News & Press

AMA Letter to Walmart CEO on Opioid Policy

Thu, 23 Aug 2018 18:24:22 GMT

The below is excerpted from an August 16, 2018, letter from the AMA to Walmart CEO and President Doug McMillon

Doug McMillon
President and Chief Executive Officer
Walmart, Inc.
702 SW 8th St.
Bentonville, AR 72716

Marybeth Hays
Executive Vice President of Consumables
and Health and Wellness
Walmart, Inc.
702 SW 8th St.
Bentonville, AR 72716

Dear Mr. McMillon and Ms. Hays:

On behalf of the American Medical Association (AMA) and our physician and medical student members, I am writing to share our concerns resulting from new Walmart pharmacy policies. The concerns specifically focus on the new policy that was announced in May whereby “Walmart and Sam’s Club will restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50 morphine milligram equivalent maximum per day.” (See https://news.walmart.com/2018/05/07/walmart-introduces-additional-measures-to-help-curb-opioid-abuse-and-misuse) There are three main reasons for our concern:

First, contrary to the news release you issued, this policy is not in alignment with the Centers for Disease Control and Prevention’s (CDC) Guideline for Prescribing Opioids for Chronic Pain. (See https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm) The CDC itself has emphasized the voluntary nature of the guidelines and argued against using them as a prescriptive standard (Continued)

Second, the new policy threshold leaves many questions unanswered. The AMA was pleased that Walmart representatives sat down with us in March of this year along with representatives from the AMA Opioid Task Force, including the Arkansas Medical Society. ... In light of the March meeting, we were greatly surprised to learn of your new corporate policy based on a hard threshold of 50 MME or seven days for an initial opioid prescription for acute pain. In the spirit of collaboration from our March 1 meeting, AMA staff has repeatedly attempted to learn more from Walmart representatives, including:
• What communication about the new policy will be shared with physicians?
• How will Walmart pharmacists implement the policy when it is not clear if a prescription is for acute or chronic pain?
• How will Walmart pharmacists adjudicate a prescription that is for more than seven days or more than 50 MME?
• Will Walmart pharmacists be bound by the new corporate policy, or will they have the professional obligation and flexibility to review prescriptions based on their corresponding responsibility under the Controlled Substances Act?
• If a state law has a threshold that is above the new corporate policy, will Walmart abide by the state law or substitute its corporate policy instead?

Third, as we have done in Congress, state legislatures and other venues across the country, we feel it necessary to point out that the focus on reducing the supply of opioid analgesics may be helpful to reduce diversion, but it will not, by itself, reverse the nation’s opioid epidemic. Walmart’s new corporate policy will almost certainly have two direct effects: it will reduce the supply of opioid analgesics, but it will also cause patients with pain to have increased suffering. (Continued)

We stand ready to work with Walmart and all stakeholders to help end the nation’s opioid epidemic. Please contact the AMA’s Daniel Blaney-Koen, JD, Senior Legislative Attorney at daniel.blaney-koen@ama-assn.org or (312) 464-4954 to continue this important discussion.

Sincerely,
James L. Madara, MD

MSDC Advocacy Urges Access to Healthy Food to Curb Obesity and Diet-Related Illness

Wed, 26 Jul 2017 13:57:52 GMT

MSDC Leads Effort to Decrease Obesity and Increase Access to Healthful Foods, Especially Among the Poor

At the Annual Meeting of the American Medical Association in June, the MSDC's AMA Delegation proposed two resolutions which addressed issues affecting District physicians and patients: the critical role of healthy eating habits and the negative impact of food deserts in managing obesity, diabetes, cardiovascular disease, and other conditions. The first resolution on healthful hospital foods aimed to improve the health of hospital patients, staff and visitors by increasing access to nutritious meals at hospitals. A second resolution addressing the Supplemental Nutrition Assistance Program (SNAP) combats food deserts and harmonize SNAP food offerings to improve access to healthful food for the poor. Read more in AMA Wire.

Studies Show Once Again that The Way To A Patient's Heart Is Through His Stomach
The role that a healthy diet plays in individual health is well-established. A recent study in the New England Journal of Medicine found that people who added healthful foods to their diets over time improved their odds for living longer. But in order to act on that knowledge, people must have access to healthful foods. Food deserts in the District of Columbia and across the nation place a barrier on patient options for a healthy diet, and the Medical Society hopes that increased access to healthful foods can help improve patient health and curb obesity, diabetes, cardiovascular disease and a range of other conditions.

A Squeaker In The House Becomes Headache For The Senate

Fri, 5 May 2017 21:00:09 GMT

A Squeaker In The House Becomes Headache For The Senate
Source: Kaiser Health News, Julie Rovner, May 4, 2017

After weeks of will-they-or-won’t-they tensions, the House managed to pass its GOP replacement for the Affordable Care Act on Thursday by a razor-thin margin. The vote was 217-213.

Democrats who lost the battle are still convinced they may win the political war. As the Republicans reached a majority for the bill, Democrats on the House floor began chanting, “Na, na, na, na … Hey, hey, hey … Goodbye.” They claim Republicans could lose their seats for supporting a bill that could cause so much disruption in voters’ health care.

Now the bill — and the multitude of questions surrounding it — moves across the Capitol to the Senate. And the job doesn’t get any easier. With only a two-vote Republican majority and no likely Democratic support, it would take only three GOP “no” votes to sink the bill.

Democrats have made clear they will unanimously oppose the bill. “Trumpcare” is just a breathtakingly irresponsible piece of legislation that would endanger the health of tens of millions of Americans and break the bank for millions more,” said Senate Minority Leader Chuck Schumer (D-N.Y.).

And Republicans in the Senate have their own internal disagreements, too.

Here are five of the biggest flashpoints that could make trouble for the bill in the upper chamber.

Read the full KHN article.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Attention to Doctor Burnout Benefits Patients and Doctors Alike

Wed, 1 Feb 2017 14:51:48 GMT

Attention to Doctor Burnout Benefits Patients and Doctors Alike
Source: NBC4 Washington, Doreen Gentzler and Christina Romano

No one is immune to burnout, least of all people who work in high pressure jobs like medicine.

“You worry about it the whole time … so it's a very stressful and also isolating profession,” said Kumudhini Hendrix, an anesthesiologist at Medstar Georgetown Hospital.

“I think there's always been some awareness that people were susceptible to burnout in the face of stress,” said Dr. Darrell G Kirch of Association of American Medical Colleges.

A recent Mayo Clinic study put physician burnout at 54 percent, concluding, “Burnout and satisfaction with work-life balance in U.S. physicians worsened from 2011 to 2014. More than half of U.S. physicians are now experiencing professional burnout.”

“Didn't realize it, but indeed I was,” Hendrix said. “A lot of depersonalization, emotional exhaustion to the point that if something doesn't go right, I would easily cry, easily get upset, of course not in front of anyone ... Got to tough it out.” “I think the belief that you come to medicine to give care not to need care is very, very deeply rooted in the profession,” Kirch said.

Those attitudes appear to be changing for the sake of the health of doctors and patients. “There actually is growing evidence that the problem of burnout among physicians has a negative impact on patient care,” Kirch said.

The Mind/Body Medicine program at the Georgetown University School of Medicine was created 15 years ago and focuses on mindfulness and meditation. It is available for medical students and faculty. Sharing, meditation and activities aimed at mindfulness are all part of the program.

Read the full NBC4 Washington story and see the video online.

Congress Votes Along Party Lines to Repeal Affordable Care Act

Fri, 13 Jan 2017 20:50:09 GMT

House Votes to Begin Obamacare Repeal Process
Source: Washington Post, Mike DeBonis, January 13, 2017

Congress took its first step toward rolling back President Obama’s health care reform law Friday, with the House voting along party lines to pass key preliminary legislation.

The measure, which was passed Thursday by the Senate, will allow Republicans to use special budget procedures to repeal major parts of the Affordable Care Act without cooperation from Democrats.

House Republicans from divergent wings of the party had raised concerns this week about taking the initial step without having a more detailed plan in place for ultimately replacing Obamacare with a GOP alternative.

But House leaders worked in recent days to address those concerns, even as President-elect Donald Trump made public statements setting out an ambitious timeline for action that many on Capitol Hill see as unrealistic. The final vote was 227 to 198.

House Speaker Paul D. Ryan (R-Wis.) said in a Friday floor speech that the measure set to be passed Friday would launch a “thoughtful, step-by-step process” toward replacing Obamacare.

“This is a critical first step toward delivering relief to Americans who are struggling under this law,” he said. “In the weeks ahead, several steps will be taken to provide relief — some steps will be taken by this body; some steps will be taken . . . by the new administration.

“Our goal is a truly patient-centered system, which means more options to choose from, lower costs and greater control over your coverage,” he continued. “And as we work to get there, we will make sure that there is a stable transition period so that people don’t have the rug pulled out from under them.”

Ryan said during a nationally televised town hall meeting Friday that Congress would act “definitely within these first 100 days” on a replacement plan.

Read the full article online.

Surgeon General Issues Report on E-cigarettes

Thu, 8 Dec 2016 21:45:50 GMT

Launching Today: Surgeon General’s Report on E-cigarettes
Letter from the Office of the Surgeon General

December 8, 2016

Dear Turn the Tide Colleague,

Today, as part of a larger effort to address addiction, U.S. Surgeon General Vivek H. Murthy published a report on an emerging public health threat affecting our country. E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General is the 33rd Surgeon General’s report in 53 years to address the impact of tobacco on health. It is the first to focus on e-cigarettes.

This report confirms that there is no acceptable level of nicotine when it comes to our kids.It notes that e-cigarettes are often a delivery system for nicotine, a highly addictive substance that can harm the developing brain. The report also confirms that the aerosol from e-cigarettes is not harmless. It can contain chemicals and particulates that are dangerous to the person using these products (“vaping”) and to anyone who may inhale that aerosol second-hand.

The Surgeon General’s report is available at E-cigarettes.SurgeonGeneral.gov. There you will also find tools for parents and a brand new Public Service Announcement from Dr. Murthy. Please help us promote this important publication by sharing it with your networks. We would also appreciate your help getting the word out on social media, using the hashtag #NoEcigs4Kids in your posts.

Like previous reports of the Surgeon General, this one discusses the marketing techniques to glamorize e-cigarettes. The Surgeon General calls on the industry to stop advertising practices which encourage young people to try these products. Our children are not an experiment, and we know enough about the risks of e-cigarettes to take action to protect them.

To mark the release of this report, the Office of the Surgeon General and the Centers for Disease Control and Prevention’s Office on Smoking and Health will host a live press conference today at 9:30 am EST. You can watch the livestream at www.hhs.gov/live.

We must never wait to prevent harm, especially when it comes to our kids. Together, we can protect America’s youth from the harms of e-cigarettes. When we know better, we must do better.

The Office of the Surgeon General
200 Independence Ave SW
Washington DC, 20201

Cancer Moonshot Could Boost National Capital Area's Research Community and Businesses

Fri, 9 Sep 2016 13:31:37 GMT

Here's What the Cancer Moonshot Recommendations Could Mean for Greater Washington

Source: Washington Business Journal, Tina Reed, September 8, 2016

At the Georgetown Lombardi Comprehensive Cancer Center, a computer program called the Georgetown Database of Cancer, or G-DOC, collects massive amounts of patient data surrounding the molecular makeup of their disease.

With the help of that database, Georgetown researchers are able to mine for patterns that might unlock the secrets of how to treat certain cancers.

But soon, that resource may become more powerful as it connects to similar tools at other cancer centers around the country. Creating a national data ecosystem is one of 10 recommendations guiding a national cancer moonshot initiative. Those recommendations were approved at the National Cancer Institute in Rockville on Wednesday. They constitute a list of priorities NCI officials hope will receive additional funding beyond the federal agency's typical budget as part of its moonshot efforts.

"The idea here is to combine these silos into a richer repository to get a fuller perspective of cancer," said Dr. Louis Weiner, the director of the Lombardi cancer center. He is also a member of the Blue Ribbon Panel of experts appointed to create those recommendations to guide the cancer initiative.

The data ecosystem example shows how cancer research in Greater Washington could receive a boost as the result of the national initiative being led by Vice President Joe Biden.

Read the full article for other ways that the Cancer Moonshot could impact the region.

$53 Million Dedicated to 44 States and DC to Help Address Opioid Epidemic

Fri, 2 Sep 2016 21:59:17 GMT

HHS Awards $53 Million to Help Address Opioid Epidemic

Source: U.S. Department of Health & Human Services issued a Press Release on August 31, 2016.

Additional funding needed to ensure access to evidence-based treatment

Today, the U.S. Department of Health and Human Services announced $53 million in funding to 44 States, four tribes and the District of Columbia to improve access to treatment for opioid use disorders, reduce opioid related deaths, and strengthen drug misuse prevention efforts. In addition, funding will also support improved data collection and analysis around opioid misuse and overdose as well as better tracking of fatal and nonfatal opioid-involved overdoses.

“The epidemic of opioid use disorders involving the non-medical use of prescription opioid pain relievers and the use of heroin has had a devastating impact on individuals, families and communities across our nation,” said Substance Abuse and Mental Health Services Administration (SAMHSA) Principal Deputy Administrator Kana Enomoto. “These grants will help address the key elements of the opioid crisis by promoting effective prevention efforts, preventing overdose deaths and helping ensure that people with opioid use disorders are able to receive vital treatment and recovery support services.”

Administered by SAMHSA and the Centers for Disease Control and Prevention (CDC), the funding supports six programs.

The Medication-Assisted Treatment Prescription Drug Opioid Addiction Grants will provide up to $11 million to 11 states to expand access to medication-assisted treatment (MAT) services for persons with opioid use disorder. This program targets states identified as having the highest rates of primary treatment admissions for heroin and prescription opioids per capita, and prioritizes those states with the most dramatic recent increases for heroin and opioids. Awardees are Alaska, Arizona, Colorado, Connecticut, Illinois, Louisiana, New Hampshire, North Carolina, Oklahoma, Oregon, and Rhode Island. (SAMHSA)

The Prescription Drug Opioid Overdose Prevention Grants will provide up to $11 million to 12 states to reduce opioid overdose-related deaths. Funding will support training on prevention of opioid overdose-related deaths as well as the purchase and distribution of naloxone to first responders. Awardees are Alaska, Arkansas, Illinois, Missouri, New Jersey, New Mexico, Oklahoma, South Carolina, Washington, West Virginia, Wisconsin, and Wyoming. (SAMHSA)

The Strategic Prevention Framework Partnerships for Prescription Drugs Grants provide $9.3 million to 21 states and four tribes to strengthen drug misuse prevention efforts. The grant program provides an opportunity for states, U.S. territories, Pacific jurisdictions, and tribal entities that have completed a Strategic Prevention Framework State Incentive Grant to target the priority issue of prescription drug misuse. The program is designed to raise awareness about the dangers of sharing medications and work to address the risks of overprescribing. The program also seeks to raise community awareness and bring prescription drug misuse prevention activities and education to schools, communities, parents, prescribers, and their patients. Awardees are Alabama, Connecticut, Delaware, Georgia, Iowa, Louisiana, Maine, Maryland, Minnesota, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Vermont, West Virginia, and Wisconsin as well as Little Traverse Bay Bands of Odawa Indians, Cherokee Nation, Southern Plains Tribal Health Board, and the Nooksack Indian Tribe. (SAMHSA)

“States are on the frontline of preventing prescription opioid overdoses—it is critical that state health departments have the support they need to combat the epidemic,” said CDC Director Tom Frieden, MD, MPH. “States can use these funds to develop, implement, and evaluate programs that save lives.”

The Prescription Drug Overdose: Prevention for States program provides up to $11.5 million in supplemental funding to 14 states. This supplemental funding will support the ongoing work of awardees, allowing awardees to address issues such as high overdose death rates in tribal communities and improve toxicology and drug screening. States can use this funding to enhance prescription drug monitoring programs (PDMPs), further prevention efforts, and execute and evaluate strategies to improve safe prescribing practices. Awardees are California, Colorado, Indiana, Kentucky, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Washington, and Wisconsin. (CDC)

The Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI) will award $6 million to 13 states and DC to advance and evaluate state-level prevention activities to address opioid misuse and overdose. That includes enhancing their ability to:

Improve data collection and analysis around opioid misuse and overdose;
Develop strategies that impact behaviors driving prescription opioid misuse and dependence; and
Work with communities to develop more comprehensive opioid overdose prevention programs.
Awardees are Alabama, Alaska, Arkansas, Georgia, Hawaii, Idaho, Kansas, Louisiana, Michigan, Minnesota, Montana, New Jersey, South Dakota, and Washington, D.C. (CDC)

AAMC President Says Hospital Star Ratings are “Deeply Flawed”

Tue, 9 Aug 2016 13:42:04 GMT

Star Ratings “Deeply Flawed,” Offer Incomplete Picture of Hospital Performance

AAMC Urges Patients Not to Be Misled by Ratings

Source: Washington, D.C., July 27, 2016—AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, MD, issued the following statement following the Centers for Medicare and Medicaid Services’ (CMS) release of the Hospital Compare Overall Hospital Quality Star Ratings:

“Patients should beware of making decisions about hospitals using the newly released star ratings. They are based on a deeply flawed methodology that does not take into account important differences in the patient populations and the complexity of conditions that teaching hospitals treat. As a result, many of the nation’s leading teaching hospitals—institutions that provide the most advanced health care in the world—have been assigned lower ratings than other hospitals that treat patients with less complex conditions or that treat only certain conditions. This new system could have very serious consequences for patients who are choosing where to go for treatment, potentially driving them away from some of the best hospitals for their conditions.

Through these star ratings, CMS has implied that hospitals have been measured on an equal basis and that the comparisons are fair, an assumption that is unfortunately not true. Teaching hospitals perform a wide array of complicated and common procedures, pioneer new treatments, and care for broader socio-demographic patient populations that may not have access to regular care. Yet under the new ratings, they are compared directly to hospitals with more homogenous patient populations and hospitals that do not do enough procedures to be counted.

Read the full statement online.

Physicians Take on Timely Issues at AMA Annual Meeting

Fri, 17 Jun 2016 22:40:56 GMT

Source: Adapted from MSDC eNewsline, June 17, 2016

At the 2016 AMA Annual Meeting, Delegates adopted a variety of policies on important issues affecting the health of patients across the country. The AMA House of Delegates took action to address illegal methamphetamine production, standards of practice for dry needling, attorney ads on drug side effects and long-term health and wellness in the juvenile justice system. In addition, dozens of physicians, including MSDC Secretary and AMA Alternate Delegate Raymond Tu, MD (pictured below left), lined up to testify about expanding AMA policy on gun violence as they shared their experiences treating victims. Read more about the AMA's expanded policy on gun violence and an overview of the Annual Meeting. See also, the "11 new AMA policies that patients should know."

ABIM Suspends Controversial MOC Requirements Through 2018

Tue, 29 Dec 2015 13:49:35 GMT

Source: Medscape Medical News, Robert Lowes, December 16, 2015

In a policy retreat longer than Napoleon's march from Moscow, the American Board of Internal Medicine (ABIM) once again has relaxed its controversial requirements for maintenance of certification (MOC).

ABIM announced today that it is lifting the requirement that physicians earn MOC credits for improving patient care and safety and incorporating their preferences in medical decision-making for an additional 2 years. The three MOC activities in question go by the name of Practice Assessment, Patient Safety, and Patient Voice. The organization told diplomates in February that they won't have to complete these requirements, widely lambasted as busywork, for at least the next 2 years. The latest decision extends the suspension through the end of 2018.

In a news release, ABIM stated that it based its decision on feedback from internists and internal medicine subspecialists and the organization's commitment to "recognizing meaningful activities physicians are already doing in practice." To make its requirements less burdensome to diplomates, ABIM has been approving more continuing medical education activities undertaken apart from recertification as counting toward MOC credit.

Today's announcement follows a string of ABIM concessions to opponents over the past year. In June it said that it would update its recertification exam. A month later, ABIM said that physicians certified in nine IM subspecialties would no longer have to maintain underlying board certifications. In perhaps the biggest bombshell of the year, ABIM said in September that it would consider replacing its 10-year MOC exam with shorter, more frequent testing that physicians could take at home or in the office.

Read the entire article online.

Physicians Stand Up Against Mergers of Powerful Insurers

Thu, 12 Nov 2015 22:16:49 GMT

From the AMA Wire

Two marriages are in the works among the nation’s largest health insurers—and physicians are speaking up, refusing to forever hold their peace. The proposed mergers, which would reduce competition in the health insurance market, pose a substantial risk of harm to patients and physicians in terms of health care access, quality and affordability.

Health insurers have claimed that the mergers—Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna—will lead to greater efficiencies and innovative payment and care management programs. But is the claim based on fact?

“There is no evidence supporting the insurers’ claim,” the AMA said in a letter delivered to the U.S. Assistant Attorney General earlier this week The letter points to studies and analyses that speak to how the opposite is often the case.

The mergers would exceed federal antitrust guidelines put in place to preserve competition around the country. According to special AMA analyses released in September, the proposed mergers of Anthem and Cigna and of Aetna and Humana would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states. The mergers also would raise significant competitive concerns in additional areas. All told, nearly one-half of all states could see reduced competition in local health insurance markets.

The AMA letter urges the Department of Justice to “block the proposed mergers,” emphasizing that “fostering competition, not consolidation, benefits American consumers through lower prices, better quality and greater choice.”

Read the entire article.

Family Doctors Who Do More, Save More

Tue, 12 May 2015 19:47:07 GMT

Is a good family doctor one who treats your knee pain and manages your recovery from heart surgery? Or is it one who refers you to an orthopedist and a cardiologist?

Those are questions at the heart of a debate about primary care – one with serious health and financial implications.

A study from the American Academy of Family Physician's Robert Graham Center sheds some light on this topic. The findings, published in the latest issue of Annals of Family Medicine, suggest that family doctors who provide more care themselves save the health system money.

The researchers looked at 3,652 family physicians and 555,165 Medicare patients across the country. They found that patients of physicians who provided a wider range of services experienced fewer hospitalizations and incurred lower health care costs.