The chief policy-making body of the Massachusetts Medical Society today passed a set of recommendations relating to the state’s new medical marijuana law, calling for the MMS to advocate for the development of appropriate certification criteria for certification for medical marijuana use.
The resolution, approved by the MMS House of Delegates at its Interim Meeting, also calls for the Society to work with the Board of Registration in Medicine to define the physician-patient relationship required for such treatment.
MMS also voted to advocate for the development of physician licensing standards for marijuana certification, and specifications for marijuana registration cards for patients.
Saturday’s resolution also calls for MMS to advocate for regulations reflecting the implications of medical use of marijuana on occupational health and safety. New Massachusetts regulations should include comprehensive treatment recommendations developed in 2010 by the American Society on Addiction Medicine.
Marijuana should be included within the existing state Prescription Monitoring Program, and physicians who prescribe it should be exempted from existing state peer-reporting requirements, the resolution stated.
The overriding refrain in medical care over the last several years has been persistent if nothing else: “the continuing cost of medical care is unsustainable.” The subsequent calls for “cost-conscious medicine” have been ringing louder and more frequently. The trend is inevitable, as governments at all levels, businesses of all sizes, and individuals who buy coverage struggle with strained budgets and rising costs.
The efforts for cost control in the Commonwealth culminated this year with Chapter 224, the cost-containment law passed earlier this year by the legislature.
So what might be the impact on physicians? How should physicians react? And what could it mean for patient care?
Some answers came from the 2012 Interim Meeting’s Ethics Forum, Serving Two Masters – What Practicing Cost-Conscious Medicine Means for Patient Care and the Public Trust.
Presenters included James E. Sabin, M.D., Clinical Professor in the Departments of Population Medicine and Psychiatry at Harvard Medical School and Director of the Harvard Pilgrim Health Care Ethics Program, and Martin Samuels, M.D., Professor of Neurology at Harvard Medical School and Neurologist-in-Chief and Chairman of the Department of Neurology at Brigham and Women’s Hospital and Co-Chair of Partners Neurology.
Over nearly two hours, the physicians offered their perspectives on the issue and the direction that physicians might take in today’s practice environment of ever-increasing fiscal constraints. Some excerpts from their presentations:
Dr. Sabin – “Implementing cost-conscious medicine will take time and will not be easy…the biggest impediment is more emotional than intellectual…We must involve patients and the public in our deliberations and policy-making…They will only trust the concept of cost-conscious medicine if they believe the quality of care is preserved and the savings will be used for good purpose.Physicians are the crucial players in this endeavor, we can be spoilers or leaders….It is our responsibility to make it work.”
Dr. Samuels – “The important question is which master do we serve? … Simultaneously considering the interests of society and the individual patient represents an irresolvable conflict of interest… Overutilization is expensive and dangerous….Errors are unavoidable, despite our best efforts, and without errors, we have no progress…Believe in the concept that physicians are required to do everything that they believe may benefit each patient, without regard to costs or the societal considerations…because the best individual care is cost effective.”
Posted in Interim Meeting 2012, MMS Oration on November 30th, 2012 by Erica Noonan – Comments Off on Moving Medicine from a Guild to an Enterprise: 2012 MMS Oration
Physicians are watching their profession rapidly transform from the guild-oriented practice of medicine to a an enterprise-oriented industry one might call ”Big Med,” said H. Eugene Lindsey, M.D., president and CEO of Atrius Health.
“One could say that we are now a guild under siege,” said Dr. Lindsey, who delivered the 2013 MMS Annual Oration, titled “Working Together: From Guild to Enterprise” on Friday as part of the Society’s two-day long Interim Meeting.
Atrius has been preparing itself for accountable care and global payments for many years, Lindsey said, but is still struggling to solve the problems plaguing virtually all modern health care organizations: increasing accountability, reducing costs and practice variations, eliminating waste and maintaining physician satisfaction levels.
“We have not been able to progress as far or as fast as we hoped,” he said. Atrius and other organizations will have to innovate quickly to stay ahead of the consequences of expected cuts in reimbursement rates and prevent loss of care quality, he said.
Another crucial objective is to improve physician happiness through improved management performance and standardization of work so that physicians have more time for patient care and critical thinking work. Among the challenges his organization will face is a predicted shortage of PCPs. By 2025, more than 130,000 physicians nationwide – more than half of them PCPs – are expected to complete retirement.
“Improving the experience of practice remains a great challenge,” said Lindsey. “We must move guild thinking into a new environment.”
Addressing the Medical Society’s House of Delegates at its 2012 Interim Meeting on November 30, MMS President Richard Aghababian, M.D., provided members with a quick perspective of the major events in health care that have taken place over the last six months – from the Supreme Court’s affirmation of the Affordable Care Act to Massachusetts’ payment reform bill to ballot questions on medical marijuana and physician-assisted suicide. Here are some highlights from his President’s Report.
State Payment Reform Bill “The state payment reform and cost control legislation is complex…and it’s already apparent that some sections will need technical corrections and amendments. We will put special focus on the sections that impose substantial administrative burdens on practices, especially those involving public reporting and provider registration. We also believe the bill may have taken the concept of transparency too far, and we will work to make these requirements more reasonable. The state is also beginning to implement one of the sections of the legislation that we favor the most – the introduction of the Disclosure, Apology and Offer system for medical liability claims.”
Physician Assisted Suicide and Medical Marijuana Ballot Questions “We implemented a comprehensive education campaign on both issues…Almost every news story on either Question 2 or Question 3 mentioned the position of the Massachusetts Medical Society …We are grateful that the assisted-suicide question did not prevail, but we still must take action by offering our members and colleagues training in compassionate, end-of-life care. CME programs are being planned.”
“The question on medical marijuana did pass…and the most important question for physicians is this: What exactly must physicians do when the law takes effect on January 1? What are our rights and responsibilities and what are the risks, both clinically and legally? ….There is more confusion than clarity, but physicians are getting questions about this from their patients every day, and they needed some answers….our legal staff quickly produced a detailed commentary about the law posted on our website. We will watch this matter closely during the regulatory process.”
Affordable Care Act and Impending Medicare Cuts “The future of the ACA is all but assured, but the future of Medicare and other federal programs is anything but certain…The AMA continues to fight for a permanent repeal of the SGR, to stabilize both Medicare and the Federal deficit….The only sensible answer is to end the SGR and move forward with a new payment model for Medicare. The AMA hopes to address the immediate cuts during this coming month, while setting the stage for a more permanent solution next year. We completely support the AMA’s approach and stand ready to assist with outreach to our congressional delegation as needed.”
Changes in the practice environment “Over the last few years, we’ve seen many physicians leave independent practices and become employed….The transition to employed status is just one of the changes we’re seeing. We have entered a period of continuous evolution in health care. There is no end point to this process…so this environment calls for a continuous improvement approach…surveying the environment, identifying the challenges and opportunities, developing a plan to adjust, implementing the plan, and assessing the results and making adjustments as needed.”
Honor Traditions and Values, Continue as Leaders In closing his remarks, Dr. Aghababian urged members to “maintain our collegiality and cohesiveness as physicians, even when certain issues threaten to divide us. We must recognize diversity of opinion, but not allow those disagreements to define us….Let us take this opportunity, at this meeting, to honor our traditions and values, while continued to serve as leaders in health care reform.”