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AAFP delegates want Medicare pay for vaccines, insulin pens
WASHINGTON– Medicare Part B should pay physicians to administer vaccines in their offices, according to resolutions passed at the annual Congress of Delegates of the American Academy of Family Physicians.
The AAFP’s policymaking body voted to advocate that the Centers for Medicare & Medicaid Services pay physicians under Medicare Part B to administer the shingles vaccine and all other vaccines recommended by the Advisory Committee on Immunization Practices. Payment should be retroactive to when the ACIP first recommends a particular vaccine, according to a resolution introduced by the New York State chapter.
The Mississippi delegation urged the delegates to approve a resolution to have Medicare pay for the cost of insulin pens, as many patients with diabetes and vision issues cannot appropriately use vials and syringes, which are covered by Medicare. The AAFP Congress backed this resolution, also.
A hotly contested resolution called for the AAFP to advocate for a ban on diagnostic testing by pharmacists. An initiative in Michigan is allowing pharmacists to test for conditions like strep and then prescribe appropriate medications. The Michigan chapter urged the Congress to take a strong stand against this expansion of scope-of-practice for pharmacists, saying that it would likely spread to other states.
Many delegates said that pharmacists did not have extensive clinical training and that patient safety could be jeopardized. Others said that they did not want to be viewed as engaging in a turf battle against pharmacists.
Ultimately, the Congress referred the proposal to the AAFP board for study.
The Congress also voted against advocating for a single-payer health care system, and referred to the AAFP board a proposal to rescind the marketing approval of the long-acting opioid Zohydro.
The New York and Rhode Island chapters asked the AAFP to lobby the U.S. Congress to pass a law to treat electronic cigarettes the same as tobacco products, and that the minimum age for purchase be made the same as well. That resolution was accepted by the delegates.
The AAFP Congress also adopted a resolution that urged the federal government to end the mandatory 30-day waiting period between when informed consent is given and when Medicaid will cover a voluntary sterilization procedure. Delegates also backed a proposal to urge coverage of vasectomy and male contraceptive services as a preventive care service – that is, a cost-free service – under the Affordable Care Act.
On Twitter @aliciaault
WASHINGTON– Medicare Part B should pay physicians to administer vaccines in their offices, according to resolutions passed at the annual Congress of Delegates of the American Academy of Family Physicians.
The AAFP’s policymaking body voted to advocate that the Centers for Medicare & Medicaid Services pay physicians under Medicare Part B to administer the shingles vaccine and all other vaccines recommended by the Advisory Committee on Immunization Practices. Payment should be retroactive to when the ACIP first recommends a particular vaccine, according to a resolution introduced by the New York State chapter.
The Mississippi delegation urged the delegates to approve a resolution to have Medicare pay for the cost of insulin pens, as many patients with diabetes and vision issues cannot appropriately use vials and syringes, which are covered by Medicare. The AAFP Congress backed this resolution, also.
A hotly contested resolution called for the AAFP to advocate for a ban on diagnostic testing by pharmacists. An initiative in Michigan is allowing pharmacists to test for conditions like strep and then prescribe appropriate medications. The Michigan chapter urged the Congress to take a strong stand against this expansion of scope-of-practice for pharmacists, saying that it would likely spread to other states.
Many delegates said that pharmacists did not have extensive clinical training and that patient safety could be jeopardized. Others said that they did not want to be viewed as engaging in a turf battle against pharmacists.
Ultimately, the Congress referred the proposal to the AAFP board for study.
The Congress also voted against advocating for a single-payer health care system, and referred to the AAFP board a proposal to rescind the marketing approval of the long-acting opioid Zohydro.
The New York and Rhode Island chapters asked the AAFP to lobby the U.S. Congress to pass a law to treat electronic cigarettes the same as tobacco products, and that the minimum age for purchase be made the same as well. That resolution was accepted by the delegates.
The AAFP Congress also adopted a resolution that urged the federal government to end the mandatory 30-day waiting period between when informed consent is given and when Medicaid will cover a voluntary sterilization procedure. Delegates also backed a proposal to urge coverage of vasectomy and male contraceptive services as a preventive care service – that is, a cost-free service – under the Affordable Care Act.
On Twitter @aliciaault
WASHINGTON– Medicare Part B should pay physicians to administer vaccines in their offices, according to resolutions passed at the annual Congress of Delegates of the American Academy of Family Physicians.
The AAFP’s policymaking body voted to advocate that the Centers for Medicare & Medicaid Services pay physicians under Medicare Part B to administer the shingles vaccine and all other vaccines recommended by the Advisory Committee on Immunization Practices. Payment should be retroactive to when the ACIP first recommends a particular vaccine, according to a resolution introduced by the New York State chapter.
The Mississippi delegation urged the delegates to approve a resolution to have Medicare pay for the cost of insulin pens, as many patients with diabetes and vision issues cannot appropriately use vials and syringes, which are covered by Medicare. The AAFP Congress backed this resolution, also.
A hotly contested resolution called for the AAFP to advocate for a ban on diagnostic testing by pharmacists. An initiative in Michigan is allowing pharmacists to test for conditions like strep and then prescribe appropriate medications. The Michigan chapter urged the Congress to take a strong stand against this expansion of scope-of-practice for pharmacists, saying that it would likely spread to other states.
Many delegates said that pharmacists did not have extensive clinical training and that patient safety could be jeopardized. Others said that they did not want to be viewed as engaging in a turf battle against pharmacists.
Ultimately, the Congress referred the proposal to the AAFP board for study.
The Congress also voted against advocating for a single-payer health care system, and referred to the AAFP board a proposal to rescind the marketing approval of the long-acting opioid Zohydro.
The New York and Rhode Island chapters asked the AAFP to lobby the U.S. Congress to pass a law to treat electronic cigarettes the same as tobacco products, and that the minimum age for purchase be made the same as well. That resolution was accepted by the delegates.
The AAFP Congress also adopted a resolution that urged the federal government to end the mandatory 30-day waiting period between when informed consent is given and when Medicaid will cover a voluntary sterilization procedure. Delegates also backed a proposal to urge coverage of vasectomy and male contraceptive services as a preventive care service – that is, a cost-free service – under the Affordable Care Act.
On Twitter @aliciaault
AT THE AAFP CONGRESS OF DELEGATES 2014
Family medicine is ascendant, says AAFP’s Cain
WASHINGTON – Family medicine has gone from the brink of collapse to a rising specialty, American Academy of Family Physicians Board Chair Jeffrey Cain said Oct. 20 in a speech capping his service on the academy leadership team.
Dr. Cain noted that he began his run as an AAFP officer in 2007, a time when the “impending collapse” description had been bestowed upon family medicine by the Institute of Medicine. “For family medicine, it really was a time of crisis,” he said at the annual Congress of Delegates of the American Academy of Family Physicians.
Payments were low, there was little student interest in the specialty, and some 47 million Americans were uninsured, he said.
“We’ve actually stopped that free fall of [family medicine] and we are now rising,” said Dr. Cain, who completes his term as board chair at the meeting.
Six years ago, insurers, payers, and employers did not see the value of primary care, but now, the adoption of the patient-centered medical home “has proven in the real world that we are the key to the triple aim” of increasing access, increasing quality, and reducing cost, Dr. Cain said.
Medicare is also paying for value, in part through grants from the Center for Medicare and Medicaid Innovation, he said.
Even President Obama has spoken publicly “about the need to make family medicine the hub of patient-centered care,” Dr. Cain said. “We have not arrived, but we’re on our way.”
In 2007, family medicine had the lowest match rate ever recorded, but the number of matches has increased each year for the past 5 years. There are now 26,000 student members of the AAFP today – one in four U.S. medical students, Dr. Cain said.
Access to primary care has increased as well, he said. Six years ago, there were some 47 million uninsured Americans. The push for the Affordable Care Act “unleashed a political firestorm,” nationally and within the AAFP membership, Dr. Cain said.
The uninsured rate has dropped from 18% to about 13% currently, he said.
“Today I stand before you a witness to what I see as the rebirth of family medicine,” Dr. Cain said.
On Twitter @aliciaault
WASHINGTON – Family medicine has gone from the brink of collapse to a rising specialty, American Academy of Family Physicians Board Chair Jeffrey Cain said Oct. 20 in a speech capping his service on the academy leadership team.
Dr. Cain noted that he began his run as an AAFP officer in 2007, a time when the “impending collapse” description had been bestowed upon family medicine by the Institute of Medicine. “For family medicine, it really was a time of crisis,” he said at the annual Congress of Delegates of the American Academy of Family Physicians.
Payments were low, there was little student interest in the specialty, and some 47 million Americans were uninsured, he said.
“We’ve actually stopped that free fall of [family medicine] and we are now rising,” said Dr. Cain, who completes his term as board chair at the meeting.
Six years ago, insurers, payers, and employers did not see the value of primary care, but now, the adoption of the patient-centered medical home “has proven in the real world that we are the key to the triple aim” of increasing access, increasing quality, and reducing cost, Dr. Cain said.
Medicare is also paying for value, in part through grants from the Center for Medicare and Medicaid Innovation, he said.
Even President Obama has spoken publicly “about the need to make family medicine the hub of patient-centered care,” Dr. Cain said. “We have not arrived, but we’re on our way.”
In 2007, family medicine had the lowest match rate ever recorded, but the number of matches has increased each year for the past 5 years. There are now 26,000 student members of the AAFP today – one in four U.S. medical students, Dr. Cain said.
Access to primary care has increased as well, he said. Six years ago, there were some 47 million uninsured Americans. The push for the Affordable Care Act “unleashed a political firestorm,” nationally and within the AAFP membership, Dr. Cain said.
The uninsured rate has dropped from 18% to about 13% currently, he said.
“Today I stand before you a witness to what I see as the rebirth of family medicine,” Dr. Cain said.
On Twitter @aliciaault
WASHINGTON – Family medicine has gone from the brink of collapse to a rising specialty, American Academy of Family Physicians Board Chair Jeffrey Cain said Oct. 20 in a speech capping his service on the academy leadership team.
Dr. Cain noted that he began his run as an AAFP officer in 2007, a time when the “impending collapse” description had been bestowed upon family medicine by the Institute of Medicine. “For family medicine, it really was a time of crisis,” he said at the annual Congress of Delegates of the American Academy of Family Physicians.
Payments were low, there was little student interest in the specialty, and some 47 million Americans were uninsured, he said.
“We’ve actually stopped that free fall of [family medicine] and we are now rising,” said Dr. Cain, who completes his term as board chair at the meeting.
Six years ago, insurers, payers, and employers did not see the value of primary care, but now, the adoption of the patient-centered medical home “has proven in the real world that we are the key to the triple aim” of increasing access, increasing quality, and reducing cost, Dr. Cain said.
Medicare is also paying for value, in part through grants from the Center for Medicare and Medicaid Innovation, he said.
Even President Obama has spoken publicly “about the need to make family medicine the hub of patient-centered care,” Dr. Cain said. “We have not arrived, but we’re on our way.”
In 2007, family medicine had the lowest match rate ever recorded, but the number of matches has increased each year for the past 5 years. There are now 26,000 student members of the AAFP today – one in four U.S. medical students, Dr. Cain said.
Access to primary care has increased as well, he said. Six years ago, there were some 47 million uninsured Americans. The push for the Affordable Care Act “unleashed a political firestorm,” nationally and within the AAFP membership, Dr. Cain said.
The uninsured rate has dropped from 18% to about 13% currently, he said.
“Today I stand before you a witness to what I see as the rebirth of family medicine,” Dr. Cain said.
On Twitter @aliciaault
AT THE AAFP CONGRESS OF DELEGATES 2014
Family docs mull abortion, EHRs, gun safety at AAFP Congress
WASHINGTON – Resolutions to end restrictions on abortion providers and to encourage discussion of gun safety predictably elicited significant debate during reference committee discussions at the American Academy of Family Physicians’ annual policy-making meeting.
The Reference Committee on Advocacy considered two abortion-related proposals submitted by the New York State chapter, both aimed at removing state-imposed restrictions on providers, such as requiring physicians who provide the services to have admitting privileges at a nearby hospital.
Currently, 27 states have laws that restrict abortion providers, said Dr. Cathleen London of Weill Cornell Physicians, N.Y., an author of the two resolutions. The statutes interfere with access to care, and do not add protections for patients, she said.
“Regardless of where you stand on this issue, making abortion difficult or illegal means that we’ll see abortions performed unsafely,” Dr. London said. “It will not stop them.”
Dr. Reid B. Blackwelder, AAFP president, urged the committee to forward the resolutions to the board of directors for study rather than vote on them directly. “We’d also like to note that the AAFP has adopted a neutral position on abortion,” said Dr. Blackwelder.
But Dr. Robert Reneker of Mercy Health in Grand Rapids, Mich., supported the organization’s neutral position. “To get mixed up in this debate on abortion, and to get off the fence, serves no purpose in furthering some of our other goals,” Dr. Reneker said.
A resolution introduced by the Michigan chapter urges the AAFP to be more outspoken on gun safety. Many delegates supported the resolution’s call for the academy to advocate for legislation that would call for safe gun storage in the home, while others objected to a provision that would allow health insurers in the Affordable Care Act’s health exchanges to collect data about guns in the home.
An opioid-related resolution from the New York State chapter urged the Food and Drug Administration to rescind approval of the long-acting hydrocodone formulation Zohydro. The drug has been viewed by many as highly abusable, but some palliative care and hospice specialists told the reference committee that it was a necessary therapy for their patients.
Delegates also vented about electronic health records. A late resolution introduced by Dr. Leonard Finn of Wellesley, Mass., laid out a wish list of improvements that he said AAFP should advocate, including interoperability.
EHRs “fail to help us do what we want to do – provide excellent care for our patients,” Dr. Finn told the Reference Committee on Practice Enhancement, adding, “No bank, no airline system would tolerate the quality of the software we have to work with.”
Dr. Cecil Bennett of Peachtree City, Ga., also expressed his frustration with current state of EHRs. “I don’t want to tweak the current system, I want to blow it up,” said Dr. Bennett.
The full Congress of Delegates will hear all of the resolutions and vote on them on Oct. 21 and Oct. 22.
On Twitter @aliciaault
WASHINGTON – Resolutions to end restrictions on abortion providers and to encourage discussion of gun safety predictably elicited significant debate during reference committee discussions at the American Academy of Family Physicians’ annual policy-making meeting.
The Reference Committee on Advocacy considered two abortion-related proposals submitted by the New York State chapter, both aimed at removing state-imposed restrictions on providers, such as requiring physicians who provide the services to have admitting privileges at a nearby hospital.
Currently, 27 states have laws that restrict abortion providers, said Dr. Cathleen London of Weill Cornell Physicians, N.Y., an author of the two resolutions. The statutes interfere with access to care, and do not add protections for patients, she said.
“Regardless of where you stand on this issue, making abortion difficult or illegal means that we’ll see abortions performed unsafely,” Dr. London said. “It will not stop them.”
Dr. Reid B. Blackwelder, AAFP president, urged the committee to forward the resolutions to the board of directors for study rather than vote on them directly. “We’d also like to note that the AAFP has adopted a neutral position on abortion,” said Dr. Blackwelder.
But Dr. Robert Reneker of Mercy Health in Grand Rapids, Mich., supported the organization’s neutral position. “To get mixed up in this debate on abortion, and to get off the fence, serves no purpose in furthering some of our other goals,” Dr. Reneker said.
A resolution introduced by the Michigan chapter urges the AAFP to be more outspoken on gun safety. Many delegates supported the resolution’s call for the academy to advocate for legislation that would call for safe gun storage in the home, while others objected to a provision that would allow health insurers in the Affordable Care Act’s health exchanges to collect data about guns in the home.
An opioid-related resolution from the New York State chapter urged the Food and Drug Administration to rescind approval of the long-acting hydrocodone formulation Zohydro. The drug has been viewed by many as highly abusable, but some palliative care and hospice specialists told the reference committee that it was a necessary therapy for their patients.
Delegates also vented about electronic health records. A late resolution introduced by Dr. Leonard Finn of Wellesley, Mass., laid out a wish list of improvements that he said AAFP should advocate, including interoperability.
EHRs “fail to help us do what we want to do – provide excellent care for our patients,” Dr. Finn told the Reference Committee on Practice Enhancement, adding, “No bank, no airline system would tolerate the quality of the software we have to work with.”
Dr. Cecil Bennett of Peachtree City, Ga., also expressed his frustration with current state of EHRs. “I don’t want to tweak the current system, I want to blow it up,” said Dr. Bennett.
The full Congress of Delegates will hear all of the resolutions and vote on them on Oct. 21 and Oct. 22.
On Twitter @aliciaault
WASHINGTON – Resolutions to end restrictions on abortion providers and to encourage discussion of gun safety predictably elicited significant debate during reference committee discussions at the American Academy of Family Physicians’ annual policy-making meeting.
The Reference Committee on Advocacy considered two abortion-related proposals submitted by the New York State chapter, both aimed at removing state-imposed restrictions on providers, such as requiring physicians who provide the services to have admitting privileges at a nearby hospital.
Currently, 27 states have laws that restrict abortion providers, said Dr. Cathleen London of Weill Cornell Physicians, N.Y., an author of the two resolutions. The statutes interfere with access to care, and do not add protections for patients, she said.
“Regardless of where you stand on this issue, making abortion difficult or illegal means that we’ll see abortions performed unsafely,” Dr. London said. “It will not stop them.”
Dr. Reid B. Blackwelder, AAFP president, urged the committee to forward the resolutions to the board of directors for study rather than vote on them directly. “We’d also like to note that the AAFP has adopted a neutral position on abortion,” said Dr. Blackwelder.
But Dr. Robert Reneker of Mercy Health in Grand Rapids, Mich., supported the organization’s neutral position. “To get mixed up in this debate on abortion, and to get off the fence, serves no purpose in furthering some of our other goals,” Dr. Reneker said.
A resolution introduced by the Michigan chapter urges the AAFP to be more outspoken on gun safety. Many delegates supported the resolution’s call for the academy to advocate for legislation that would call for safe gun storage in the home, while others objected to a provision that would allow health insurers in the Affordable Care Act’s health exchanges to collect data about guns in the home.
An opioid-related resolution from the New York State chapter urged the Food and Drug Administration to rescind approval of the long-acting hydrocodone formulation Zohydro. The drug has been viewed by many as highly abusable, but some palliative care and hospice specialists told the reference committee that it was a necessary therapy for their patients.
Delegates also vented about electronic health records. A late resolution introduced by Dr. Leonard Finn of Wellesley, Mass., laid out a wish list of improvements that he said AAFP should advocate, including interoperability.
EHRs “fail to help us do what we want to do – provide excellent care for our patients,” Dr. Finn told the Reference Committee on Practice Enhancement, adding, “No bank, no airline system would tolerate the quality of the software we have to work with.”
Dr. Cecil Bennett of Peachtree City, Ga., also expressed his frustration with current state of EHRs. “I don’t want to tweak the current system, I want to blow it up,” said Dr. Bennett.
The full Congress of Delegates will hear all of the resolutions and vote on them on Oct. 21 and Oct. 22.
On Twitter @aliciaault
AT THE AAFP CONGRESS OF DELEGATES
Ebola: CDC director cautions against proposal to ban flights from West Africa
WASHINGTON – The director of the Centers for Disease Control and Prevention cautioned against proposals to ban flights from West African countries affected by the Ebola epidemic during a hearing held by the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations Oct. 16.
At the hearing, subcommittee chairman Tim Murphy (R-Penn.) proposed an immediate ban on commercial, non-essential travel from three West African nations to the United States. Additionally, he called for a mandatory quarantine for any American who treats an Ebola patient in those countries.
Dr. Tom Frieden told the subcommittee that a flight ban might drive people to come into the country by other means, which could lead to potentially more infections because those people would not be efficiently tracked. He added that the CDC continues to be “confident that Ebola is not a significant public health threat to the United States.”
Starting today, passengers from Sierra Leone, Guinea, and Liberia are screened upon exiting those countries, he said. They are having their temperatures taken and are being subjected to additional screening upon entering the United States at five major airports: Atlanta’s Hartsfield; Dulles, near Washington, D.C.; New York’s J.F.K.; Newark, N.J.; and Chicago’s O’Hare.
“Your protocol depends on everyone being honest,” Rep Murphy countered. It depends on thermometers being accurate, and it still does not catch people who are asymptomatic but carrying the virus.
House subcommittee members also wanted to know whether officials at the CDC and Texas Health Presbyterian Hospital had determined how two nurses involved in the care of an Ebola patient became infected, despite theoretically following CDC protocols. Nancy Pham and Amber Vinson provided care for Thomas Eric Duncan, who developed the infection after flying from Liberia to Dallas, where he died on Oct. 8.
“We’ve learned frontline hospital workers were not fully trained in those procedures, do not have proper equipment, do not know how to properly put on and remove safety gear,” said subcommittee chairman Tim Murphy (R-Penn.). “Educating, training and assisting our public health workforce on the frontlines across the country must be a priority.” Dr. Daniel Varga, chief clinical officer and senior vice president for Texas Health Resources, the parent company of Texas Health Presbyterian Hospital, said the investigation continues. Both nurses were “using full protective measures under the CDC protocols,” and officials still don’t know how or when the nurses were infected.
Dr. Frieden said that “more than 20 of the world’s top disease detectives” are at the Dallas hospital trying to determine what went wrong and that they are also conducting extensive contact tracing.
Dr. Varga acknowledged that there had been no actual training rehearsal of the hospital’s emergency room workers in handling a potential Ebola patient before Mr. Duncan arrived at the facility in late September.
“Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes,” said Dr. Varga.
Rep. Murphy called for immediate and thorough training of U.S. hospital personnel in the proper use of personal protective equipment. Specialized medical centers should be identified for treatment of Ebola patients, and those centers need to be expanded, he said.
Currently, there are four specialized centers and they have a limited bed capacity. They are located at the National Institutes of Health in Bethesda, Md. (2 beds), at Emory University (2 beds), the Nebraska Medical Center (10 beds), and St. Patrick Hospital in Missoula, Mont. (3 beds).
The CDC is continuing to field calls from health care providers, and to offer training and education, Dr. Frieden said.
Hospitals and clinicians should keep Ebola in mind when treating any patient who presents with a fever or flu-like symptoms, and ask whether the patient has traveled to West Africa within the last 21 days.
Meanwhile, 45% of Americans say they are worried about contracting Ebola, according to a poll released on Oct. 16 by the Kaiser Family Foundation. A similar number thought, mistakenly, that they could get the virus by shaking hands with someone who is asymptomatic. A majority said they had confidence in the CDC, their local hospital, and state health officials to contain the virus.
The Oversight and Investigations Subcommittee plans to hold another hearing on Ebola preparedness in November, said Rep. Murphy.
On Twitter @aliciaault
WASHINGTON – The director of the Centers for Disease Control and Prevention cautioned against proposals to ban flights from West African countries affected by the Ebola epidemic during a hearing held by the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations Oct. 16.
At the hearing, subcommittee chairman Tim Murphy (R-Penn.) proposed an immediate ban on commercial, non-essential travel from three West African nations to the United States. Additionally, he called for a mandatory quarantine for any American who treats an Ebola patient in those countries.
Dr. Tom Frieden told the subcommittee that a flight ban might drive people to come into the country by other means, which could lead to potentially more infections because those people would not be efficiently tracked. He added that the CDC continues to be “confident that Ebola is not a significant public health threat to the United States.”
Starting today, passengers from Sierra Leone, Guinea, and Liberia are screened upon exiting those countries, he said. They are having their temperatures taken and are being subjected to additional screening upon entering the United States at five major airports: Atlanta’s Hartsfield; Dulles, near Washington, D.C.; New York’s J.F.K.; Newark, N.J.; and Chicago’s O’Hare.
“Your protocol depends on everyone being honest,” Rep Murphy countered. It depends on thermometers being accurate, and it still does not catch people who are asymptomatic but carrying the virus.
House subcommittee members also wanted to know whether officials at the CDC and Texas Health Presbyterian Hospital had determined how two nurses involved in the care of an Ebola patient became infected, despite theoretically following CDC protocols. Nancy Pham and Amber Vinson provided care for Thomas Eric Duncan, who developed the infection after flying from Liberia to Dallas, where he died on Oct. 8.
“We’ve learned frontline hospital workers were not fully trained in those procedures, do not have proper equipment, do not know how to properly put on and remove safety gear,” said subcommittee chairman Tim Murphy (R-Penn.). “Educating, training and assisting our public health workforce on the frontlines across the country must be a priority.” Dr. Daniel Varga, chief clinical officer and senior vice president for Texas Health Resources, the parent company of Texas Health Presbyterian Hospital, said the investigation continues. Both nurses were “using full protective measures under the CDC protocols,” and officials still don’t know how or when the nurses were infected.
Dr. Frieden said that “more than 20 of the world’s top disease detectives” are at the Dallas hospital trying to determine what went wrong and that they are also conducting extensive contact tracing.
Dr. Varga acknowledged that there had been no actual training rehearsal of the hospital’s emergency room workers in handling a potential Ebola patient before Mr. Duncan arrived at the facility in late September.
“Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes,” said Dr. Varga.
Rep. Murphy called for immediate and thorough training of U.S. hospital personnel in the proper use of personal protective equipment. Specialized medical centers should be identified for treatment of Ebola patients, and those centers need to be expanded, he said.
Currently, there are four specialized centers and they have a limited bed capacity. They are located at the National Institutes of Health in Bethesda, Md. (2 beds), at Emory University (2 beds), the Nebraska Medical Center (10 beds), and St. Patrick Hospital in Missoula, Mont. (3 beds).
The CDC is continuing to field calls from health care providers, and to offer training and education, Dr. Frieden said.
Hospitals and clinicians should keep Ebola in mind when treating any patient who presents with a fever or flu-like symptoms, and ask whether the patient has traveled to West Africa within the last 21 days.
Meanwhile, 45% of Americans say they are worried about contracting Ebola, according to a poll released on Oct. 16 by the Kaiser Family Foundation. A similar number thought, mistakenly, that they could get the virus by shaking hands with someone who is asymptomatic. A majority said they had confidence in the CDC, their local hospital, and state health officials to contain the virus.
The Oversight and Investigations Subcommittee plans to hold another hearing on Ebola preparedness in November, said Rep. Murphy.
On Twitter @aliciaault
WASHINGTON – The director of the Centers for Disease Control and Prevention cautioned against proposals to ban flights from West African countries affected by the Ebola epidemic during a hearing held by the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations Oct. 16.
At the hearing, subcommittee chairman Tim Murphy (R-Penn.) proposed an immediate ban on commercial, non-essential travel from three West African nations to the United States. Additionally, he called for a mandatory quarantine for any American who treats an Ebola patient in those countries.
Dr. Tom Frieden told the subcommittee that a flight ban might drive people to come into the country by other means, which could lead to potentially more infections because those people would not be efficiently tracked. He added that the CDC continues to be “confident that Ebola is not a significant public health threat to the United States.”
Starting today, passengers from Sierra Leone, Guinea, and Liberia are screened upon exiting those countries, he said. They are having their temperatures taken and are being subjected to additional screening upon entering the United States at five major airports: Atlanta’s Hartsfield; Dulles, near Washington, D.C.; New York’s J.F.K.; Newark, N.J.; and Chicago’s O’Hare.
“Your protocol depends on everyone being honest,” Rep Murphy countered. It depends on thermometers being accurate, and it still does not catch people who are asymptomatic but carrying the virus.
House subcommittee members also wanted to know whether officials at the CDC and Texas Health Presbyterian Hospital had determined how two nurses involved in the care of an Ebola patient became infected, despite theoretically following CDC protocols. Nancy Pham and Amber Vinson provided care for Thomas Eric Duncan, who developed the infection after flying from Liberia to Dallas, where he died on Oct. 8.
“We’ve learned frontline hospital workers were not fully trained in those procedures, do not have proper equipment, do not know how to properly put on and remove safety gear,” said subcommittee chairman Tim Murphy (R-Penn.). “Educating, training and assisting our public health workforce on the frontlines across the country must be a priority.” Dr. Daniel Varga, chief clinical officer and senior vice president for Texas Health Resources, the parent company of Texas Health Presbyterian Hospital, said the investigation continues. Both nurses were “using full protective measures under the CDC protocols,” and officials still don’t know how or when the nurses were infected.
Dr. Frieden said that “more than 20 of the world’s top disease detectives” are at the Dallas hospital trying to determine what went wrong and that they are also conducting extensive contact tracing.
Dr. Varga acknowledged that there had been no actual training rehearsal of the hospital’s emergency room workers in handling a potential Ebola patient before Mr. Duncan arrived at the facility in late September.
“Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes,” said Dr. Varga.
Rep. Murphy called for immediate and thorough training of U.S. hospital personnel in the proper use of personal protective equipment. Specialized medical centers should be identified for treatment of Ebola patients, and those centers need to be expanded, he said.
Currently, there are four specialized centers and they have a limited bed capacity. They are located at the National Institutes of Health in Bethesda, Md. (2 beds), at Emory University (2 beds), the Nebraska Medical Center (10 beds), and St. Patrick Hospital in Missoula, Mont. (3 beds).
The CDC is continuing to field calls from health care providers, and to offer training and education, Dr. Frieden said.
Hospitals and clinicians should keep Ebola in mind when treating any patient who presents with a fever or flu-like symptoms, and ask whether the patient has traveled to West Africa within the last 21 days.
Meanwhile, 45% of Americans say they are worried about contracting Ebola, according to a poll released on Oct. 16 by the Kaiser Family Foundation. A similar number thought, mistakenly, that they could get the virus by shaking hands with someone who is asymptomatic. A majority said they had confidence in the CDC, their local hospital, and state health officials to contain the virus.
The Oversight and Investigations Subcommittee plans to hold another hearing on Ebola preparedness in November, said Rep. Murphy.
On Twitter @aliciaault
AT A U.S. HOUSE HEARING
Many will be automatically re-enrolled in ACA plans
WASHINGTON – Unless patients actively choose a new plan before Dec. 15, those who paid for a health insurance plan through the federal marketplace in 2014 will be automatically re-enrolled in the same plan for 2015, federal officials said.
The goal is to ensure there will be no gaps in coverage, Kevin Counihan, CEO of the federal health insurance marketplace, said at the Health Insurance Exchanges Forum held by America’s Health Insurance Plans.
Mr. Counihan did not give an estimate on how many people might be automatically re-enrolled, but he did say that some 7.3 million Americans had selected and paid for a health plan through the federal marketplace.
Mr. Counihan was appointed in late August to oversee the operations of healthcare.gov, the web portal for the federal health insurance marketplace. He is also director of the Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight.
Open enrollment for health plans offered under the Affordable Care Act begins Nov. 15.
The CMS is starting to send notices to patients who either enrolled in a plan in 2014, or had been determined to be eligible but did not enroll, reminding them that they can start the renewal process on Nov. 15. The notices will arrive by mail or e-mail, depending on what the patient indicated as a preference.
At the same time, patients will receive notices from their current insurers, letting them know whether there are network or benefits changes, or if there is an increase or decrease in the premiums or other costs.
Patients have until Dec. 15 to enroll in a plan for coverage that starts on Jan. 1.
If they do not renew a current plan or elect a new plan by Dec. 15, they will be automatically re-enrolled in the existing plan, said Ben Walker, director of open enrollment for the federal marketplace at the CCIIO.
They will get the same amount of advance payment of the premium tax credit and same subsidies as in 2014. Those credits and cost-sharing reductions are subject to change, depending on a patient’s updated eligibility information.
Even if they’ve been auto-enrolled, they can eventually go back and select a different plan, as long as they do it by Feb. 15, when open season ends, Mr. Walker said at the meeting. The coverage in the new plan will start on the first day of the next or second month depending on when the patient enrolled.
The National Governors Association is somewhat concerned about the automatic re-enrollments, Esther Krofah, program director in the NGA’s health division, said at the meeting. “We have to make sure consumers are aware of their options and are taking the steps they need to protect themselves,” she said.
Rachel Klein, organizational strategy and enrollment program director for Families USA, said that patients could be confused, or potentially harmed, by the automatic re-enrollment. In some cases, they might want to stay with the plan, especially if they’ve developed a relationship with a physician in that plan’s network, she said.
But they may also have gotten a new diagnosis that requires them to see a particular doctor, who might not be in the plan, said Ms. Klein. For that reason, it will be especially important for patients to be able to “compare in much greater detail the plans available,” she said.
To help increase awareness of the re-enrollment process, the CMS on Oct. 15 launched the “Five Steps to Staying Covered” campaign, urging patients to review their current plans, and then, starting on Nov. 15, to update their income and other information, compare the current plan with other plans, choose a plan, and enroll.
The CMS has been testing the healthcare.gov website and is encouraged by what it has seen so far, Mr. Counihan told health plan representatives.
“We feel confident we’re going to have a successful 2015,” he said.
On Twitter @aliciaault
WASHINGTON – Unless patients actively choose a new plan before Dec. 15, those who paid for a health insurance plan through the federal marketplace in 2014 will be automatically re-enrolled in the same plan for 2015, federal officials said.
The goal is to ensure there will be no gaps in coverage, Kevin Counihan, CEO of the federal health insurance marketplace, said at the Health Insurance Exchanges Forum held by America’s Health Insurance Plans.
Mr. Counihan did not give an estimate on how many people might be automatically re-enrolled, but he did say that some 7.3 million Americans had selected and paid for a health plan through the federal marketplace.
Mr. Counihan was appointed in late August to oversee the operations of healthcare.gov, the web portal for the federal health insurance marketplace. He is also director of the Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight.
Open enrollment for health plans offered under the Affordable Care Act begins Nov. 15.
The CMS is starting to send notices to patients who either enrolled in a plan in 2014, or had been determined to be eligible but did not enroll, reminding them that they can start the renewal process on Nov. 15. The notices will arrive by mail or e-mail, depending on what the patient indicated as a preference.
At the same time, patients will receive notices from their current insurers, letting them know whether there are network or benefits changes, or if there is an increase or decrease in the premiums or other costs.
Patients have until Dec. 15 to enroll in a plan for coverage that starts on Jan. 1.
If they do not renew a current plan or elect a new plan by Dec. 15, they will be automatically re-enrolled in the existing plan, said Ben Walker, director of open enrollment for the federal marketplace at the CCIIO.
They will get the same amount of advance payment of the premium tax credit and same subsidies as in 2014. Those credits and cost-sharing reductions are subject to change, depending on a patient’s updated eligibility information.
Even if they’ve been auto-enrolled, they can eventually go back and select a different plan, as long as they do it by Feb. 15, when open season ends, Mr. Walker said at the meeting. The coverage in the new plan will start on the first day of the next or second month depending on when the patient enrolled.
The National Governors Association is somewhat concerned about the automatic re-enrollments, Esther Krofah, program director in the NGA’s health division, said at the meeting. “We have to make sure consumers are aware of their options and are taking the steps they need to protect themselves,” she said.
Rachel Klein, organizational strategy and enrollment program director for Families USA, said that patients could be confused, or potentially harmed, by the automatic re-enrollment. In some cases, they might want to stay with the plan, especially if they’ve developed a relationship with a physician in that plan’s network, she said.
But they may also have gotten a new diagnosis that requires them to see a particular doctor, who might not be in the plan, said Ms. Klein. For that reason, it will be especially important for patients to be able to “compare in much greater detail the plans available,” she said.
To help increase awareness of the re-enrollment process, the CMS on Oct. 15 launched the “Five Steps to Staying Covered” campaign, urging patients to review their current plans, and then, starting on Nov. 15, to update their income and other information, compare the current plan with other plans, choose a plan, and enroll.
The CMS has been testing the healthcare.gov website and is encouraged by what it has seen so far, Mr. Counihan told health plan representatives.
“We feel confident we’re going to have a successful 2015,” he said.
On Twitter @aliciaault
WASHINGTON – Unless patients actively choose a new plan before Dec. 15, those who paid for a health insurance plan through the federal marketplace in 2014 will be automatically re-enrolled in the same plan for 2015, federal officials said.
The goal is to ensure there will be no gaps in coverage, Kevin Counihan, CEO of the federal health insurance marketplace, said at the Health Insurance Exchanges Forum held by America’s Health Insurance Plans.
Mr. Counihan did not give an estimate on how many people might be automatically re-enrolled, but he did say that some 7.3 million Americans had selected and paid for a health plan through the federal marketplace.
Mr. Counihan was appointed in late August to oversee the operations of healthcare.gov, the web portal for the federal health insurance marketplace. He is also director of the Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight.
Open enrollment for health plans offered under the Affordable Care Act begins Nov. 15.
The CMS is starting to send notices to patients who either enrolled in a plan in 2014, or had been determined to be eligible but did not enroll, reminding them that they can start the renewal process on Nov. 15. The notices will arrive by mail or e-mail, depending on what the patient indicated as a preference.
At the same time, patients will receive notices from their current insurers, letting them know whether there are network or benefits changes, or if there is an increase or decrease in the premiums or other costs.
Patients have until Dec. 15 to enroll in a plan for coverage that starts on Jan. 1.
If they do not renew a current plan or elect a new plan by Dec. 15, they will be automatically re-enrolled in the existing plan, said Ben Walker, director of open enrollment for the federal marketplace at the CCIIO.
They will get the same amount of advance payment of the premium tax credit and same subsidies as in 2014. Those credits and cost-sharing reductions are subject to change, depending on a patient’s updated eligibility information.
Even if they’ve been auto-enrolled, they can eventually go back and select a different plan, as long as they do it by Feb. 15, when open season ends, Mr. Walker said at the meeting. The coverage in the new plan will start on the first day of the next or second month depending on when the patient enrolled.
The National Governors Association is somewhat concerned about the automatic re-enrollments, Esther Krofah, program director in the NGA’s health division, said at the meeting. “We have to make sure consumers are aware of their options and are taking the steps they need to protect themselves,” she said.
Rachel Klein, organizational strategy and enrollment program director for Families USA, said that patients could be confused, or potentially harmed, by the automatic re-enrollment. In some cases, they might want to stay with the plan, especially if they’ve developed a relationship with a physician in that plan’s network, she said.
But they may also have gotten a new diagnosis that requires them to see a particular doctor, who might not be in the plan, said Ms. Klein. For that reason, it will be especially important for patients to be able to “compare in much greater detail the plans available,” she said.
To help increase awareness of the re-enrollment process, the CMS on Oct. 15 launched the “Five Steps to Staying Covered” campaign, urging patients to review their current plans, and then, starting on Nov. 15, to update their income and other information, compare the current plan with other plans, choose a plan, and enroll.
The CMS has been testing the healthcare.gov website and is encouraged by what it has seen so far, Mr. Counihan told health plan representatives.
“We feel confident we’re going to have a successful 2015,” he said.
On Twitter @aliciaault
AT THE AHIP HEALTH INSURANCE EXCHANGES FORUM
One-third of Medicaid programs will extend primary care pay bump
WASHINGTON – One-third of the nation’s Medicaid programs say they will extend the primary care pay bump, whether or not the federal government continues to fund it, according to a survey conducted for the Kaiser Family Foundation and the National Association of State Medicaid Directors.
Medicaid programs from all 50 states and the District of Columbia responded to the survey.
Programs in 15 states – Alaska, Alabama, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maryland, Maine, Michigan, Mississippi, Nebraska, Nevada, New Mexico, and South Carolina – said they will continue Medicaid pay parity, the higher reimbursement rate that was established by the Affordable Care Act, but which expires at the end of December.
The ACA required state Medicaid plans to pay primary care physicians (internists, family physicians, and pediatricians) at the Medicare rate. The federal government has covered the cost.
Programs in 22 states said they would not extend the higher reimbursement rate beyond this year; the remaining 14 programs said they had not made a decision, in part because they wanted to see whether the pay bump had increased physician participation in Medicaid, but also because they were waiting to see whether Congress would continue the higher reimbursement rate.
Darin Gordon, director of TennCare, Tennesse’s Medicaid program, said that his state was too financially strapped to extend the pay bump. “We’re not in a situation where we can sustain that without the continuation of that funding,” Mr. Gordon said at a briefing held by the Kaiser Family Foundation.
Kate McEvoy, Connecticut’s Medicaid director, said that the pay raise has been a great success in her state.
The “primary care rate increase was a tremendous precipitator of increased participation” by physicians in the program, said Ms. McEvoy. She said it had been an “enormously effective” policy that helped widen provider networks and increase access to care in the state.
Before the temporary rate bump, 1,622 primary care providers participated in Medicaid in Connecticut; that number had risen to 3,458 by the end of July 2014.
The expanded network of providers was crucial because the state elected to expand eligibility under the ACA, Ms. McEvoy said. At the end of 2013, there were 626,519 enrollees; as of August, there were 745,145, according to state figures.
The Connecticut Medicaid program decided to continue the Medicaid pay raise – at a less-than-100% level – for 2 years; it will now expire on June 30, 2016, the end of the state’s fiscal year.
On Twitter @aliciaault
WASHINGTON – One-third of the nation’s Medicaid programs say they will extend the primary care pay bump, whether or not the federal government continues to fund it, according to a survey conducted for the Kaiser Family Foundation and the National Association of State Medicaid Directors.
Medicaid programs from all 50 states and the District of Columbia responded to the survey.
Programs in 15 states – Alaska, Alabama, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maryland, Maine, Michigan, Mississippi, Nebraska, Nevada, New Mexico, and South Carolina – said they will continue Medicaid pay parity, the higher reimbursement rate that was established by the Affordable Care Act, but which expires at the end of December.
The ACA required state Medicaid plans to pay primary care physicians (internists, family physicians, and pediatricians) at the Medicare rate. The federal government has covered the cost.
Programs in 22 states said they would not extend the higher reimbursement rate beyond this year; the remaining 14 programs said they had not made a decision, in part because they wanted to see whether the pay bump had increased physician participation in Medicaid, but also because they were waiting to see whether Congress would continue the higher reimbursement rate.
Darin Gordon, director of TennCare, Tennesse’s Medicaid program, said that his state was too financially strapped to extend the pay bump. “We’re not in a situation where we can sustain that without the continuation of that funding,” Mr. Gordon said at a briefing held by the Kaiser Family Foundation.
Kate McEvoy, Connecticut’s Medicaid director, said that the pay raise has been a great success in her state.
The “primary care rate increase was a tremendous precipitator of increased participation” by physicians in the program, said Ms. McEvoy. She said it had been an “enormously effective” policy that helped widen provider networks and increase access to care in the state.
Before the temporary rate bump, 1,622 primary care providers participated in Medicaid in Connecticut; that number had risen to 3,458 by the end of July 2014.
The expanded network of providers was crucial because the state elected to expand eligibility under the ACA, Ms. McEvoy said. At the end of 2013, there were 626,519 enrollees; as of August, there were 745,145, according to state figures.
The Connecticut Medicaid program decided to continue the Medicaid pay raise – at a less-than-100% level – for 2 years; it will now expire on June 30, 2016, the end of the state’s fiscal year.
On Twitter @aliciaault
WASHINGTON – One-third of the nation’s Medicaid programs say they will extend the primary care pay bump, whether or not the federal government continues to fund it, according to a survey conducted for the Kaiser Family Foundation and the National Association of State Medicaid Directors.
Medicaid programs from all 50 states and the District of Columbia responded to the survey.
Programs in 15 states – Alaska, Alabama, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maryland, Maine, Michigan, Mississippi, Nebraska, Nevada, New Mexico, and South Carolina – said they will continue Medicaid pay parity, the higher reimbursement rate that was established by the Affordable Care Act, but which expires at the end of December.
The ACA required state Medicaid plans to pay primary care physicians (internists, family physicians, and pediatricians) at the Medicare rate. The federal government has covered the cost.
Programs in 22 states said they would not extend the higher reimbursement rate beyond this year; the remaining 14 programs said they had not made a decision, in part because they wanted to see whether the pay bump had increased physician participation in Medicaid, but also because they were waiting to see whether Congress would continue the higher reimbursement rate.
Darin Gordon, director of TennCare, Tennesse’s Medicaid program, said that his state was too financially strapped to extend the pay bump. “We’re not in a situation where we can sustain that without the continuation of that funding,” Mr. Gordon said at a briefing held by the Kaiser Family Foundation.
Kate McEvoy, Connecticut’s Medicaid director, said that the pay raise has been a great success in her state.
The “primary care rate increase was a tremendous precipitator of increased participation” by physicians in the program, said Ms. McEvoy. She said it had been an “enormously effective” policy that helped widen provider networks and increase access to care in the state.
Before the temporary rate bump, 1,622 primary care providers participated in Medicaid in Connecticut; that number had risen to 3,458 by the end of July 2014.
The expanded network of providers was crucial because the state elected to expand eligibility under the ACA, Ms. McEvoy said. At the end of 2013, there were 626,519 enrollees; as of August, there were 745,145, according to state figures.
The Connecticut Medicaid program decided to continue the Medicaid pay raise – at a less-than-100% level – for 2 years; it will now expire on June 30, 2016, the end of the state’s fiscal year.
On Twitter @aliciaault
AT A KAISER FAMILY FOUNDATION BRIEFING
Cancer community turns focus to ‘value’
WASHINGTON – A coalition of cancer researchers, patient advocates, oncologists, and pharmaceutical companies has issued a 13-point call to action to create a path toward better value in cancer care.
The white paper was released at Turning the Tide Against Cancer on Oct. 9. The meeting was sponsored by the Personalized Medicine Coalition, the American Association for Cancer Research, and Feinstein Kean Healthcare, a consulting firm.
Those organizations convened an initial “Turning the Tide” meeting in 2012. At that first gathering, participants discussed how the rapid-fire scientific developments in oncology could be incorporated into clinical care without bankrupting physicians, payers, or patients.
In the 2 years since, a task force met and created the new call to action, which focuses on how to foster a shift toward patient-centeredness in research and care, and how to address cost and value in ways that align with patient-centeredness and that do not hamper innovation.
Among the recommendations:
- The government should encourage clinical trials that enable study of multiple drugs simultaneously.
- The Food and Drug Administration should modernize its regulation of personalized medicine.
- Congress should help fund the development of cancer quality and outcomes measures.
- Federal and state marketplace plans should offer broad coverage of oncology drugs and services.
- The government should do more to standardize clinical decision-making tools and make them available to the public in an easily-understood format.
“We must not only continue to support cutting-edge cancer research, but also engage patients as partners throughout the continuum of research and care because, by doing so, we can develop a better understanding of their individual needs and preferences and ensure that they receive the most effective treatment for their particular disease,” Dr. Margaret Foti, chief executive officer of the AACR, said in a statement.
The new report “demonstrates the value of shared commitment and collaboration,” John J. Castellani, president and CEO of the Pharmaceutical Research and Manufacturers of America, said at the Turning the Tide meeting.
The rising – and in some cases extremely high – cost of oncology chemotherapies and personalized medicine diagnostics has attracted growing attention as these treatments gain more widespread use.
Mr. Castellani sidestepped the expense issue, but other speakers took it on directly.
“I personally am very weary of drugs and biologics being the lightning rod in this discussion,” said Patricia J. Goldsmith, CEO of CancerCare, a patient support organization. “There’s a whole host of other cost drivers and factors in the delivery of oncology care that are not really being discussed,” she said at the meeting.
“All of us in the medical community have an important role to play in restraining costs and creating value for our patients,” said Dr. Richard L. Schilsky, chief medical officer of the American Society of Clinical Oncology. The high cost of therapies and increasing copays and deductibles play a role in rising cancer care costs, but “so do the practices that doctors follow,” as well as patient expectations, he said.
Patients need to be well-informed about what can and can’t be achieved, doctors need to practice evidence-based medicine, and reimbursement needs to be overhauled to focus on spending time with patients instead of just getting paid for a service, Dr. Schilsky said at the meeting.
He suggested that value can’t be a static concept, especially when it comes to chemotherapies. A newly introduced drug might provide value initially, but less so over time as other, better therapies become available.
ASCO has spent a year developing a framework for physicians and patients to discuss value, he said. The idea is to have a user-friendly way for patients to compare the value of various treatment approaches in consultation with the doctor. That project is close to completion, said Dr. Schilsky.
Dr. Michael Kolodziej, national medical director for oncology solutions at Aetna, agreed that the patient needed to be made more of the focus of cancer care, from drug development into the physician’s office. In clinical trials, “we are not recording what’s important to patients,” he said at the meeting.
But he also took drug makers to task for developing too many me-too products. “We do not need another [tyrosine-kinase inhibitor] for chronic myelogenous leukemia,” said Dr. Kolodziej. Manufacturers should be rewarded for innovation, but “we have dissociated true innovation from reimbursement,” he added.
Ms. Goldsmith, who was recently diagnosed with cancer, said that even with her background, the conversations with her surgeons and oncologists were difficult to navigate. “We have to do better by patients,” she said.
Dr. Schilsky agreed. “Doctors, like everybody else, have varying communications skills,” he said. “But the one thing doctors don’t have is time.”
He said that physicians should be equipped and encouraged to spend that time talking with patients.
On Twitter @aliciaault
WASHINGTON – A coalition of cancer researchers, patient advocates, oncologists, and pharmaceutical companies has issued a 13-point call to action to create a path toward better value in cancer care.
The white paper was released at Turning the Tide Against Cancer on Oct. 9. The meeting was sponsored by the Personalized Medicine Coalition, the American Association for Cancer Research, and Feinstein Kean Healthcare, a consulting firm.
Those organizations convened an initial “Turning the Tide” meeting in 2012. At that first gathering, participants discussed how the rapid-fire scientific developments in oncology could be incorporated into clinical care without bankrupting physicians, payers, or patients.
In the 2 years since, a task force met and created the new call to action, which focuses on how to foster a shift toward patient-centeredness in research and care, and how to address cost and value in ways that align with patient-centeredness and that do not hamper innovation.
Among the recommendations:
- The government should encourage clinical trials that enable study of multiple drugs simultaneously.
- The Food and Drug Administration should modernize its regulation of personalized medicine.
- Congress should help fund the development of cancer quality and outcomes measures.
- Federal and state marketplace plans should offer broad coverage of oncology drugs and services.
- The government should do more to standardize clinical decision-making tools and make them available to the public in an easily-understood format.
“We must not only continue to support cutting-edge cancer research, but also engage patients as partners throughout the continuum of research and care because, by doing so, we can develop a better understanding of their individual needs and preferences and ensure that they receive the most effective treatment for their particular disease,” Dr. Margaret Foti, chief executive officer of the AACR, said in a statement.
The new report “demonstrates the value of shared commitment and collaboration,” John J. Castellani, president and CEO of the Pharmaceutical Research and Manufacturers of America, said at the Turning the Tide meeting.
The rising – and in some cases extremely high – cost of oncology chemotherapies and personalized medicine diagnostics has attracted growing attention as these treatments gain more widespread use.
Mr. Castellani sidestepped the expense issue, but other speakers took it on directly.
“I personally am very weary of drugs and biologics being the lightning rod in this discussion,” said Patricia J. Goldsmith, CEO of CancerCare, a patient support organization. “There’s a whole host of other cost drivers and factors in the delivery of oncology care that are not really being discussed,” she said at the meeting.
“All of us in the medical community have an important role to play in restraining costs and creating value for our patients,” said Dr. Richard L. Schilsky, chief medical officer of the American Society of Clinical Oncology. The high cost of therapies and increasing copays and deductibles play a role in rising cancer care costs, but “so do the practices that doctors follow,” as well as patient expectations, he said.
Patients need to be well-informed about what can and can’t be achieved, doctors need to practice evidence-based medicine, and reimbursement needs to be overhauled to focus on spending time with patients instead of just getting paid for a service, Dr. Schilsky said at the meeting.
He suggested that value can’t be a static concept, especially when it comes to chemotherapies. A newly introduced drug might provide value initially, but less so over time as other, better therapies become available.
ASCO has spent a year developing a framework for physicians and patients to discuss value, he said. The idea is to have a user-friendly way for patients to compare the value of various treatment approaches in consultation with the doctor. That project is close to completion, said Dr. Schilsky.
Dr. Michael Kolodziej, national medical director for oncology solutions at Aetna, agreed that the patient needed to be made more of the focus of cancer care, from drug development into the physician’s office. In clinical trials, “we are not recording what’s important to patients,” he said at the meeting.
But he also took drug makers to task for developing too many me-too products. “We do not need another [tyrosine-kinase inhibitor] for chronic myelogenous leukemia,” said Dr. Kolodziej. Manufacturers should be rewarded for innovation, but “we have dissociated true innovation from reimbursement,” he added.
Ms. Goldsmith, who was recently diagnosed with cancer, said that even with her background, the conversations with her surgeons and oncologists were difficult to navigate. “We have to do better by patients,” she said.
Dr. Schilsky agreed. “Doctors, like everybody else, have varying communications skills,” he said. “But the one thing doctors don’t have is time.”
He said that physicians should be equipped and encouraged to spend that time talking with patients.
On Twitter @aliciaault
WASHINGTON – A coalition of cancer researchers, patient advocates, oncologists, and pharmaceutical companies has issued a 13-point call to action to create a path toward better value in cancer care.
The white paper was released at Turning the Tide Against Cancer on Oct. 9. The meeting was sponsored by the Personalized Medicine Coalition, the American Association for Cancer Research, and Feinstein Kean Healthcare, a consulting firm.
Those organizations convened an initial “Turning the Tide” meeting in 2012. At that first gathering, participants discussed how the rapid-fire scientific developments in oncology could be incorporated into clinical care without bankrupting physicians, payers, or patients.
In the 2 years since, a task force met and created the new call to action, which focuses on how to foster a shift toward patient-centeredness in research and care, and how to address cost and value in ways that align with patient-centeredness and that do not hamper innovation.
Among the recommendations:
- The government should encourage clinical trials that enable study of multiple drugs simultaneously.
- The Food and Drug Administration should modernize its regulation of personalized medicine.
- Congress should help fund the development of cancer quality and outcomes measures.
- Federal and state marketplace plans should offer broad coverage of oncology drugs and services.
- The government should do more to standardize clinical decision-making tools and make them available to the public in an easily-understood format.
“We must not only continue to support cutting-edge cancer research, but also engage patients as partners throughout the continuum of research and care because, by doing so, we can develop a better understanding of their individual needs and preferences and ensure that they receive the most effective treatment for their particular disease,” Dr. Margaret Foti, chief executive officer of the AACR, said in a statement.
The new report “demonstrates the value of shared commitment and collaboration,” John J. Castellani, president and CEO of the Pharmaceutical Research and Manufacturers of America, said at the Turning the Tide meeting.
The rising – and in some cases extremely high – cost of oncology chemotherapies and personalized medicine diagnostics has attracted growing attention as these treatments gain more widespread use.
Mr. Castellani sidestepped the expense issue, but other speakers took it on directly.
“I personally am very weary of drugs and biologics being the lightning rod in this discussion,” said Patricia J. Goldsmith, CEO of CancerCare, a patient support organization. “There’s a whole host of other cost drivers and factors in the delivery of oncology care that are not really being discussed,” she said at the meeting.
“All of us in the medical community have an important role to play in restraining costs and creating value for our patients,” said Dr. Richard L. Schilsky, chief medical officer of the American Society of Clinical Oncology. The high cost of therapies and increasing copays and deductibles play a role in rising cancer care costs, but “so do the practices that doctors follow,” as well as patient expectations, he said.
Patients need to be well-informed about what can and can’t be achieved, doctors need to practice evidence-based medicine, and reimbursement needs to be overhauled to focus on spending time with patients instead of just getting paid for a service, Dr. Schilsky said at the meeting.
He suggested that value can’t be a static concept, especially when it comes to chemotherapies. A newly introduced drug might provide value initially, but less so over time as other, better therapies become available.
ASCO has spent a year developing a framework for physicians and patients to discuss value, he said. The idea is to have a user-friendly way for patients to compare the value of various treatment approaches in consultation with the doctor. That project is close to completion, said Dr. Schilsky.
Dr. Michael Kolodziej, national medical director for oncology solutions at Aetna, agreed that the patient needed to be made more of the focus of cancer care, from drug development into the physician’s office. In clinical trials, “we are not recording what’s important to patients,” he said at the meeting.
But he also took drug makers to task for developing too many me-too products. “We do not need another [tyrosine-kinase inhibitor] for chronic myelogenous leukemia,” said Dr. Kolodziej. Manufacturers should be rewarded for innovation, but “we have dissociated true innovation from reimbursement,” he added.
Ms. Goldsmith, who was recently diagnosed with cancer, said that even with her background, the conversations with her surgeons and oncologists were difficult to navigate. “We have to do better by patients,” she said.
Dr. Schilsky agreed. “Doctors, like everybody else, have varying communications skills,” he said. “But the one thing doctors don’t have is time.”
He said that physicians should be equipped and encouraged to spend that time talking with patients.
On Twitter @aliciaault
AT TURNING THE TIDE AGAINST CANCER
Medicaid programs moving to alternative pay and delivery models
WASHINGTON – Most Medicaid programs are embracing alternative delivery models that include patient-centered medical homes, shared risk, and value-based payment.
That conclusion is based on the results of a survey of the nation’s 51 Medicaid programs conducted for the Kaiser Family Foundation and the National Association of Medicaid Directors.
Not surprisingly, states that decided to expand Medicaid eligibility under the Affordable Care Act had higher enrollment growth and greater overall spending. The federal government is covering 100% of the cost of new Medicaid enrollees through 2016. Enrollment grew 18% in the 28 expansion states (which includes Washington), and spending rose 18%. Just 4% of the spending came out of state coffers. In nonexpansion states, enrollment grew 5%, while spending rose about 7%.
All states are looking for ways to contain costs and improve access and quality, said Vern Smith, who is a consultant with Health Management Associates and was involved in the survey.
In fiscal 2015 (which started in June 2014), 40 states have established some kind of payment or delivery system reform as compared to 30 in FY14, Mr. Smith said at a briefing held by Kaiser. “In some ways, this an even bigger story than the eligibility and enrollment changes.”
The models that states are using to align payment with outcomes and accountability include patient-centered medical homes, Medicaid health homes, and accountable care organizations. States are also increasingly integrating behavioral and physical health programs, Mr. Smith said.
Managed care is the main vehicle for achieving the new payment and delivery models; only three states – Alaska, Wyoming, and Connecticut – do not use managed care for their Medicaid recipients.
Overall, 24 states had a medical home in place in fiscal 2013, 17 were adding or expanding them in FY14, and 20 said they planned to do so in FY15, according to the Kaiser survey. Connecticut has a patient-centered medical home program that includes 1,273 providers and covers 254,000 of its 745,000 Medicaid recipients.
To spur new delivery and payment models, Tennessee launched an initiative in 2013 to focus on value as it pays for Medicaid services, Darin Gordon, director of TennCare, said at the briefing.
The goal over the next 5 years is “to get over 50% of our spend in some type of value-based payment,” he said.
The trend seems likely to stick, the survey authors said. “Whether a state elected to expand or not, Medicaid programs across the nation are being transformed with new enrollment procedures and outreach efforts combined with increased emphasis on delivery system reforms,” said Diane Rowland, executive vice president of the Kaiser Family Foundation.
On Twitter @aliciaault
WASHINGTON – Most Medicaid programs are embracing alternative delivery models that include patient-centered medical homes, shared risk, and value-based payment.
That conclusion is based on the results of a survey of the nation’s 51 Medicaid programs conducted for the Kaiser Family Foundation and the National Association of Medicaid Directors.
Not surprisingly, states that decided to expand Medicaid eligibility under the Affordable Care Act had higher enrollment growth and greater overall spending. The federal government is covering 100% of the cost of new Medicaid enrollees through 2016. Enrollment grew 18% in the 28 expansion states (which includes Washington), and spending rose 18%. Just 4% of the spending came out of state coffers. In nonexpansion states, enrollment grew 5%, while spending rose about 7%.
All states are looking for ways to contain costs and improve access and quality, said Vern Smith, who is a consultant with Health Management Associates and was involved in the survey.
In fiscal 2015 (which started in June 2014), 40 states have established some kind of payment or delivery system reform as compared to 30 in FY14, Mr. Smith said at a briefing held by Kaiser. “In some ways, this an even bigger story than the eligibility and enrollment changes.”
The models that states are using to align payment with outcomes and accountability include patient-centered medical homes, Medicaid health homes, and accountable care organizations. States are also increasingly integrating behavioral and physical health programs, Mr. Smith said.
Managed care is the main vehicle for achieving the new payment and delivery models; only three states – Alaska, Wyoming, and Connecticut – do not use managed care for their Medicaid recipients.
Overall, 24 states had a medical home in place in fiscal 2013, 17 were adding or expanding them in FY14, and 20 said they planned to do so in FY15, according to the Kaiser survey. Connecticut has a patient-centered medical home program that includes 1,273 providers and covers 254,000 of its 745,000 Medicaid recipients.
To spur new delivery and payment models, Tennessee launched an initiative in 2013 to focus on value as it pays for Medicaid services, Darin Gordon, director of TennCare, said at the briefing.
The goal over the next 5 years is “to get over 50% of our spend in some type of value-based payment,” he said.
The trend seems likely to stick, the survey authors said. “Whether a state elected to expand or not, Medicaid programs across the nation are being transformed with new enrollment procedures and outreach efforts combined with increased emphasis on delivery system reforms,” said Diane Rowland, executive vice president of the Kaiser Family Foundation.
On Twitter @aliciaault
WASHINGTON – Most Medicaid programs are embracing alternative delivery models that include patient-centered medical homes, shared risk, and value-based payment.
That conclusion is based on the results of a survey of the nation’s 51 Medicaid programs conducted for the Kaiser Family Foundation and the National Association of Medicaid Directors.
Not surprisingly, states that decided to expand Medicaid eligibility under the Affordable Care Act had higher enrollment growth and greater overall spending. The federal government is covering 100% of the cost of new Medicaid enrollees through 2016. Enrollment grew 18% in the 28 expansion states (which includes Washington), and spending rose 18%. Just 4% of the spending came out of state coffers. In nonexpansion states, enrollment grew 5%, while spending rose about 7%.
All states are looking for ways to contain costs and improve access and quality, said Vern Smith, who is a consultant with Health Management Associates and was involved in the survey.
In fiscal 2015 (which started in June 2014), 40 states have established some kind of payment or delivery system reform as compared to 30 in FY14, Mr. Smith said at a briefing held by Kaiser. “In some ways, this an even bigger story than the eligibility and enrollment changes.”
The models that states are using to align payment with outcomes and accountability include patient-centered medical homes, Medicaid health homes, and accountable care organizations. States are also increasingly integrating behavioral and physical health programs, Mr. Smith said.
Managed care is the main vehicle for achieving the new payment and delivery models; only three states – Alaska, Wyoming, and Connecticut – do not use managed care for their Medicaid recipients.
Overall, 24 states had a medical home in place in fiscal 2013, 17 were adding or expanding them in FY14, and 20 said they planned to do so in FY15, according to the Kaiser survey. Connecticut has a patient-centered medical home program that includes 1,273 providers and covers 254,000 of its 745,000 Medicaid recipients.
To spur new delivery and payment models, Tennessee launched an initiative in 2013 to focus on value as it pays for Medicaid services, Darin Gordon, director of TennCare, said at the briefing.
The goal over the next 5 years is “to get over 50% of our spend in some type of value-based payment,” he said.
The trend seems likely to stick, the survey authors said. “Whether a state elected to expand or not, Medicaid programs across the nation are being transformed with new enrollment procedures and outreach efforts combined with increased emphasis on delivery system reforms,” said Diane Rowland, executive vice president of the Kaiser Family Foundation.
On Twitter @aliciaault
AT A KAISER BRIEFING
Pioneer ACOs improve in second year
WASHINGTON – The accountable care organizations that are participating in Medicare’s highest risk, highest reward program improved in both quality of care and controlling costs in the second year, according to new government figures.
Even so, groups continue to leave the Pioneer ACO program. In the first year, 2012, there were 32 ACOs agreeing to share a high proportion of savings – or take on a high proportion of losses – as part of the Pioneer ACO program; 23 participated in 2013. Currently, 19 ACOs are participating, according to the Centers for Medicare & Medicaid Services.
Dr. Patrick Conway, CMS chief medical officer and deputy administrator for innovation and quality, said that drop outs were expected.
“We purposely set up the Pioneer program and our ACO program so that ACOs could migrate risk tracks,” Dr. Conway said at the meeting. “We actually predicted at this point we would have less Pioneer ACOs than we have now,” he said.
CMS would like to see every ACO stay in the Pioneer program, he said, adding, “but the reality is we set up the policy construct to allow flexibility of risk tracks.”
Dr. Conway noted that there are still some 600,000 Medicare beneficiaries who receive care through ACOs in the Pioneer program.
Overall, the 23 ACOs that participated in both 2012 and 2013 saved $90 million for 2013; they saved $128 million in 2012.
Not surprisingly, many hospitals that lost money in the first year did not participate in the second year, according to the CMS data. But some did, despite continued losses.
At least half of the Pioneers shared in savings, said Dr. Conway.
Beth Israel Deaconess Care Organization appeared to be a fairly big winner, generating $17.6 million in savings, and getting to keep some $10.6 million.
The San Francisco-based Brown & Toland Physicians’ ACO generated $4.5 million in savings, keeping almost $2.5 million. The Mount Auburn Cambridge Independent Practice Association, in the Boston area, kept $2.2 million of the $3.6 million it generated for Medicare.
Pioneers that created savings in the first 2 years are eligible to start receiving a per member per month prospective payment in 2014 if they are still participating.
The CMS has not yet released data on how many Pioneer ACOs are operating under that payment arrangement.
The Pioneer ACOs also improved quality of care, with mean performance scores for the group rising from 71% to 84%, said Dr. Conway. The Pioneers improved in 28 of the 33 goals measured.
He said he was particularly impressed with the overall improvement in six out of the seven measures of patient experience.
Patients reported on whether they received timely appointments, had good access to specialists, how well the physician communicated, and if there was shared decision making, among other measures.
Going forward, the CMS is considering removing some process measures and adding more outcome measures, said Dr. Conway.
On Twitter @aliciaault
WASHINGTON – The accountable care organizations that are participating in Medicare’s highest risk, highest reward program improved in both quality of care and controlling costs in the second year, according to new government figures.
Even so, groups continue to leave the Pioneer ACO program. In the first year, 2012, there were 32 ACOs agreeing to share a high proportion of savings – or take on a high proportion of losses – as part of the Pioneer ACO program; 23 participated in 2013. Currently, 19 ACOs are participating, according to the Centers for Medicare & Medicaid Services.
Dr. Patrick Conway, CMS chief medical officer and deputy administrator for innovation and quality, said that drop outs were expected.
“We purposely set up the Pioneer program and our ACO program so that ACOs could migrate risk tracks,” Dr. Conway said at the meeting. “We actually predicted at this point we would have less Pioneer ACOs than we have now,” he said.
CMS would like to see every ACO stay in the Pioneer program, he said, adding, “but the reality is we set up the policy construct to allow flexibility of risk tracks.”
Dr. Conway noted that there are still some 600,000 Medicare beneficiaries who receive care through ACOs in the Pioneer program.
Overall, the 23 ACOs that participated in both 2012 and 2013 saved $90 million for 2013; they saved $128 million in 2012.
Not surprisingly, many hospitals that lost money in the first year did not participate in the second year, according to the CMS data. But some did, despite continued losses.
At least half of the Pioneers shared in savings, said Dr. Conway.
Beth Israel Deaconess Care Organization appeared to be a fairly big winner, generating $17.6 million in savings, and getting to keep some $10.6 million.
The San Francisco-based Brown & Toland Physicians’ ACO generated $4.5 million in savings, keeping almost $2.5 million. The Mount Auburn Cambridge Independent Practice Association, in the Boston area, kept $2.2 million of the $3.6 million it generated for Medicare.
Pioneers that created savings in the first 2 years are eligible to start receiving a per member per month prospective payment in 2014 if they are still participating.
The CMS has not yet released data on how many Pioneer ACOs are operating under that payment arrangement.
The Pioneer ACOs also improved quality of care, with mean performance scores for the group rising from 71% to 84%, said Dr. Conway. The Pioneers improved in 28 of the 33 goals measured.
He said he was particularly impressed with the overall improvement in six out of the seven measures of patient experience.
Patients reported on whether they received timely appointments, had good access to specialists, how well the physician communicated, and if there was shared decision making, among other measures.
Going forward, the CMS is considering removing some process measures and adding more outcome measures, said Dr. Conway.
On Twitter @aliciaault
WASHINGTON – The accountable care organizations that are participating in Medicare’s highest risk, highest reward program improved in both quality of care and controlling costs in the second year, according to new government figures.
Even so, groups continue to leave the Pioneer ACO program. In the first year, 2012, there were 32 ACOs agreeing to share a high proportion of savings – or take on a high proportion of losses – as part of the Pioneer ACO program; 23 participated in 2013. Currently, 19 ACOs are participating, according to the Centers for Medicare & Medicaid Services.
Dr. Patrick Conway, CMS chief medical officer and deputy administrator for innovation and quality, said that drop outs were expected.
“We purposely set up the Pioneer program and our ACO program so that ACOs could migrate risk tracks,” Dr. Conway said at the meeting. “We actually predicted at this point we would have less Pioneer ACOs than we have now,” he said.
CMS would like to see every ACO stay in the Pioneer program, he said, adding, “but the reality is we set up the policy construct to allow flexibility of risk tracks.”
Dr. Conway noted that there are still some 600,000 Medicare beneficiaries who receive care through ACOs in the Pioneer program.
Overall, the 23 ACOs that participated in both 2012 and 2013 saved $90 million for 2013; they saved $128 million in 2012.
Not surprisingly, many hospitals that lost money in the first year did not participate in the second year, according to the CMS data. But some did, despite continued losses.
At least half of the Pioneers shared in savings, said Dr. Conway.
Beth Israel Deaconess Care Organization appeared to be a fairly big winner, generating $17.6 million in savings, and getting to keep some $10.6 million.
The San Francisco-based Brown & Toland Physicians’ ACO generated $4.5 million in savings, keeping almost $2.5 million. The Mount Auburn Cambridge Independent Practice Association, in the Boston area, kept $2.2 million of the $3.6 million it generated for Medicare.
Pioneers that created savings in the first 2 years are eligible to start receiving a per member per month prospective payment in 2014 if they are still participating.
The CMS has not yet released data on how many Pioneer ACOs are operating under that payment arrangement.
The Pioneer ACOs also improved quality of care, with mean performance scores for the group rising from 71% to 84%, said Dr. Conway. The Pioneers improved in 28 of the 33 goals measured.
He said he was particularly impressed with the overall improvement in six out of the seven measures of patient experience.
Patients reported on whether they received timely appointments, had good access to specialists, how well the physician communicated, and if there was shared decision making, among other measures.
Going forward, the CMS is considering removing some process measures and adding more outcome measures, said Dr. Conway.
On Twitter @aliciaault
AT THE U.S. NEWS HOSPITAL OF TOMORROW MEETING
Hydrocodone rescheduling takes effect Oct. 6
Physicians should ready themselves now for the new set of rules expected when hydrocodone-containing products become subject to tighter regulation on Oct. 6, according to various physician groups.
After a years-long process, the Drug Enforcement Administration announced in late August that it would be moving hydrocodone-containing products from schedule III to schedule II.
That rule takes effect on Oct. 6.
After that date, physicians who want to prescribe HCPs will have to use tamper-proof prescription forms, or use e-prescribing programs. They can call in a 72-hour supply, but must follow that up by mailing the prescription to the pharmacy. Refills by fax or phone are otherwise prohibited.
Patients who are on long term HCP therapy can get up to a 90-day supply through three separate, no-refill prescriptions.
The American Medical Association, which campaigned against the rescheduling of HCPs, is now urging its members to be prepared for the changes in prescribing and work flow that will come with the new landscape.
In a fact sheet, the AMA says that physicians should try to refill prescriptions before Oct. 6, noting that these prescriptions will essentially be grandfathered in under the old rules until Apr. 2015.
The American Society of Clinical Oncology in early September also notified its members of the coming changes, and said that it, too, had opposed rescheduling of HCPs.
Many physician groups have said that moving HCPs to schedule II will not stop abuse or diversion and may hurt patients who have a legitimate need. Dr. Reid Blackwelder, president of the American Academy of Family Physicians, said that “it’s hard to say,” whether upscheduling will make a dent in inappropriate or unnecessary prescribing.
He said in an interview that his practice already requires patients on long-term opioid therapy to come in at least every 3 months for refills and an evaluation. Although physicians may have to change their practice schedules to accommodate refill visits, those visits are good opportunities for education and follow-up, said Dr. Blackwelder.
Requiring face-to-face visits “creates more opportunities to review a treatment plan and make sure it still makes sense,” he said, noting that for many patients, short-acting opioids are the wrong medication.
Dr. Andrew Kolodny, for one, is applauding the rescheduling of HCPs, saying that the explosion in prescriptions for HCPs such as Vicodin (hydrocodone/acetaminophen) has been the single biggest contributor to the rise in opioid addiction.
“I think this is going to have an enormous impact on bringing the epidemic to an end,” Dr. Kolodny, chief medical officer at the Phoenix House Foundation and director of Physicians for Responsible Opioid Prescribing, said in an interview.
He noted that many opioid addicts get their start with HCPs, in part because they are ubiquitous.
The schedule change will bring “a sharp reduction in prescribing of hydrocodone-containing products,” because “it will communicate to prescribers that this drug is every bit as addictive as the other opioids, and needs to be prescribed cautiously,” said Dr. Kolodny.
Dr. Kolodny disclosed that Physicians for Responsible Opioid Prescribing does not accept any industry funding. It is a financed as a Phoenix House program.
On Twitter @aliciaault
Physicians should ready themselves now for the new set of rules expected when hydrocodone-containing products become subject to tighter regulation on Oct. 6, according to various physician groups.
After a years-long process, the Drug Enforcement Administration announced in late August that it would be moving hydrocodone-containing products from schedule III to schedule II.
That rule takes effect on Oct. 6.
After that date, physicians who want to prescribe HCPs will have to use tamper-proof prescription forms, or use e-prescribing programs. They can call in a 72-hour supply, but must follow that up by mailing the prescription to the pharmacy. Refills by fax or phone are otherwise prohibited.
Patients who are on long term HCP therapy can get up to a 90-day supply through three separate, no-refill prescriptions.
The American Medical Association, which campaigned against the rescheduling of HCPs, is now urging its members to be prepared for the changes in prescribing and work flow that will come with the new landscape.
In a fact sheet, the AMA says that physicians should try to refill prescriptions before Oct. 6, noting that these prescriptions will essentially be grandfathered in under the old rules until Apr. 2015.
The American Society of Clinical Oncology in early September also notified its members of the coming changes, and said that it, too, had opposed rescheduling of HCPs.
Many physician groups have said that moving HCPs to schedule II will not stop abuse or diversion and may hurt patients who have a legitimate need. Dr. Reid Blackwelder, president of the American Academy of Family Physicians, said that “it’s hard to say,” whether upscheduling will make a dent in inappropriate or unnecessary prescribing.
He said in an interview that his practice already requires patients on long-term opioid therapy to come in at least every 3 months for refills and an evaluation. Although physicians may have to change their practice schedules to accommodate refill visits, those visits are good opportunities for education and follow-up, said Dr. Blackwelder.
Requiring face-to-face visits “creates more opportunities to review a treatment plan and make sure it still makes sense,” he said, noting that for many patients, short-acting opioids are the wrong medication.
Dr. Andrew Kolodny, for one, is applauding the rescheduling of HCPs, saying that the explosion in prescriptions for HCPs such as Vicodin (hydrocodone/acetaminophen) has been the single biggest contributor to the rise in opioid addiction.
“I think this is going to have an enormous impact on bringing the epidemic to an end,” Dr. Kolodny, chief medical officer at the Phoenix House Foundation and director of Physicians for Responsible Opioid Prescribing, said in an interview.
He noted that many opioid addicts get their start with HCPs, in part because they are ubiquitous.
The schedule change will bring “a sharp reduction in prescribing of hydrocodone-containing products,” because “it will communicate to prescribers that this drug is every bit as addictive as the other opioids, and needs to be prescribed cautiously,” said Dr. Kolodny.
Dr. Kolodny disclosed that Physicians for Responsible Opioid Prescribing does not accept any industry funding. It is a financed as a Phoenix House program.
On Twitter @aliciaault
Physicians should ready themselves now for the new set of rules expected when hydrocodone-containing products become subject to tighter regulation on Oct. 6, according to various physician groups.
After a years-long process, the Drug Enforcement Administration announced in late August that it would be moving hydrocodone-containing products from schedule III to schedule II.
That rule takes effect on Oct. 6.
After that date, physicians who want to prescribe HCPs will have to use tamper-proof prescription forms, or use e-prescribing programs. They can call in a 72-hour supply, but must follow that up by mailing the prescription to the pharmacy. Refills by fax or phone are otherwise prohibited.
Patients who are on long term HCP therapy can get up to a 90-day supply through three separate, no-refill prescriptions.
The American Medical Association, which campaigned against the rescheduling of HCPs, is now urging its members to be prepared for the changes in prescribing and work flow that will come with the new landscape.
In a fact sheet, the AMA says that physicians should try to refill prescriptions before Oct. 6, noting that these prescriptions will essentially be grandfathered in under the old rules until Apr. 2015.
The American Society of Clinical Oncology in early September also notified its members of the coming changes, and said that it, too, had opposed rescheduling of HCPs.
Many physician groups have said that moving HCPs to schedule II will not stop abuse or diversion and may hurt patients who have a legitimate need. Dr. Reid Blackwelder, president of the American Academy of Family Physicians, said that “it’s hard to say,” whether upscheduling will make a dent in inappropriate or unnecessary prescribing.
He said in an interview that his practice already requires patients on long-term opioid therapy to come in at least every 3 months for refills and an evaluation. Although physicians may have to change their practice schedules to accommodate refill visits, those visits are good opportunities for education and follow-up, said Dr. Blackwelder.
Requiring face-to-face visits “creates more opportunities to review a treatment plan and make sure it still makes sense,” he said, noting that for many patients, short-acting opioids are the wrong medication.
Dr. Andrew Kolodny, for one, is applauding the rescheduling of HCPs, saying that the explosion in prescriptions for HCPs such as Vicodin (hydrocodone/acetaminophen) has been the single biggest contributor to the rise in opioid addiction.
“I think this is going to have an enormous impact on bringing the epidemic to an end,” Dr. Kolodny, chief medical officer at the Phoenix House Foundation and director of Physicians for Responsible Opioid Prescribing, said in an interview.
He noted that many opioid addicts get their start with HCPs, in part because they are ubiquitous.
The schedule change will bring “a sharp reduction in prescribing of hydrocodone-containing products,” because “it will communicate to prescribers that this drug is every bit as addictive as the other opioids, and needs to be prescribed cautiously,” said Dr. Kolodny.
Dr. Kolodny disclosed that Physicians for Responsible Opioid Prescribing does not accept any industry funding. It is a financed as a Phoenix House program.
On Twitter @aliciaault
