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.

Two physicians moving medicine

The AMA recently unveiled a digital magazine, Moving Medicine, that is exclusive to AMA members. Two physician profiles carry my byline in the inaugural issue. You can read them below.

Recognizing the patterns of truth
You may have seen the movie based the life of Bennet I. Omalu, MD, MBA, MPH. Find out the real story behind what he has discovered—in CTE and in letting science lead the way.

Digital designs for the age of evidence
JAMA Editor-in-Chief Howard Bauchner, MD, has worked relentlessly to devise ways for the AMA’s crown jewel of high-quality research to be available to physicians on command.

5 reasons why physicians should use social media professionally

As social media has moved from a toy of the technorati to a mainstream facet of American life, many physicians have learned how to get the most out of Facebook, Twitter and the like while avoiding some of the ethical pitfalls. But if you’re still trying to understand why smart use of social media could help your physician career, AMA member Tyeese L. Gaines, DO (@doctorty), has got the answers.

The board-certified emergency physician spent years as a health care journalist, has earned an MBA, recently launched her own urgent-care practice in New Jersey, and offers training to physicians on how to navigate the intersection of medicine and social media. So, if your social media use is restricted to checking in for pictures of friends’ children on Facebook, here is Dr. Gaines’ perspective on why you should consider engaging more deeply at a professional level.

My lede. The whole shebang.

Hello, Simon

It’s been nearly a month since the birth of our second boy, Simon. The doctor notes that he is coming along quite nicely, thanks no doubt to the well-balanced diet provided by chef Mama Elizabeth. Lucas is learning all about what it means to be a big brother and performing splendidly in the role.

Simon emits many amusing noises and seems not quite yet sold on this whole being-on-the-outside thing. I don’t blame him one bit. As Randy Newman sings, “It’s a jungle out there.”

So who knows what adventures await? We’ll just have to hang on tight and enjoy the ride.

Simon hangs tight

Stay up to date on Simon’s progress (at least as much as can be told with photos) at this password-protected website. Friends and family, please send your request for access to the address below:

8 physician advocacy wins that set the stage for 2019

Given the turbulence in Washington, it’s easy to overlook the many policy wins scored on behalf of patients and physicians at the national and state levels. In her opening address to the AMA State Advocacy Summit, AMA President Barbara L. McAneny, MD, detailed how physician advocacy has made a difference on gun violence, regulatory relief, physician payment and more, while offering a look ahead to the Association’s ambitious 2019 policy goals.

My latest for the AMA. The whole shebang.

Digital health funding hits $8.1 billion. How to spend it wisely.

A recently released report details the record growth in funding in the digital health space that has experts wondering whether a market bubble is forming. This much is clear: No flood of cash can replace the unique insight that physicians offer health tech entrepreneurs to ensure that innovations are safe, effective, scalable and evidence-based.

The report—“2018 Year End Funding Report: Is digital health in a bubble?”—comes from San Francisco-based health tech funder Rock Health. Researchers tallied $8.1 billion in funding in digital health last year, up 42 percent from $5.7 billion in 2017.

My latest for the AMA. The whole shebang.