal wrote that “The trove of Medicare data released Wednesday shows a wide cast of characters in the top ranks of the highest-reimbursed doctors, and reveals as much about the limits of the newly public billing records as it does about medical practice.”

The New York Times noted the limits of the data as well, writing that “Many other doctors worried that the data released was incomplete and often misleading. In some cases, enormous payments that seem to be going to one doctor are actually distributed to multiple others. But the data tables do not reveal that the money was shared.”  Much of the news coverage in the Commonwealth focused on local physicians receiving large payments.

Reaction from physicians was mixed; some were outraged, some were surprised, some were resigned to the data’s release as part of the continuing trend in transparency.  CMS released the data with a minimum of explanation, saying only that there may be legitimate reasons why doctors get high Medicare payments. But physician payments, from whatever source, are part of the highly complex nature of health care spending and require some perspective for better understanding.

MMS President Dr. Ronald Dunlap offers such a perspective in this commentary, published May 2 on WBUR’s CommonHealth website.

 

April Physician Focus: Health Care Disparities

Posted in Health, Health Policy, Medicine, Physician Focus, Primary Care on March 31st, 2014 by MMS Communications – Comments Off on April Physician Focus: Health Care Disparities

A dozen years ago, the Institute of Medicine released its groundbreaking report on health care disparities, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. That report concluded that wide differences exist between racial and ethnic minorities and whites in access to health, availability of insurance, and the quality of care they received.

The IOM report made public a topic that today still commands the attention of the medical community, and it’s the subject of the April episode of Physician Focus.

Guests for the show are Ronald Dunlap, M.D. (photo, center), President of the Massachusetts Medical Society, and Milagros Abreu, M.D., M.P.H. (right), Vice Chair of the MMS Committee on Diversity in Medicine and Founder and President of the Latino Health Insurance Program in Framingham. Alice Coombs, M.D., (left) past president of MMS and a member of the American Medical Association’s Commission to End Health Care Disparities, serves as host.

Among the topics of conversation by the physicians are the causes of health care disparities, their consequences on the health outcomes of patients, and the steps both physicians and patients can take to reduce these differences and improve care.

April’s Physician Focus is part of a renewed attention to the issue of health care disparities by the Medical Society, as outlined by Dr. Dunlap in his blog post of March 28 (below).

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