E-prescribing controlled substances: Here’s why the clicks add up

Electronic prescribing has taken off, making it easier for physicians to get orders quickly and safely to the pharmacy of the patient’s choice. Yet while 70% of physicians e-prescribe, only 20% are able to electronically order controlled substances such as analgesic opioids.

And accessing the information in state prescription drug-monitoring program databases—a key tool to prevent opioid misuse or diversion—is another question altogether. It often means that physicians have to start a separate workflow with new windows, logins, and more clicks and keystrokes.

My latest for the AMA. The whole shebang.

Doctors battle state law that forces them to mislead patients

The AMA has filed a federal lawsuit challenging the constitutionality of North Dakota legal provisions forcing physicians to violate the AMA Code of Medical Ethics and act as mouthpieces for politically motivated messages that are misleading and could lead to patient harm.

North Dakota law already requires physicians or members of the doctor’s care team to tell women set to have an abortion that the procedure “will terminate the life of a whole, separate, unique, living human being.”

Now a provision set to take effect Aug. 1 would force them to also tell women “that it may be possible to reverse the effect of an abortion-inducing drug if she changes her mind, but time if of the essence, and information and assistance with reversing the effects of an abortion-inducing drug are available” in government-printed materials to be given to the patients.

Together, the two provisions “compel physicians and their agents to speak government-mandated messages that entail providing to their patients misleading or even patently false, nonmedical information with which they disagree,” says the complaint filed by the AMA and other plaintiffs.

My latest for the AMA. The whole shebang.

Men at Work

For blocks around, the black and yellow towers
Soar above the construction site
Approach to hear its cacophony
Of grinding, hammering, shouting
Men at work

Look up for a glimpse of their project
Come closer and the view ahead’s obscured
By tarpaulin-shielded, chain-link fencing
Come closer yet to find
Not all is opaque

See the upturned earth where the new building
Will have its foundation
The broken-up rock and concrete that
Will be carried away
See immense machines marching and
Men at work
In their hard hats and reflective gear
Work gloves and blue jeans

This morning’s kindergartners
Scattered the playground at summer camp
Letting the sand slip through their fingers
And the cool wind ruffle their t-shirts
Grinding down their temporary towers
Hammering away at invisible inventions
Yelling away, but with their reasons
Deeply engaged in the earnest business of
Children at play

Back at the work site
Look about to find
A bald-headed old man
In a beat-up windbreaker
Use the fence to steady himself
And discover a spot
Where two posts
Are imperfectly joined
To offer an unimpeded view of
Men at work
That leaves the old-timer
Shining the ecstatic beam of a
Little boy

— 30 —

AMA principles will further gender equity among physicians

The AMA House of Delegates has adopted a comprehensive set of principles on gender equity in medicine designed to address what an AMA Board of Trustees report calls “a complex, pervasive issue that requires a multilayered approach.”

“The statistics on pay and leadership disparities in medicine are jarring, but sadly, unsurprising,” said AMA Board of Trustees Chair Jesse M. Ehrenfeld, MD, MPH. “Even as the number of women in medicine increases—and women now outnumber men as physicians-in-training—more must be done to spur change and eliminate the bias and discrimination that adversely affect women and, consequently, our profession.”

My latest for the AMA. The whole shebang.

Time to scrutinize PBMs’ outsized role in Rx decision-making

The increasingly powerful role that pharmacy benefit managers play in the prices and availability of prescription drugs is one that merits careful scrutiny from regulators, says an AMA Council on Medical Service report whose recommendations were adopted at the 2019 AMA Annual Meeting in Chicago.

“It’s time to pull back the curtain on pharmacy benefit managers and how their practices negatively impact patients. How is it that PBMs and health plans profit from negotiated discounts on prescription drugs, while patients pay co-pays based on high drug list prices that even the plans themselves are not paying?” said Russell Kridel, MD, a member of the AMA Board of Trustees. “Because of market concentration and lack of transparency, patients and physicians are essentially powerless in the face of PBM pricing and coverage decisions.”

My latest for the AMA. The whole shebang.

Physicians: The ACA should be strengthened, not abandoned

The AMA House of Delegates today adopted new policy to boost its push for universal coverage by improving the Affordable Care Act (ACA) while maintaining the Association’s opposition to a single-payer approach to health system reform.

“Since the ACA was enacted into law in 2010, millions of Americans have gained health insurance. The policy question now is how to improve the law to insure even more,” said AMA President Barbara L. McAneny, MD. “We need policies to make coverage more affordable for millions of Americans—both in the premiums they pay, as well as their cost-sharing responsibilities.”

My latest for the AMA. The whole shebang.

What’s at stake in this week’s CVS-Aetna merger hearing

What’s the news: In an unprecedented three-day hearing this week, Judge Richard Leon of the U.S. District Court for the District of Columbia will hear from six witnesses about the $70 billion merger of pharmacy giant CVS Corp. and mega-insurer Aetna Inc. The U.S. Department of Justice (DOJ) decided in October 2018 to allow the merger after requiring a divestiture of Aetna’s Medicare Part D business.

Judge Leon’s decision to hold a hearing that includes live witnesses as part of a Tunney Act review of the DOJ action is a first, antitrust experts say.

My latest for the AMA. The whole shebang.

AMA: Regulate network adequacy to stop surprise medical bills

Policies aimed at addressing unanticipated out-of-network care—often called surprise billing—should not put patients in the middle of payment negotiations or reward payers whose inadequate, narrow provider networks are a primary driver of the problem.

That was the key message from AMA Trustee S. Bobby Mukkamala, MD, at today’s House Ways and Means Health Subcommittee hearing on surprise medical bills.

“The AMA has long been concerned about gaps in out-of-network coverage and is committed to working on solutions to protect patients from the financial impact of ‘surprise’ coverage gaps,” said Dr. Mukkamala, a board-certified otolaryngologist—head-and-neck surgeon who practices in Flint, Michigan.

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3 big questions for the AMA’s new chief health equity officer

Pediatrician, preventive medicine and public health physician Aletha Maybank MD, MPH, has taken on the task of leading the AMA’s new Center for Health Equity, which the AMA House of Delegates directed the Association to create as part of sweeping policy on health equity adopted at the 2018 AMA Annual Meeting.

Dr. Maybank comes well-prepared for her new position. She was founding director of the New York City health department’s Center for Health Equity. In that role, she led changes in the culture and public health practice of the health department by building the capacity of staff to better understand how their work advances or exacerbates health equity.

She also oversaw the rebranding of local district public health offices as Neighborhood Health Action Centers, renewing the agency’s commitment to neighborhood-based work and enhancing coordination of these efforts. In addition, she oversaw one of the first place-based community health worker efforts in New York City public housing.

Dr. Maybank took some time to answer three big questions about her role—and the AMA’s—in the struggle to ensure that all Americans have access to high-quality, affordable health care.

The lede to my latest article for the AMA. The whole shebang.

Wearables improve post-op recovery when every step counts

It’s the surgeon’s standard advice to patients as soon as they awaken from the procedure: start walking. Walk with help. Walk to the chair in your room. Walk as much as you can. But how many steps should patients actually aim for? One patient’s understanding of the instruction can differ from another’s, with a related impact on their recovery.

Researchers at Cedars-Sinai Medical Center are looking to put a finer point on the matter with the help of wearable activity trackers. For a study whose results were published in JAMA Network Open, they outfitted 100 patients with digital step-counters and found that those who took 1,000 steps on day one post-surgery had 63% lower odds of a prolonged length of stay related to their operation.

The lede for my  latest at the AMA. The whole shebang.

How the CDC’s opioid prescribing guidance went astray

What’s the news: Three authors of the Centers for Disease Control and Prevention’s controversial 2016 guideline on opioid prescribing now say their advice has been misused in ways that can harm patients.

These misapplications “include inflexible application of recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages, resulting in sudden opioid discontinuation or dismissal of patients from a physician’s practice,” wrote the CDC’s Deborah Dowell, MD, MPH, Tamara Haegerich, PhD, and Roger Chou, MD, in a New England Journal of Medicine essay, “No Shortcuts to Safer Opioid Prescribing.”

My latest for the AMA. The whole shebang.