Critical treatment gap seen in effort to stem opioid epidemic

Confronted by the gravity of an opioid epidemic that contributes to the deaths of 91 Americans daily, the nation’s physicians are making much greater use of state prescription drug-monitoring programs, reducing opioid prescriptions, and increasing prescriptions for the life-saving antidote naloxone. Tens of thousands of physicians nationwide are now certified to provide office-based medication-assisted treatment for opioid-use disorders, yet there remains a treatment gap that leaves too many patients who want help unable to get it.

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New changes don’t fix AHCA shortcomings, threaten key protections

The most recent effort to broaden support for the American Health Care Act, which comes in the form of an amendment proposed by New Jersey Rep. Tom MacArthur, does not address the most serious flaws in the bill and would also undermine critical health insurance consumer protections. For these reasons, the AMA “remains opposed to passage of this legislation,” the Association’s CEO and Executive Vice President, James L. Madara, MD, said today in a letter to House Republican and Democratic leaders.

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Appeals court should uphold decision blocking Anthem-Cigna merger

Giant health insurance company Anthem is appealing a federal judge’s February ruling that blocked its proposed acquisition of fellow health insurer Cigna, arguing that the merger would result in $2.4 billion in “efficiencies” that would benefit consumers. But in an amicus brief filed with the U.S. Court of Appeals for the District of Columbia, the AMA Litigation Center strongly disputed that argument and urged a three-judge panel to uphold the lower court’s ruling to protect patients and physicians.

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Major patient groups join AMA to voice concerns on House bill

When Laurie Merges lost her corporate job in Cleveland two years ago, she enrolled her children—including one on the autism spectrum who needs treatment—in Ohio’s Medicaid plan. Told of her eligibility for Medicaid under the expanded version of the program that Ohio implemented, at first Merges thought the coverage might be superfluous, as she expected to soon regain employer-sponsored insurance when she found a new job.

“But then I thought, ‘It’s a good safety net,’” Merges said today at a news conference held by the AMA and three major organizations representing patients, the American Cancer Society Cancer Action Network, the American Diabetes Association and the American Heart Association. The availability of that expanded Medicaid safety net, under which nearly 700,000 Ohioans were enrolled as of 2015, may have saved Merges’ life. She was soon diagnosed with stage 3b breast cancer, underwent bilateral mastectomy, 33 rounds of radiation and, 15 months later, is still taking oral chemotherapy.

“Without that coverage, I never would have been able to do it,” Merges said. “Thanks to my treatment, I’m hopeful I’ll be around to watch my children grow.”

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“Medspeak” can shut down effective communication with patients

The 56-year-old inpatient is scared and worried. His physician has told him the swelling in his right calf that brought him to the hospital may be caused by an “agent” or “pathogen,” but he is confused. An “agent” sounds like a person, and a “pathogen” sounds like “psychopath.” When the physician returns with the diagnosis, cellulitis, and says it is an “inflammation of the skin and subcutaneous tissues,” the patient is further confused and flummoxed about deciding whether to stay in the hospital for antibiotic treatment or receive a prescription and rest at home.

This kind of “medspeak” can get in the way of patients’ sharing decision-making with their physicians and should be avoided. There are some evidence-based methods that help close critical communication gaps.

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The fierce urgency of addressing language, literacy care barriers

In the absence of a qualified interpreter, patients with limited English proficiency can have trouble conveying critical information about symptoms and experiences. Offering reliable access to quality language and interpretive services is one strategy for improving cross-cultural communication in health care organizations. This is one pathway to quality care and shared decision-making, which some argue is not only an urgent priority, but also a clinical, legal and ethical obligation.

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Oscars’ big snafu and the AMA “Code of Medical Ethics”

The accounting firm of PricewaterhouseCoopers issued a public apology for the errors that led to the mistaken announcement of “La La Land,” rather than “Moonlight,” as the winner of this year’s best-picture Oscar. “We are currently investigating how this could have happened, and deeply regret that this occurred,” the firm said in a statement.

Delivering the wrong Oscar envelope is a far cry from delivering the wrong medication to a patient. The Academy Awards oops led to some awkward moments watched by millions worldwide, but no one was injured. That is not always the case when things go wrong in medicine. The AMA Code of Medical Ethics has guidance for physicians on the proper handling of medical errors.

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Health reform: No going back on key market protections

Look around the dinner table tonight. You are very likely to break bread with one person who has a preexisting condition that, under the old rules, would have made it very difficult to secure health insurance coverage. Depending on the criteria used, as much as half of the non-elderly U.S. population has a preexisting condition. That amounts to as many as 133 million people—patients who should not be discriminated against in the health insurance marketplace. The ban on using preexisting conditions to deny coverage is one of the key health reforms that any replacement plan should maintain.

My latest at AMA Wire. The whole shebang.