The President’s Podium: MMS Grassroots Advocacy Leads to Another Positive Step in the Opioid Battle

Posted in Drug Abuse, Leadership, opioids, Public Health on February 26th, 2016 by MMS Communications – Comments Off on The President’s Podium: MMS Grassroots Advocacy Leads to Another Positive Step in the Opioid Battle

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

Dr. Dennis Dimitri, MMS PresidentLed by two members of the Massachusetts congressional delegation, another encouraging step has been taken in the battle against opioid abuse, and it is a prime example of the value and effectiveness of the Massachusetts Medical Society’s grassroots physician advocacy.

In a bipartisan effort, Senator Elizabeth Warren and Representative Katherine Clark, along with Senator Shelley Moore Capito (R-West Virginia) and Representative Steve Strivers (R-Ohio), have filed legislation in Congress to allow the partial filling of opioid prescriptions.

The Reducing Unused Medications Act would permit prescriptions for pain medications to be partially filled at the request of the physician or patient. The goal of the bill is simple: to reduce the amount of unused pain pills, thereby limiting the number of drugs that can be diverted.

It is a critically important goal. One of the major factors contributing to the opioid epidemic is the availability of prescription medications. Physicians have come to realize that, in their efforts to reduce pain, too many prescriptions have been written. This overprescribing has led to the diversion of medications, so much so, in fact, that the majority of individuals – estimates are about 70 percent – who misuse or abuse pain medications get them from prescriptions written for friends or family. The number of Americans 12 years of age and older who report using prescription pain medications for nonmedical use approaches 12 million.

A partial-fill prescription would help patients balance the need to relieve pain with an adequate supply of pain medication by only filling part of the prescription. Should they need additional pain relief, patients will be able to return to the pharmacy to fill the remaining portion of their prescription. Partial-fill prescriptions can be a useful tool for physicians, many of whom find it genuinely hard to know how much pain medication to prescribe.

The idea of partial-fill prescriptions began within our own medical society, with the concept first surfacing at a Worcester North District Medical Society meeting with my predecessor, Dr. Rick Pieters. With MMS advocating for its adoption, the idea caught the attention of elected officials at both the state and Federal levels.

Massachusetts State Senator John F. Keenan (D-Quincy), who served as Vice Chair of the Special Senate Committee on Opioid Addiction Prevention, Treatment and Recovery Options, included a provision for it in a bill the Senate passed last year, and Senator Warren and Representative Clark have now filed a bill in Congress.

Questions remain, however, about the legality of partial-fill prescriptions. Current Drug Enforcement Administration regulations allow for partial fills for Schedule III, IV, and V, but prohibit them, with few exceptions, for Schedule II.

The legislation filed by Senator Warren and Representative Clark (which follows an effort last year by both legislators, supported by the entire Massachusetts Congressional delegation and dozens of others members of Congress, urging DEA to allow such prescriptions) elevates the importance of this step in the fight against opioid abuse. Most importantly, the bill would provide clarity from the DEA about the legality of partial-fill prescriptions and permit states to act.

MMS strongly supports partial-fill prescriptions and believes they can be an important tool in fighting opioid abuse. Last year, at the Massachusetts State House we testified in support of House Bill 1929, legislation permitting partial-fill prescriptions, with the caveat that the bill allow for the remainder of the partial-filled prescription to remain valid.

Improving the way prescription painkillers are prescribed can reduce the number of people who misuse, abuse, or overdose from these powerful drugs, while making sure patients have access to safe, effective treatment. The partial-fill concept is one way to do that, and we are encouraged by and strongly endorse the action of Senator Warren and Representative Clark.

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

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

Posted in Annual Meeting 2015, Leadership, workforce on May 8th, 2015 by MMS Communications – Comments Off on The President’s Podium: “Physicians Really Are Different”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Watch Dr. Dimitri’s remarks here:

The President’s Podium: Opinions of our Profession

Posted in Leadership, workforce on December 2nd, 2014 by MMS Communications – Comments Off on The President’s Podium: Opinions of our Profession

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

My President’s Message in the November issue of Vital Signs, our monthly publication for MMS members, cited encouraging findings from The Physicians Foundation 2014 survey. The survey, which received  responses from more than 20,000 physicians across the U.S., found that 49 percent of us feel positive about the future of the medical profession. While that’s still below half, it’s a huge 26 percent increase from TPF’s 2012 survey.

Despite the trend, however, pessimism and negativity are growing, even from some colleagues within the profession. In an August 29 essay in The Wall Street Journal headlined Why Doctors Are Sick of their Profession, cardiologist Dr. Sandeep Jauhar writes:

“Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future …. The growing discontent has serious consequences for patients.”

Other physicians have expressed similar dissatisfaction with the profession, whether it stems from administrative overload, more legislative or regulatory requirements, or intrusion into the physician-patient relationship.

This kind of perspective is reaching patients. An essay entitled Doctors Tell All – and It’s Bad in the November edition of The Atlantic by Meghan O’Rourke – a self-described “patient and the daughter of a patient” – states:

“A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments…. Few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades.”

Medicine has indeed changed dramatically. But is our profession deteriorating as fast as some suggest? Are patients being negatively affected?

Many of us may bristle at the increasing administrative hassles, the interference in the physician-patient relationship, and the loss of independence.

I do not, however, believe medicine is “just another profession.” And I don’t think our patients do either.

Consider these assessments: a Gallup poll ranks doctors fourth among professions in honesty and ethics, and a Harris poll shows doctors to be regarded as the most prestigious occupation in America. The Harris poll also found that 91 percent of respondents would encourage a child to become a doctor.

Consider also an October 23 Perspective article in the New England Journal of Medicine, which seems to paint a different picture.

A review of polls on public trust in U.S. physicians and medical leaders from 1966 through 2014, as well as a survey of 29 countries, reveals that “public trust in the leaders of the U.S. medical profession has declined sharply over the past half century and that “the level of public trust in physicians as a group in the United States ranks near the bottom of trust levels in a survey of 29 industrialized countries.”

The authors of the article cite a Gallup poll of June 2014 indicating that only 23 percent of the public has confidence in the U.S. health care system. “We believe,” the authors write, “that the medical profession and its leaders are seen as a contributing factor.” Yet another Gallup poll released in November shows that 66 percent of Americans are satisfied with how the health care system works.

But here’s the key finding from the NEJM article: the decline in trust is not reflected in patient satisfaction with medical care. While the U.S. may rank near the bottom internationally in the public trust in physicians, it ranks near the top in patient satisfaction with medical treatment.

Our own public opinion poll of last year found a similar result. The overwhelming majority of Massachusetts residents (84 percent) remains as satisfied with the health care they receive as they were before reform began in 2006. The biggest reason: the “quality of care.” That reflects the work we’re doing as physicians.

So as the polls continue, and the pessimism persists, let’s take both in stride. Most of all, let’s listen, to our patients. They are, in the end, the best judges of our performance as physicians, and they’re telling us we’re doing well.

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

The President’s Podium: Physician, Inc.

Posted in Health Policy, Health Reform, Leadership, Payment Reform, Regulation on March 18th, 2014 by MMS Communications – Comments Off on The President’s Podium: Physician, Inc.

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

In my first post on this site last August, I called attention to a survey of DSC_0003 Dunlap 4x6 color 300 ppi_editednearly 3,500 physicians that found that 60 percent of physicians would not recommend their profession as a career.

I suggested that the finding was not surprising, as the high level of discontent within our profession is due mostly to the growing business and administrative requirements of medicine that we must meet and maintain. As we began our medical careers, few of us thought we would become “providers” in the health care “industry.”

The March edition of our member newsletter, Vital Signs, recognizes this reality with the theme of The Business of Being a Physician.  My President’s Message in that issue said “we cannot pretend that we can divorce ourselves from the financial realities battering the health care industry.”  Like it or not, the establishment of business principles in the profession of medicine long ago stopped being a trend; it has been a reality to an increasing extent, and is now widespread.

The business and financial aspects of medicine weigh on all of us. They threaten the viability of many practices and push physicians to make hard choices about their profession and careers.  They intrude into the physician-patient relationship, steal time from engaging our patients, and erode the control we should have over how we practice medicine and how we care for our patients.

The legislative, regulatory, and commercial mandates and requirements continue to increase. Some of these changes are positive; some not so much so. Collectively, however, they present enormous challenges.

At the Federal level, the Affordable Care Act has set regulations on such areas as quality reporting, physician ownership and referrals, medical homes, accountable care organizations and payment practices.  The presence of the Independent Payment Advisory Board, despite its inactivity, still looms, and the explosion of billing codes, known as the ICD-10, is scheduled to take effect later this year.

At the state level, legislative efforts such as Chapter 224 have added more requirements: insurance regulations governing such newly-named entities as “Risk-Bearing Provider Organizations,” proficiency with electronic medical records, and price transparency, just to name a few.  Regulations and requirements from insurers and regulators further add to our administrative load.

We are being inundated with compliance measures and calls for metrics and analytics and other databases, even when many practices are ill-equipped to provide such information given inadequate or nonexistent health information technology systems.

The Medical Society continues to speak out on these issues. In testimony before the Massachusetts Health Policy Commission in February, I pointed out that the rising number of requirements asked of physicians takes time away from patient care, adds to administrative demands, and raises the costs of practicing medicine.  I further said such requirements will drive small to mid-sized practices to merge or align with larger entities that have the ability to meet such requirements and that this could lead to further consolidations and higher costs in the health care market –a phenomenon already well underway in the Commonwealth.

On the national level, rising physician frustration with the direction of medicine is leading more of our colleagues into the political arena. A New York Times report of March 8  noted that “a heightened political awareness and a healthy self-regard that they could do a better job, are drawing a surprising large number [of physicians] to the power of elective office.”

Such political activism by physicians is rare at the state level.  Whether more physicians in national office, while a hopeful sign, will affect change remains to be seen. But it is likely to alter one critical dynamic: bringing added weight to the voice of physicians in the conversation about health care.  That is a key development.

It is imperative that those who propose changes to the practice of medicine recognize and understand how the consequences of those changes – intended and unintended – will affect the practice of medicine.  Who better to tell them than those of us on the front lines of patient care?  We must accept that we’re now part of an “industry” and that the “business of medicine” is here to stay due to cost constraints. It is necessary however, for physicians to have an unmistakable and conspicuous voice in how that business operates.

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

The President’s Podium: Unhappy Doctors?

Posted in Health Reform, Leadership, Medicine on August 12th, 2013 by MMS Communications – 1 Comment

by Ronald Dunlap, M.D., President, Massachusetts Medical Society 

The headline shouted the news – 60% of Docs Wouldn’t Recommend Their Profession as a Career – recounting the sentiments of a nationwide survey of nearly 3,500 physicians. And while we may parse the responses – Is it a generational thing? Does specialty matter? – it’s likely most physicians aren’t surprised at the result. Changes to our profession have been fast and extensive in recent years, and we’re constantly adjusting to new demands.

When six out of ten doctors, however, suggest they’re unhappy, it prompts some key questions. What might patients think of this? Are discontented doctors affecting the physician-patient relationship? Or are survey respondents just blowing off steam out of frustration?  I think that it’s an important issue. Here’s my take on the reasons behind the survey results:

Mounting administrative and mandated requirements. Prior authorizations, certifications, complex billing, and the myriad of administrative tasks before us all steal time from the thing we most love to do: engagement in patient care. Ever-expanding oversight (though some, we’ll agree, is good and necessary) through more and more rules and mandates from insurers, legislators, and regulators, some duplicating the others, steal more time, and chip away at the control we have over how we practice medicine.

The imposition of information technology. Advocates say IT will lead to better quality care, but for many physicians, it’s been more of a disruption than an improvement to medical practice. Big investments of money and time, without appreciable return, along with lack of interoperability among systems, have soured many on computers, despite financial incentives. Computers have provided some benefits and may yet prove to improve health care, but the evidence so far is limited, and the transition is not complete.

The cost of educating physicians. Many young doctors avoid primary care or public health positions in favor of higher-paying specialties that may offer a more flexible lifestyle. It’s easy to understand why, when they’re coming out of medical school with hundreds of thousands of dollars in debt. The extraordinary cost and years of training are raising questions about the return on their investment of time and money.

Other issues weigh on our perspective. These include declining and changing reimbursements, the specter of liability, the uncertainty of reform, and imperfect rating systems from a host of sources telling us how well (or not) we practice medicine.

These are legitimate concerns. I suggest, however, that our discontent is not with the practice of medicine, but rather with the business of medicine – a fact borne out by the survey that prompted this post. I suspect, as those who conducted the survey do, that the disenchantment was prompted in part by colleagues letting off steam.

As my fellow MMS members and I work to fix what’s wrong, I remind myself that “physician” remains at the top of every poll ever taken of most admired professions and that, in the words of Dr. William Osler, we are distinguished from all other vocations by our unique ability to do good. I hope my patients feel the same way.

The President’s Podium is a new feature that will appear regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   



Interim 2012 President’s Report: “Honor Traditions, Continue as Leaders”

Posted in Interim Meeting 2012, Leadership, Payment Reform on November 30th, 2012 by MMS Communications – Comments Off on Interim 2012 President’s Report: “Honor Traditions, Continue as Leaders”

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.”

Dr. Aghababian’s complete remarks may be read here.


Five Physician Leadership Skills For the Future

Posted in Health Policy, Leadership on February 3rd, 2012 by MMS – Comments Off on Five Physician Leadership Skills For the Future

Physician leaders are much in demand today, but the physician leader of the future must be more than just an accomplished clinician. Just as vital will be skills in:

  • Communication and collaboration skills
  • Peer review and management abilities
  • Long-term goal setting and strategic planning
  • An understanding of health care economics and data

That’s what more 50 physicians heard at the MMS this week, as they gathered to strengthen their skills in a subject rarely taught in medical school or residency: Leadership. It was the inaugural sessions of the MMS’ new Physician Leadership Institute.

“The reinvention of health care is just beginning,” MMS President Dr. Lynda Young told the attendees of the four-part series. “We want to teach more physicians the art, science and discipline of leadership.”

The first session, “Changing Paradigms in Healthcare; What Does the Future Hold?” included a overview of health care industry trends, as well as seminars on change management, generational differences among physicians, emerging roles for physician leaders, and coaching and mentoring skills.

The group will meet for two online sessions, before the final live module, “Evolving Roles for Physician Leaders in the Age of Healthcare  Reform,”  focusing on organizational transformation, goal-setting and problem-solving, and technology implementation, scheduled for September 14.

This week’s session was conducted by the California-based Institute for Medical Leadership, with training conducted by its president and CEO,  Susan Reynolds, M.D., and presentations from  Institute faculty members C. E. Mickey Bilbrey, former president and CEO of the University of Tennessee Medical Center,  and Richard Corlin, M.D., president of the AMA from 2001-2002.

Clinical integration, cooperation between health systems and hospitals, cost management, and quality measurement techniques will be vital to the future of the industry, so physicians must be the ones to lead patients, peers, administrators, payers, and elected officials in the right direction, Institute staff said.

“We have to have great physician-leaders to lead this process,” Bilbrey said. “You can’t sit on the sidelines.”

Reynolds described the evolving roles for physicians to lead in areas of quality and patient safety and information technology, including many executive positions that did not exist only a few years ago.

One of the biggest challenges for physician-leaders is abandoning traditional, dictatorial model of management in favor of the team-building, collaborative approach demanded by 21st century health care systems.

“The most successful physician leaders are going to be the one who close the gaps,” said Reynolds.

Erica Noonan