User login
Culture change key in adopting an oncology alternative payment model
SAN DIEGO – If you consider participating in an alternative payment model for your practice, expect to devote a lot of time to work flow changes, according to Blase N. Polite, MD.
“The culture change is one of the hardest things people face as they go into alternative payment models,” Dr. Polite, deputy section chief of clinical operations at the University of Chicago Medical Center, said at the annual meeting of the American College of Physicians.
“You want work flow changes designed to enable you to take better care of your patients in a consistent manner,” he noted. “It has to be designed with a busy clinic and a busy clinician in mind. You want to be able to share the work flow burden among different groups in the system, so it’s important to allow individuals to work at the upper end of their training.”
“We are paid $160 per month throughout the 6-month episode, and you can have as many recurring 6-month episodes as needed, assuming the patient continued to receive chemotherapy in IV or oral format,” Dr. Polite said.
“Our management fees are contingent on documented adherence to care processes,” he added. “We are held accountable to cost of care, quality metrics, and care processes. The shared savings are subject to bringing down costs while maintaining quality. If by year three you have not achieved shared savings, you have two choices: either drop out of the model, or agree to two-sided risk.”
CMS also is collecting detailed stage, molecular data, and recurrence/progression data on each patient.
The ability to perform risk adjustment in your patient population is a cornerstone of any alternative payment model, he said. These include variables such as cancer type, age, sex, selected noncancer comorbidities, receipt of radiation, and participation in a clinical trial.
As an example, Dr. Polite discussed the hypothetical case of a 65-year-old man with lymphoma, Medicare Part D coverage, and no Medicaid.
“If that patient has no comorbidities, the target treatment price is $23,657.80,” he said. “If that patient has been coded for three comorbidities, our target price goes up to $32,090.28. So, you see an almost $10,000 difference in our target price based on whether or not you appropriately coded and accounted for comorbidities in your patient.”
In a 6-month period, about one-third of costs in the university’s oncology care model are related to chemotherapy, another one-third are inpatient costs, “and everything else comes out as rounding error on the back end, such as evaluation and management coding, imaging, and radiation therapy,” Dr. Polite said.
CMS periodically sends national data such as the number of inpatient admissions per 100 patients and ED visits per 100 patients, so the center can compare itself with other practices in the model.
“You have to have a way to think through those data,” he said. “We can look at our drug expenditures and see where it is we’re spending the most money. Are there places where we can save money? Another key area: How do you identify your high-risk patients?”
Currently, Dr. Polite and his associates conduct risk assessments with every new patient, including the Vulnerable Elders Survey (VES-13), the Mini-Cog, the Patient Health Questionnaire–4 (PHQ-4), as well as questions intended to gauge the patient’s social support, financial situation, and health literacy.
“This is triggering within the medical record a best practices alert that is telling the physician there is a recommendation that this patient ought to be referred to social work or geriatric oncology, or psycho-oncology or physical therapy depending on their needs,” he said. “What remains a difficulty is we have about 18% of our patients who have a positive screen. But only in 23% of the cases so far do we have physicians who are actually acting on that screen.”
Clinicians considering adoption of an oncology care model should expect to devote time and resources to additional cancer registry abstraction and data entry, and make electronic medical record changes for data capture and identifying high-risk patients.
“You also want to invest in care coordination and navigation, staffing for after-hours urgent care to avoid emergency department costs, hospitalizations, and readmissions, staffing for pharmacists to manage high-risk patients on complex medications, staffing of additional palliative care providers, and system tools to make sure referral loops are closed,” Dr. Polite said.
“Those are places where money can help you,” he added. “But at the end of the day, money cannot help getting all the staff to collect and act upon the information provided to them.”
Dr. Polite disclosed that he has received research grants from Merck and is a consultant for GLG and Pfizer.
SAN DIEGO – If you consider participating in an alternative payment model for your practice, expect to devote a lot of time to work flow changes, according to Blase N. Polite, MD.
“The culture change is one of the hardest things people face as they go into alternative payment models,” Dr. Polite, deputy section chief of clinical operations at the University of Chicago Medical Center, said at the annual meeting of the American College of Physicians.
“You want work flow changes designed to enable you to take better care of your patients in a consistent manner,” he noted. “It has to be designed with a busy clinic and a busy clinician in mind. You want to be able to share the work flow burden among different groups in the system, so it’s important to allow individuals to work at the upper end of their training.”
“We are paid $160 per month throughout the 6-month episode, and you can have as many recurring 6-month episodes as needed, assuming the patient continued to receive chemotherapy in IV or oral format,” Dr. Polite said.
“Our management fees are contingent on documented adherence to care processes,” he added. “We are held accountable to cost of care, quality metrics, and care processes. The shared savings are subject to bringing down costs while maintaining quality. If by year three you have not achieved shared savings, you have two choices: either drop out of the model, or agree to two-sided risk.”
CMS also is collecting detailed stage, molecular data, and recurrence/progression data on each patient.
The ability to perform risk adjustment in your patient population is a cornerstone of any alternative payment model, he said. These include variables such as cancer type, age, sex, selected noncancer comorbidities, receipt of radiation, and participation in a clinical trial.
As an example, Dr. Polite discussed the hypothetical case of a 65-year-old man with lymphoma, Medicare Part D coverage, and no Medicaid.
“If that patient has no comorbidities, the target treatment price is $23,657.80,” he said. “If that patient has been coded for three comorbidities, our target price goes up to $32,090.28. So, you see an almost $10,000 difference in our target price based on whether or not you appropriately coded and accounted for comorbidities in your patient.”
In a 6-month period, about one-third of costs in the university’s oncology care model are related to chemotherapy, another one-third are inpatient costs, “and everything else comes out as rounding error on the back end, such as evaluation and management coding, imaging, and radiation therapy,” Dr. Polite said.
CMS periodically sends national data such as the number of inpatient admissions per 100 patients and ED visits per 100 patients, so the center can compare itself with other practices in the model.
“You have to have a way to think through those data,” he said. “We can look at our drug expenditures and see where it is we’re spending the most money. Are there places where we can save money? Another key area: How do you identify your high-risk patients?”
Currently, Dr. Polite and his associates conduct risk assessments with every new patient, including the Vulnerable Elders Survey (VES-13), the Mini-Cog, the Patient Health Questionnaire–4 (PHQ-4), as well as questions intended to gauge the patient’s social support, financial situation, and health literacy.
“This is triggering within the medical record a best practices alert that is telling the physician there is a recommendation that this patient ought to be referred to social work or geriatric oncology, or psycho-oncology or physical therapy depending on their needs,” he said. “What remains a difficulty is we have about 18% of our patients who have a positive screen. But only in 23% of the cases so far do we have physicians who are actually acting on that screen.”
Clinicians considering adoption of an oncology care model should expect to devote time and resources to additional cancer registry abstraction and data entry, and make electronic medical record changes for data capture and identifying high-risk patients.
“You also want to invest in care coordination and navigation, staffing for after-hours urgent care to avoid emergency department costs, hospitalizations, and readmissions, staffing for pharmacists to manage high-risk patients on complex medications, staffing of additional palliative care providers, and system tools to make sure referral loops are closed,” Dr. Polite said.
“Those are places where money can help you,” he added. “But at the end of the day, money cannot help getting all the staff to collect and act upon the information provided to them.”
Dr. Polite disclosed that he has received research grants from Merck and is a consultant for GLG and Pfizer.
SAN DIEGO – If you consider participating in an alternative payment model for your practice, expect to devote a lot of time to work flow changes, according to Blase N. Polite, MD.
“The culture change is one of the hardest things people face as they go into alternative payment models,” Dr. Polite, deputy section chief of clinical operations at the University of Chicago Medical Center, said at the annual meeting of the American College of Physicians.
“You want work flow changes designed to enable you to take better care of your patients in a consistent manner,” he noted. “It has to be designed with a busy clinic and a busy clinician in mind. You want to be able to share the work flow burden among different groups in the system, so it’s important to allow individuals to work at the upper end of their training.”
“We are paid $160 per month throughout the 6-month episode, and you can have as many recurring 6-month episodes as needed, assuming the patient continued to receive chemotherapy in IV or oral format,” Dr. Polite said.
“Our management fees are contingent on documented adherence to care processes,” he added. “We are held accountable to cost of care, quality metrics, and care processes. The shared savings are subject to bringing down costs while maintaining quality. If by year three you have not achieved shared savings, you have two choices: either drop out of the model, or agree to two-sided risk.”
CMS also is collecting detailed stage, molecular data, and recurrence/progression data on each patient.
The ability to perform risk adjustment in your patient population is a cornerstone of any alternative payment model, he said. These include variables such as cancer type, age, sex, selected noncancer comorbidities, receipt of radiation, and participation in a clinical trial.
As an example, Dr. Polite discussed the hypothetical case of a 65-year-old man with lymphoma, Medicare Part D coverage, and no Medicaid.
“If that patient has no comorbidities, the target treatment price is $23,657.80,” he said. “If that patient has been coded for three comorbidities, our target price goes up to $32,090.28. So, you see an almost $10,000 difference in our target price based on whether or not you appropriately coded and accounted for comorbidities in your patient.”
In a 6-month period, about one-third of costs in the university’s oncology care model are related to chemotherapy, another one-third are inpatient costs, “and everything else comes out as rounding error on the back end, such as evaluation and management coding, imaging, and radiation therapy,” Dr. Polite said.
CMS periodically sends national data such as the number of inpatient admissions per 100 patients and ED visits per 100 patients, so the center can compare itself with other practices in the model.
“You have to have a way to think through those data,” he said. “We can look at our drug expenditures and see where it is we’re spending the most money. Are there places where we can save money? Another key area: How do you identify your high-risk patients?”
Currently, Dr. Polite and his associates conduct risk assessments with every new patient, including the Vulnerable Elders Survey (VES-13), the Mini-Cog, the Patient Health Questionnaire–4 (PHQ-4), as well as questions intended to gauge the patient’s social support, financial situation, and health literacy.
“This is triggering within the medical record a best practices alert that is telling the physician there is a recommendation that this patient ought to be referred to social work or geriatric oncology, or psycho-oncology or physical therapy depending on their needs,” he said. “What remains a difficulty is we have about 18% of our patients who have a positive screen. But only in 23% of the cases so far do we have physicians who are actually acting on that screen.”
Clinicians considering adoption of an oncology care model should expect to devote time and resources to additional cancer registry abstraction and data entry, and make electronic medical record changes for data capture and identifying high-risk patients.
“You also want to invest in care coordination and navigation, staffing for after-hours urgent care to avoid emergency department costs, hospitalizations, and readmissions, staffing for pharmacists to manage high-risk patients on complex medications, staffing of additional palliative care providers, and system tools to make sure referral loops are closed,” Dr. Polite said.
“Those are places where money can help you,” he added. “But at the end of the day, money cannot help getting all the staff to collect and act upon the information provided to them.”
Dr. Polite disclosed that he has received research grants from Merck and is a consultant for GLG and Pfizer.
EXPERT ANALYSIS AT ACP INTERNAL MEDICINE
Order entry tool halves prescription drug costs
SAN DIEGO – What if you could cut patient drug costs, improve adherence, and cut hospitalization by using an online tool?
“Sounds like science fiction, right? I’m here to tell you it’s reality,” Alan A. Kubey, MD, said at the annual meeting of the American College of Physicians.
During his medical internship 3 years ago, Dr. Kubey met an 83-year-old woman on Medicare Part A and B, but not D, coverage. She was on a cardiology service, came in with a non-ST segment elevation myocardial infarction, and was treated conservatively. “She confided in me that it was hard for her, on a fixed income, to afford her medications and to do the things she loved to do,” said Dr. Kubey, who is now a hospitalist at Mayo Clinic, Rochester, Minn., and at Thomas Jefferson University Hospital, Philadelphia. After researching pharmacy options online, Dr. Kubey told the patient that he could get her medication cost down from $465 per day to $65 per day. “She was blown away, and I was blown away,” he said. “It seemed too good to be true. I then did a long retrospective analysis of patients in similar situations.”
During the ACP’s “Dragon’s Lair” competition at the meeting, Dr. Kubey earned the top prize of $7,500 to study the idea further. To date, he and his fellow researchers have used the tool for 25 patients and have saved each one about $5,600 per year in medication costs. Specifically, average costs have dropped from $6,282.54 per year to $598.84 per year, a savings of 88%. “Our plan now is to prospectively validate this in a small, single-site trial to show that this works,” he said. “If it does, we want to study it and develop it further and provide it more broadly to empower clinicians to improve the lives of patients.”
Each year, patients in the United States spend $325 billion on outpatient medications that hold the power to improve health and to save lives. “Yet, we know that up to 45% of patients don’t fill those scripts because of cost,” Dr. Kubey said. “Medication nonadherence leads to an additional $100 billion to $300 billion per year in excess care and an incalculable human cost in lost health. Providers are responsible for guiding patients in their medication decision making, yet study after study shows that physicians are woefully ill informed on the cost of medications. Yet even the astute clinician faces a Byzantine landscape that makes no sense, where a medication may cost up to 69-fold from one pharmacy to the next. What are we to do?
“We believe that you have to do it at the point of entry. There are innovative tools for patients like GoodRx, but, in my opinion, that puts too much on the patients’ shoulders. We want to bring this information directly to the provider – to build upon the progress that the likes of GoodRx have accomplished and add our advanced algorithm to rapidly empower the physician to send the patient to the most cost-effective pharmacy for the most cost-effective regimen on day 1.”
Dr. Kubey reported having no financial disclosures.
SAN DIEGO – What if you could cut patient drug costs, improve adherence, and cut hospitalization by using an online tool?
“Sounds like science fiction, right? I’m here to tell you it’s reality,” Alan A. Kubey, MD, said at the annual meeting of the American College of Physicians.
During his medical internship 3 years ago, Dr. Kubey met an 83-year-old woman on Medicare Part A and B, but not D, coverage. She was on a cardiology service, came in with a non-ST segment elevation myocardial infarction, and was treated conservatively. “She confided in me that it was hard for her, on a fixed income, to afford her medications and to do the things she loved to do,” said Dr. Kubey, who is now a hospitalist at Mayo Clinic, Rochester, Minn., and at Thomas Jefferson University Hospital, Philadelphia. After researching pharmacy options online, Dr. Kubey told the patient that he could get her medication cost down from $465 per day to $65 per day. “She was blown away, and I was blown away,” he said. “It seemed too good to be true. I then did a long retrospective analysis of patients in similar situations.”
During the ACP’s “Dragon’s Lair” competition at the meeting, Dr. Kubey earned the top prize of $7,500 to study the idea further. To date, he and his fellow researchers have used the tool for 25 patients and have saved each one about $5,600 per year in medication costs. Specifically, average costs have dropped from $6,282.54 per year to $598.84 per year, a savings of 88%. “Our plan now is to prospectively validate this in a small, single-site trial to show that this works,” he said. “If it does, we want to study it and develop it further and provide it more broadly to empower clinicians to improve the lives of patients.”
Each year, patients in the United States spend $325 billion on outpatient medications that hold the power to improve health and to save lives. “Yet, we know that up to 45% of patients don’t fill those scripts because of cost,” Dr. Kubey said. “Medication nonadherence leads to an additional $100 billion to $300 billion per year in excess care and an incalculable human cost in lost health. Providers are responsible for guiding patients in their medication decision making, yet study after study shows that physicians are woefully ill informed on the cost of medications. Yet even the astute clinician faces a Byzantine landscape that makes no sense, where a medication may cost up to 69-fold from one pharmacy to the next. What are we to do?
“We believe that you have to do it at the point of entry. There are innovative tools for patients like GoodRx, but, in my opinion, that puts too much on the patients’ shoulders. We want to bring this information directly to the provider – to build upon the progress that the likes of GoodRx have accomplished and add our advanced algorithm to rapidly empower the physician to send the patient to the most cost-effective pharmacy for the most cost-effective regimen on day 1.”
Dr. Kubey reported having no financial disclosures.
SAN DIEGO – What if you could cut patient drug costs, improve adherence, and cut hospitalization by using an online tool?
“Sounds like science fiction, right? I’m here to tell you it’s reality,” Alan A. Kubey, MD, said at the annual meeting of the American College of Physicians.
During his medical internship 3 years ago, Dr. Kubey met an 83-year-old woman on Medicare Part A and B, but not D, coverage. She was on a cardiology service, came in with a non-ST segment elevation myocardial infarction, and was treated conservatively. “She confided in me that it was hard for her, on a fixed income, to afford her medications and to do the things she loved to do,” said Dr. Kubey, who is now a hospitalist at Mayo Clinic, Rochester, Minn., and at Thomas Jefferson University Hospital, Philadelphia. After researching pharmacy options online, Dr. Kubey told the patient that he could get her medication cost down from $465 per day to $65 per day. “She was blown away, and I was blown away,” he said. “It seemed too good to be true. I then did a long retrospective analysis of patients in similar situations.”
During the ACP’s “Dragon’s Lair” competition at the meeting, Dr. Kubey earned the top prize of $7,500 to study the idea further. To date, he and his fellow researchers have used the tool for 25 patients and have saved each one about $5,600 per year in medication costs. Specifically, average costs have dropped from $6,282.54 per year to $598.84 per year, a savings of 88%. “Our plan now is to prospectively validate this in a small, single-site trial to show that this works,” he said. “If it does, we want to study it and develop it further and provide it more broadly to empower clinicians to improve the lives of patients.”
Each year, patients in the United States spend $325 billion on outpatient medications that hold the power to improve health and to save lives. “Yet, we know that up to 45% of patients don’t fill those scripts because of cost,” Dr. Kubey said. “Medication nonadherence leads to an additional $100 billion to $300 billion per year in excess care and an incalculable human cost in lost health. Providers are responsible for guiding patients in their medication decision making, yet study after study shows that physicians are woefully ill informed on the cost of medications. Yet even the astute clinician faces a Byzantine landscape that makes no sense, where a medication may cost up to 69-fold from one pharmacy to the next. What are we to do?
“We believe that you have to do it at the point of entry. There are innovative tools for patients like GoodRx, but, in my opinion, that puts too much on the patients’ shoulders. We want to bring this information directly to the provider – to build upon the progress that the likes of GoodRx have accomplished and add our advanced algorithm to rapidly empower the physician to send the patient to the most cost-effective pharmacy for the most cost-effective regimen on day 1.”
Dr. Kubey reported having no financial disclosures.
EXPERT ANALYSIS AT ACP INTERNAL MEDICINE
Shared-savings ESRD organization reduced missed treatments, hospitalizations
SAN DIEGO – In the first year since Delaware Valley Nephrology joined an end–stage renal disease seamless care organization, patient hospitalizations have declined by 40% and rehospitalizations by 20%, according to Edward R. Jones, MD.
At the annual meeting of the American College of Physicians, Dr. Jones, a nephrologist at a Philadelphia-based practice, described his experience with the alternative payment model, which focuses on managing costs while providing better health outcomes.
More than 15 months ago, Dr. Jones and seven other nephrologists in his practice partnered with Fresenius Medical Care to form an ESCO with two other nephrology groups, amounting to 45 physicians who work out of 30 dialysis units in 14 hospitals and care for 1,000 patients.
It became one of 13 ESCOs that have been operating nationwide since October 2015. The ESCOs share savings with the Centers for Medicare & Medicaid Services if matched beneficiaries’ expenditures decrease and quality is maintained or improved, and it shares losses if beneficiaries’ expenditures increase.
To be eligible for participation in the ESCO, patients must be enrolled in Medicare Parts A and B and have Medicare as their primary payer. They are ineligible if they are enrolled in a Medicare Advantage plan. Patients must not have received a kidney transplant in the last 12 months and must receive at least 51% of annual dialysis services in the ESCO’s market area.
“The governing structure of the ESCO was critical as we put it together,” Dr. Jones said. “We insisted that a nephrologist be at the table of the governing body, as well as a consumer advocate, and no one controls more than 50% of the vote.
“The concept here is that a benchmark for spending is set,” he explained. “If your spending is less than the benchmark expenditure, there are shared savings. The opposite occurs if there are losses, so it’s a fairly straightforward program.”
To illustrate how the ESCO works, he discussed a hypothetical model in which the ESCO used $50 million of expenditures from 2012 to 2015.
“If the actual ESCO expenditures are $47 million, there are $3 million in potential shared savings,” Dr. Jones explained. “It’s potential because two things are necessary. First, you have to have hit at least 1% savings or 1% loss. This allows for any random outcomes. Of $3 million of potential shared savings, CMS keeps 25%.
“The remaining shared savings depends on where you hit on the metric performance,” he continued. “In the first year, it’s a pay for reporting [system], so all we had to do is hit three measures. So, the first year was great.”
In the second year of ESCO participation, centers have to perform in the 90th percentile on 16 metrics to get full shared savings. Drawn from Medicare claims and medical records, the list of metrics includes diabetic foot exam, medication reconciliation, and advanced care planning, and it accounts for 50% of the score. Surveys of person- and caregiver-centered experience outcomes compose 33% of the score.
“These metrics are compared to all other metrics throughout the country,” Dr. Jones said. “Wherever you fall, you generate a certain number of points, between 0 and 2. It’s tied to quality and outcomes. If you’re in the 90th percentile you get all 2 points. If you’re below the 50th percentile, you get no points.”
The goal of the ESCO is to achieve the minimal savings rate, to maximize achievement of quality metrics, and to reduce expenses below the set benchmark. In Dr. Jones’ practice area, ESRD care costs about $87,000 per patient per year – 34% are related to inpatient costs, and 30% are related to dialysis costs.
Keys to a successful ESCO include “a cooperative and engaged nephrologist” and the ability to gather analytics.
“There is no way that a practice of my size has the capability of generating the analytics to be able to risk-stratify patients,” he said. “Who is likely to be readmitted? We put all of our effort into those folks. Medication reconciliation accounts for a lot of rehospitalization. We spend a lot of time on that.”
There is also increased use of care navigators. “Our goal is for patients to call the care navigators before they call the nephrologist,” Dr. Jones said. “We have safety net clinics that are open 24/7. So, if a patient comes in on a Saturday or Sunday, we can divert the patient to those areas.”
In the first year since joining the ESCO, patient hospitalizations at Dr. Jones’ practice have declined by 40%, and rehospitalizations have dropped by 20%.
“Importantly, we know that when a patient is not in his dialysis chair within 15 minutes, the care navigator calls him,” he said. “The number of missed treatments is down dramatically.”
Dr. Jones reported owning stock in Cytosorbents. He also serves as a consultant for Fresenius Medical Care, Fresenius Medical Services, Physicians Choice Dialysis, and Reliant Renal Care. He is also an advisory board member for Cytosorbents and Fresenius.
SAN DIEGO – In the first year since Delaware Valley Nephrology joined an end–stage renal disease seamless care organization, patient hospitalizations have declined by 40% and rehospitalizations by 20%, according to Edward R. Jones, MD.
At the annual meeting of the American College of Physicians, Dr. Jones, a nephrologist at a Philadelphia-based practice, described his experience with the alternative payment model, which focuses on managing costs while providing better health outcomes.
More than 15 months ago, Dr. Jones and seven other nephrologists in his practice partnered with Fresenius Medical Care to form an ESCO with two other nephrology groups, amounting to 45 physicians who work out of 30 dialysis units in 14 hospitals and care for 1,000 patients.
It became one of 13 ESCOs that have been operating nationwide since October 2015. The ESCOs share savings with the Centers for Medicare & Medicaid Services if matched beneficiaries’ expenditures decrease and quality is maintained or improved, and it shares losses if beneficiaries’ expenditures increase.
To be eligible for participation in the ESCO, patients must be enrolled in Medicare Parts A and B and have Medicare as their primary payer. They are ineligible if they are enrolled in a Medicare Advantage plan. Patients must not have received a kidney transplant in the last 12 months and must receive at least 51% of annual dialysis services in the ESCO’s market area.
“The governing structure of the ESCO was critical as we put it together,” Dr. Jones said. “We insisted that a nephrologist be at the table of the governing body, as well as a consumer advocate, and no one controls more than 50% of the vote.
“The concept here is that a benchmark for spending is set,” he explained. “If your spending is less than the benchmark expenditure, there are shared savings. The opposite occurs if there are losses, so it’s a fairly straightforward program.”
To illustrate how the ESCO works, he discussed a hypothetical model in which the ESCO used $50 million of expenditures from 2012 to 2015.
“If the actual ESCO expenditures are $47 million, there are $3 million in potential shared savings,” Dr. Jones explained. “It’s potential because two things are necessary. First, you have to have hit at least 1% savings or 1% loss. This allows for any random outcomes. Of $3 million of potential shared savings, CMS keeps 25%.
“The remaining shared savings depends on where you hit on the metric performance,” he continued. “In the first year, it’s a pay for reporting [system], so all we had to do is hit three measures. So, the first year was great.”
In the second year of ESCO participation, centers have to perform in the 90th percentile on 16 metrics to get full shared savings. Drawn from Medicare claims and medical records, the list of metrics includes diabetic foot exam, medication reconciliation, and advanced care planning, and it accounts for 50% of the score. Surveys of person- and caregiver-centered experience outcomes compose 33% of the score.
“These metrics are compared to all other metrics throughout the country,” Dr. Jones said. “Wherever you fall, you generate a certain number of points, between 0 and 2. It’s tied to quality and outcomes. If you’re in the 90th percentile you get all 2 points. If you’re below the 50th percentile, you get no points.”
The goal of the ESCO is to achieve the minimal savings rate, to maximize achievement of quality metrics, and to reduce expenses below the set benchmark. In Dr. Jones’ practice area, ESRD care costs about $87,000 per patient per year – 34% are related to inpatient costs, and 30% are related to dialysis costs.
Keys to a successful ESCO include “a cooperative and engaged nephrologist” and the ability to gather analytics.
“There is no way that a practice of my size has the capability of generating the analytics to be able to risk-stratify patients,” he said. “Who is likely to be readmitted? We put all of our effort into those folks. Medication reconciliation accounts for a lot of rehospitalization. We spend a lot of time on that.”
There is also increased use of care navigators. “Our goal is for patients to call the care navigators before they call the nephrologist,” Dr. Jones said. “We have safety net clinics that are open 24/7. So, if a patient comes in on a Saturday or Sunday, we can divert the patient to those areas.”
In the first year since joining the ESCO, patient hospitalizations at Dr. Jones’ practice have declined by 40%, and rehospitalizations have dropped by 20%.
“Importantly, we know that when a patient is not in his dialysis chair within 15 minutes, the care navigator calls him,” he said. “The number of missed treatments is down dramatically.”
Dr. Jones reported owning stock in Cytosorbents. He also serves as a consultant for Fresenius Medical Care, Fresenius Medical Services, Physicians Choice Dialysis, and Reliant Renal Care. He is also an advisory board member for Cytosorbents and Fresenius.
SAN DIEGO – In the first year since Delaware Valley Nephrology joined an end–stage renal disease seamless care organization, patient hospitalizations have declined by 40% and rehospitalizations by 20%, according to Edward R. Jones, MD.
At the annual meeting of the American College of Physicians, Dr. Jones, a nephrologist at a Philadelphia-based practice, described his experience with the alternative payment model, which focuses on managing costs while providing better health outcomes.
More than 15 months ago, Dr. Jones and seven other nephrologists in his practice partnered with Fresenius Medical Care to form an ESCO with two other nephrology groups, amounting to 45 physicians who work out of 30 dialysis units in 14 hospitals and care for 1,000 patients.
It became one of 13 ESCOs that have been operating nationwide since October 2015. The ESCOs share savings with the Centers for Medicare & Medicaid Services if matched beneficiaries’ expenditures decrease and quality is maintained or improved, and it shares losses if beneficiaries’ expenditures increase.
To be eligible for participation in the ESCO, patients must be enrolled in Medicare Parts A and B and have Medicare as their primary payer. They are ineligible if they are enrolled in a Medicare Advantage plan. Patients must not have received a kidney transplant in the last 12 months and must receive at least 51% of annual dialysis services in the ESCO’s market area.
“The governing structure of the ESCO was critical as we put it together,” Dr. Jones said. “We insisted that a nephrologist be at the table of the governing body, as well as a consumer advocate, and no one controls more than 50% of the vote.
“The concept here is that a benchmark for spending is set,” he explained. “If your spending is less than the benchmark expenditure, there are shared savings. The opposite occurs if there are losses, so it’s a fairly straightforward program.”
To illustrate how the ESCO works, he discussed a hypothetical model in which the ESCO used $50 million of expenditures from 2012 to 2015.
“If the actual ESCO expenditures are $47 million, there are $3 million in potential shared savings,” Dr. Jones explained. “It’s potential because two things are necessary. First, you have to have hit at least 1% savings or 1% loss. This allows for any random outcomes. Of $3 million of potential shared savings, CMS keeps 25%.
“The remaining shared savings depends on where you hit on the metric performance,” he continued. “In the first year, it’s a pay for reporting [system], so all we had to do is hit three measures. So, the first year was great.”
In the second year of ESCO participation, centers have to perform in the 90th percentile on 16 metrics to get full shared savings. Drawn from Medicare claims and medical records, the list of metrics includes diabetic foot exam, medication reconciliation, and advanced care planning, and it accounts for 50% of the score. Surveys of person- and caregiver-centered experience outcomes compose 33% of the score.
“These metrics are compared to all other metrics throughout the country,” Dr. Jones said. “Wherever you fall, you generate a certain number of points, between 0 and 2. It’s tied to quality and outcomes. If you’re in the 90th percentile you get all 2 points. If you’re below the 50th percentile, you get no points.”
The goal of the ESCO is to achieve the minimal savings rate, to maximize achievement of quality metrics, and to reduce expenses below the set benchmark. In Dr. Jones’ practice area, ESRD care costs about $87,000 per patient per year – 34% are related to inpatient costs, and 30% are related to dialysis costs.
Keys to a successful ESCO include “a cooperative and engaged nephrologist” and the ability to gather analytics.
“There is no way that a practice of my size has the capability of generating the analytics to be able to risk-stratify patients,” he said. “Who is likely to be readmitted? We put all of our effort into those folks. Medication reconciliation accounts for a lot of rehospitalization. We spend a lot of time on that.”
There is also increased use of care navigators. “Our goal is for patients to call the care navigators before they call the nephrologist,” Dr. Jones said. “We have safety net clinics that are open 24/7. So, if a patient comes in on a Saturday or Sunday, we can divert the patient to those areas.”
In the first year since joining the ESCO, patient hospitalizations at Dr. Jones’ practice have declined by 40%, and rehospitalizations have dropped by 20%.
“Importantly, we know that when a patient is not in his dialysis chair within 15 minutes, the care navigator calls him,” he said. “The number of missed treatments is down dramatically.”
Dr. Jones reported owning stock in Cytosorbents. He also serves as a consultant for Fresenius Medical Care, Fresenius Medical Services, Physicians Choice Dialysis, and Reliant Renal Care. He is also an advisory board member for Cytosorbents and Fresenius.
EXPERT ANALYSIS AT ACP INTERNAL MEDICINE
Michigan model embeds pharmacists into primary care
SAN DIEGO – Incorporating pharmacists into primary care offices has the potential to significantly impact patient care and save health care costs, according to Hae Mi Choe, PharmD.
Drug-related morbidity in the United States costs an estimated $290 billion annually, or about 13% of total health care expenditures, said Dr. Choe, associate dean at the University of Michigan College of Pharmacy and director of pharmacy innovations and partnerships at the University of Michigan Medical Group, Ann Arbor.
Dr. Choe described her experience helping to create a group practice model at the university health system for clinical pharmacists as part of the patient-centered medical home movement.
A total of 11 pharmacists are embedded in 14 primary care clinics in the University of Michigan Health System (now known as Michigan Medicine) to provide disease management and comprehensive medication review services. The pharmacists’ time at each site varies depending on patient volume, but typically ranges from 1 to 3 days per week.
They work to identify patients struggling to manage their diabetes, hypertension, or hyperlipidemia. “For patients who may not have reached their HbA1c goal, for instance, we may reach out to the physician and say, ‘Do you think Mrs. Jones would benefit from seeing a pharmacist?’ ” she said.
For comprehensive medication review, pharmacists schedule two visits. The first involves sitting down with the patient to review all of their medications, “trying to understand the patients’ perception of their medication, their preference in how they go about their treatment regimen, their understanding of the disease state, and identify potential barriers to treatment like medication cost,” Dr. Choe explained.
“Then we schedule the patient back in 2 weeks, after we’ve discussed issues with physicians and created a treatment plan,” she continued. “At that time, we discuss new treatment plan to improve efficacy, safety, and lower drug costs.”
Combined, both visits amount to 75-90 minutes of the pharmacist’s time.
“We try to provide comprehensive medication review at least once a year for complex patients,” she said. “It’s our version of an annual physical exam. One patient I saw was taking 32 medications prescribed by nine different specialists. She was taking her medication eight times per day.”
Another patient who came in for a comprehensive medication review transported his drugs in a suitcase. “He told me that he was about to go to Florida, and that the suitcase for his medications was bigger than the one for his clothes,” Dr. Choe said.
“You’d be surprised what patients take that you were not aware of,” she added. “Research shows that up to 50% of the time, patients do not take medications as prescribed. For antihypertensives, roughly one-quarter of patients don’t fill the prescription to begin with, and another one-quarter don’t take it as prescribed. That’s 50% right there.”
Pharmacists in the Michigan Medicine practice model have full access to the health system’s electronic medical record, including bidirectional communication with physicians.
“We also have population-level data, so if I wanted to drill down on clinic A and ask, who in clinic A is not achieving HbA1c, blood pressure, or other quality metrics, with a click of a button we can drill down to that population base,” she said. The pharmacists have been granted special clinical privileges, including the ability to initiate medication, adjust dosing, and discontinue therapy based on delegation protocols.
When Dr. Choe and her associates analyzed 2,674 interventions made during the first year of the program’s implementation, 50% involved increasing a dose, followed by adding a medication (20%), decreasing a dose (13%), deleting a medication (9%), and optimizing a medication regimen (8%). In addition, patients with a baseline HbA1c of greater than 7% experienced a 1% drop in their HbA1c level. Results were similar for patients whose baseline HbA1c level was greater than 8% and greater than 9% (drops of 1.4% and 1.9%, respectively).
The pharmacist program has expanded to Michigan Medicine chronic kidney disease clinics, outpatient psychiatric clinic, anticoagulation services, transitions of care services, palliative care services, transplant services, transplant clinics, oncology clinics, and telehealth services, Dr. Choe said.
For clinicians looking to embed pharmacists into their clinics, she recommended identifying key stakeholders with whom to collaborate.
“That could be a physician champion, and having a lead pharmacist who not only has the strong clinical ability but leadership skills to build a program,” she said. “You would also benefit from having someone in your team with a clinical operation background, and someone with quality and data expertise. Start small and aim for a bigger impact.”
Dr. Choe reported having no financial disclosures.
SAN DIEGO – Incorporating pharmacists into primary care offices has the potential to significantly impact patient care and save health care costs, according to Hae Mi Choe, PharmD.
Drug-related morbidity in the United States costs an estimated $290 billion annually, or about 13% of total health care expenditures, said Dr. Choe, associate dean at the University of Michigan College of Pharmacy and director of pharmacy innovations and partnerships at the University of Michigan Medical Group, Ann Arbor.
Dr. Choe described her experience helping to create a group practice model at the university health system for clinical pharmacists as part of the patient-centered medical home movement.
A total of 11 pharmacists are embedded in 14 primary care clinics in the University of Michigan Health System (now known as Michigan Medicine) to provide disease management and comprehensive medication review services. The pharmacists’ time at each site varies depending on patient volume, but typically ranges from 1 to 3 days per week.
They work to identify patients struggling to manage their diabetes, hypertension, or hyperlipidemia. “For patients who may not have reached their HbA1c goal, for instance, we may reach out to the physician and say, ‘Do you think Mrs. Jones would benefit from seeing a pharmacist?’ ” she said.
For comprehensive medication review, pharmacists schedule two visits. The first involves sitting down with the patient to review all of their medications, “trying to understand the patients’ perception of their medication, their preference in how they go about their treatment regimen, their understanding of the disease state, and identify potential barriers to treatment like medication cost,” Dr. Choe explained.
“Then we schedule the patient back in 2 weeks, after we’ve discussed issues with physicians and created a treatment plan,” she continued. “At that time, we discuss new treatment plan to improve efficacy, safety, and lower drug costs.”
Combined, both visits amount to 75-90 minutes of the pharmacist’s time.
“We try to provide comprehensive medication review at least once a year for complex patients,” she said. “It’s our version of an annual physical exam. One patient I saw was taking 32 medications prescribed by nine different specialists. She was taking her medication eight times per day.”
Another patient who came in for a comprehensive medication review transported his drugs in a suitcase. “He told me that he was about to go to Florida, and that the suitcase for his medications was bigger than the one for his clothes,” Dr. Choe said.
“You’d be surprised what patients take that you were not aware of,” she added. “Research shows that up to 50% of the time, patients do not take medications as prescribed. For antihypertensives, roughly one-quarter of patients don’t fill the prescription to begin with, and another one-quarter don’t take it as prescribed. That’s 50% right there.”
Pharmacists in the Michigan Medicine practice model have full access to the health system’s electronic medical record, including bidirectional communication with physicians.
“We also have population-level data, so if I wanted to drill down on clinic A and ask, who in clinic A is not achieving HbA1c, blood pressure, or other quality metrics, with a click of a button we can drill down to that population base,” she said. The pharmacists have been granted special clinical privileges, including the ability to initiate medication, adjust dosing, and discontinue therapy based on delegation protocols.
When Dr. Choe and her associates analyzed 2,674 interventions made during the first year of the program’s implementation, 50% involved increasing a dose, followed by adding a medication (20%), decreasing a dose (13%), deleting a medication (9%), and optimizing a medication regimen (8%). In addition, patients with a baseline HbA1c of greater than 7% experienced a 1% drop in their HbA1c level. Results were similar for patients whose baseline HbA1c level was greater than 8% and greater than 9% (drops of 1.4% and 1.9%, respectively).
The pharmacist program has expanded to Michigan Medicine chronic kidney disease clinics, outpatient psychiatric clinic, anticoagulation services, transitions of care services, palliative care services, transplant services, transplant clinics, oncology clinics, and telehealth services, Dr. Choe said.
For clinicians looking to embed pharmacists into their clinics, she recommended identifying key stakeholders with whom to collaborate.
“That could be a physician champion, and having a lead pharmacist who not only has the strong clinical ability but leadership skills to build a program,” she said. “You would also benefit from having someone in your team with a clinical operation background, and someone with quality and data expertise. Start small and aim for a bigger impact.”
Dr. Choe reported having no financial disclosures.
SAN DIEGO – Incorporating pharmacists into primary care offices has the potential to significantly impact patient care and save health care costs, according to Hae Mi Choe, PharmD.
Drug-related morbidity in the United States costs an estimated $290 billion annually, or about 13% of total health care expenditures, said Dr. Choe, associate dean at the University of Michigan College of Pharmacy and director of pharmacy innovations and partnerships at the University of Michigan Medical Group, Ann Arbor.
Dr. Choe described her experience helping to create a group practice model at the university health system for clinical pharmacists as part of the patient-centered medical home movement.
A total of 11 pharmacists are embedded in 14 primary care clinics in the University of Michigan Health System (now known as Michigan Medicine) to provide disease management and comprehensive medication review services. The pharmacists’ time at each site varies depending on patient volume, but typically ranges from 1 to 3 days per week.
They work to identify patients struggling to manage their diabetes, hypertension, or hyperlipidemia. “For patients who may not have reached their HbA1c goal, for instance, we may reach out to the physician and say, ‘Do you think Mrs. Jones would benefit from seeing a pharmacist?’ ” she said.
For comprehensive medication review, pharmacists schedule two visits. The first involves sitting down with the patient to review all of their medications, “trying to understand the patients’ perception of their medication, their preference in how they go about their treatment regimen, their understanding of the disease state, and identify potential barriers to treatment like medication cost,” Dr. Choe explained.
“Then we schedule the patient back in 2 weeks, after we’ve discussed issues with physicians and created a treatment plan,” she continued. “At that time, we discuss new treatment plan to improve efficacy, safety, and lower drug costs.”
Combined, both visits amount to 75-90 minutes of the pharmacist’s time.
“We try to provide comprehensive medication review at least once a year for complex patients,” she said. “It’s our version of an annual physical exam. One patient I saw was taking 32 medications prescribed by nine different specialists. She was taking her medication eight times per day.”
Another patient who came in for a comprehensive medication review transported his drugs in a suitcase. “He told me that he was about to go to Florida, and that the suitcase for his medications was bigger than the one for his clothes,” Dr. Choe said.
“You’d be surprised what patients take that you were not aware of,” she added. “Research shows that up to 50% of the time, patients do not take medications as prescribed. For antihypertensives, roughly one-quarter of patients don’t fill the prescription to begin with, and another one-quarter don’t take it as prescribed. That’s 50% right there.”
Pharmacists in the Michigan Medicine practice model have full access to the health system’s electronic medical record, including bidirectional communication with physicians.
“We also have population-level data, so if I wanted to drill down on clinic A and ask, who in clinic A is not achieving HbA1c, blood pressure, or other quality metrics, with a click of a button we can drill down to that population base,” she said. The pharmacists have been granted special clinical privileges, including the ability to initiate medication, adjust dosing, and discontinue therapy based on delegation protocols.
When Dr. Choe and her associates analyzed 2,674 interventions made during the first year of the program’s implementation, 50% involved increasing a dose, followed by adding a medication (20%), decreasing a dose (13%), deleting a medication (9%), and optimizing a medication regimen (8%). In addition, patients with a baseline HbA1c of greater than 7% experienced a 1% drop in their HbA1c level. Results were similar for patients whose baseline HbA1c level was greater than 8% and greater than 9% (drops of 1.4% and 1.9%, respectively).
The pharmacist program has expanded to Michigan Medicine chronic kidney disease clinics, outpatient psychiatric clinic, anticoagulation services, transitions of care services, palliative care services, transplant services, transplant clinics, oncology clinics, and telehealth services, Dr. Choe said.
For clinicians looking to embed pharmacists into their clinics, she recommended identifying key stakeholders with whom to collaborate.
“That could be a physician champion, and having a lead pharmacist who not only has the strong clinical ability but leadership skills to build a program,” she said. “You would also benefit from having someone in your team with a clinical operation background, and someone with quality and data expertise. Start small and aim for a bigger impact.”
Dr. Choe reported having no financial disclosures.
EXPERT ANALYSIS AT ACP INTERNAL MEDICINE
Evidence for medical marijuana largely up in smoke
SAN DIEGO – Despite the popularity of medical marijuana, robust evidence for its use is limited or nonexistent for most medical conditions.
“This is a tough subject to study,” Ellie Grossman, MD, said at the annual meeting of the American College of Physicians. “There is federal money that can only be used in very limited ways to study it. Our science is way behind the times in terms of what our patients are doing and using.”
Typical limitations of marijuana studies include self-report of quantity/duration used and the fact that biochemical/quantifiable measures are lacking. “For inhaled marijuana, there is variability in how much is inhaled and how deeply it’s being inhaled,” said Dr. Grossman, an internist who practices in Somerville, Mass. 
Then there’s the issue of recall bias and the question as to whether oral cannabinoids equate to the plant-derived forms of medical marijuana that patients obtain from their local dispensaries.
That matters, because the majority of published studies on the topic have evaluated oral cannabinoids, not the plant form. “So, what we’re studying is vastly different from what our patients are using,” she said.
The most solid indication clinicians have for recommending medical marijuana is for chronic pain, and the most common condition studied has been neuropathy.
“Most evidence compares cannabinoid to placebo,” said Dr. Grossman, primary care lead for behavioral health integration at Cambridge (Mass.) Health Alliance. “There’s almost nothing out there comparing cannabinoid to any other pain-relieving agent that a patient might choose to use.
“A lot of the literature comes from oral synthesized agents,” she continued. “There’s a little bit of science about inhaled forms, but a lot of this is very different from what my patient got last week in a medical marijuana dispensary in Massachusetts.”
Results from a systematic review of 79 studies of cannabinoids for medical use in 6,462 study participants showed that, compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs. 20%; odds ratio, 3.82), reduction in pain (37% vs. 31%; OR, 1.41), a greater average reduction in numerical rating scale pain assessment (on a 0- to 10-point scale; weighted mean difference of –0.46), and average reduction in the Ashworth spasticity scale (–0.36) (JAMA 2015 Jun 23-30;313[24]:2456-73).
A separate meta-analysis of studies compared inhaled cannabis sativa to placebo for chronic painful neuropathy. The researchers found that those patients who used inhaled cannabis sativa were 3.2 times more likely to achieve a 30% or greater reduction in pain, compared with those in the placebo group (J. Pain 2015 Dec;16[12]:1221-32).
However, Dr. Grossman cautioned that the number of patients studied was fewer than 200, “so, you could argue that this is a body of knowledge where the jury is still out.”
According to a 2017 report from the National Academy of Sciences titled, “The Health Effects of Cannabis and Cannabinoids,” another area in which the knowledge base is less solid is the use of oral cannabinoids for chemotherapy-induced nausea and vomiting.
“There’s a reasonable amount of evidence showing that some of these are better than placebo for relief of these symptoms,” Dr. Grossman said. “That said, the jury’s out as to whether they are any better than our other antiemetic agents. And there are no studies comparing them to neurokinin-1 inhibitors, which are the newest class of drug often used by oncologists for this indication. There is also no good evidence about inhaled plant cannabis.”
Studies of oral cannabinoids for multiple-sclerosis–related spasticity have demonstrated a small improvement on patient-reported spasticity (less than 1 point on a 10-point scale), but there was no improvement in clinician-reported outcomes. At the same time, their use for weight loss/anorexia in HIV “is very limited, and there are no studies of plant-derived cannabis,” Dr. Grossman said.
According to the National Academy of Sciences report, some evidence supports the use of oral cannabinoids for short-term sleep outcomes in patients with chronic diseases such as fibromyalgia and MS. One small study of oral cannabinoid for anxiety found that it improved social anxiety symptoms on the public speaking test, but there have been no studies using inhaled cannabinoids/marijuana.
The health risks of medical marijuana are largely unknown, Dr. Grossman said, noting that most evidence on longer‐term health risks comes from epidemiologic studies of recreational cannabis users.
“Medical marijuana users tend to be older and tend to be sicker,” she said. “We don’t know anything about the long-term effects in that sicker population.”
Among healthier people, Dr. Grossman continued, cannabis use is associated with increased risk of cough, wheeze, and sputum/phlegm. “There’s also an increased risk of motor vehicle accidents,” she said. “That is certainly a concern in places where they’re legalizing marijuana.”
Cannabis use is associated with lower neonatal birth weight, case reports/series of unintentional pediatric ingestions, and a possible increase in suicidal ideation, suicide attempts, and completed suicides.
“The evidence is very limited regarding associations with myocardial infarction, stroke, COPD, and mortality,” she added. “We don’t really know.”
Dr. Grossman reported having no financial disclosures.
SAN DIEGO – Despite the popularity of medical marijuana, robust evidence for its use is limited or nonexistent for most medical conditions.
“This is a tough subject to study,” Ellie Grossman, MD, said at the annual meeting of the American College of Physicians. “There is federal money that can only be used in very limited ways to study it. Our science is way behind the times in terms of what our patients are doing and using.”
Typical limitations of marijuana studies include self-report of quantity/duration used and the fact that biochemical/quantifiable measures are lacking. “For inhaled marijuana, there is variability in how much is inhaled and how deeply it’s being inhaled,” said Dr. Grossman, an internist who practices in Somerville, Mass.
Then there’s the issue of recall bias and the question as to whether oral cannabinoids equate to the plant-derived forms of medical marijuana that patients obtain from their local dispensaries.
That matters, because the majority of published studies on the topic have evaluated oral cannabinoids, not the plant form. “So, what we’re studying is vastly different from what our patients are using,” she said.
The most solid indication clinicians have for recommending medical marijuana is for chronic pain, and the most common condition studied has been neuropathy.
“Most evidence compares cannabinoid to placebo,” said Dr. Grossman, primary care lead for behavioral health integration at Cambridge (Mass.) Health Alliance. “There’s almost nothing out there comparing cannabinoid to any other pain-relieving agent that a patient might choose to use.
“A lot of the literature comes from oral synthesized agents,” she continued. “There’s a little bit of science about inhaled forms, but a lot of this is very different from what my patient got last week in a medical marijuana dispensary in Massachusetts.”
Results from a systematic review of 79 studies of cannabinoids for medical use in 6,462 study participants showed that, compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs. 20%; odds ratio, 3.82), reduction in pain (37% vs. 31%; OR, 1.41), a greater average reduction in numerical rating scale pain assessment (on a 0- to 10-point scale; weighted mean difference of –0.46), and average reduction in the Ashworth spasticity scale (–0.36) (JAMA 2015 Jun 23-30;313[24]:2456-73).
A separate meta-analysis of studies compared inhaled cannabis sativa to placebo for chronic painful neuropathy. The researchers found that those patients who used inhaled cannabis sativa were 3.2 times more likely to achieve a 30% or greater reduction in pain, compared with those in the placebo group (J. Pain 2015 Dec;16[12]:1221-32).
However, Dr. Grossman cautioned that the number of patients studied was fewer than 200, “so, you could argue that this is a body of knowledge where the jury is still out.”
According to a 2017 report from the National Academy of Sciences titled, “The Health Effects of Cannabis and Cannabinoids,” another area in which the knowledge base is less solid is the use of oral cannabinoids for chemotherapy-induced nausea and vomiting.
“There’s a reasonable amount of evidence showing that some of these are better than placebo for relief of these symptoms,” Dr. Grossman said. “That said, the jury’s out as to whether they are any better than our other antiemetic agents. And there are no studies comparing them to neurokinin-1 inhibitors, which are the newest class of drug often used by oncologists for this indication. There is also no good evidence about inhaled plant cannabis.”
Studies of oral cannabinoids for multiple-sclerosis–related spasticity have demonstrated a small improvement on patient-reported spasticity (less than 1 point on a 10-point scale), but there was no improvement in clinician-reported outcomes. At the same time, their use for weight loss/anorexia in HIV “is very limited, and there are no studies of plant-derived cannabis,” Dr. Grossman said.
According to the National Academy of Sciences report, some evidence supports the use of oral cannabinoids for short-term sleep outcomes in patients with chronic diseases such as fibromyalgia and MS. One small study of oral cannabinoid for anxiety found that it improved social anxiety symptoms on the public speaking test, but there have been no studies using inhaled cannabinoids/marijuana.
The health risks of medical marijuana are largely unknown, Dr. Grossman said, noting that most evidence on longer‐term health risks comes from epidemiologic studies of recreational cannabis users.
“Medical marijuana users tend to be older and tend to be sicker,” she said. “We don’t know anything about the long-term effects in that sicker population.”
Among healthier people, Dr. Grossman continued, cannabis use is associated with increased risk of cough, wheeze, and sputum/phlegm. “There’s also an increased risk of motor vehicle accidents,” she said. “That is certainly a concern in places where they’re legalizing marijuana.”
Cannabis use is associated with lower neonatal birth weight, case reports/series of unintentional pediatric ingestions, and a possible increase in suicidal ideation, suicide attempts, and completed suicides.
“The evidence is very limited regarding associations with myocardial infarction, stroke, COPD, and mortality,” she added. “We don’t really know.”
Dr. Grossman reported having no financial disclosures.
SAN DIEGO – Despite the popularity of medical marijuana, robust evidence for its use is limited or nonexistent for most medical conditions.
“This is a tough subject to study,” Ellie Grossman, MD, said at the annual meeting of the American College of Physicians. “There is federal money that can only be used in very limited ways to study it. Our science is way behind the times in terms of what our patients are doing and using.”
Typical limitations of marijuana studies include self-report of quantity/duration used and the fact that biochemical/quantifiable measures are lacking. “For inhaled marijuana, there is variability in how much is inhaled and how deeply it’s being inhaled,” said Dr. Grossman, an internist who practices in Somerville, Mass.
Then there’s the issue of recall bias and the question as to whether oral cannabinoids equate to the plant-derived forms of medical marijuana that patients obtain from their local dispensaries.
That matters, because the majority of published studies on the topic have evaluated oral cannabinoids, not the plant form. “So, what we’re studying is vastly different from what our patients are using,” she said.
The most solid indication clinicians have for recommending medical marijuana is for chronic pain, and the most common condition studied has been neuropathy.
“Most evidence compares cannabinoid to placebo,” said Dr. Grossman, primary care lead for behavioral health integration at Cambridge (Mass.) Health Alliance. “There’s almost nothing out there comparing cannabinoid to any other pain-relieving agent that a patient might choose to use.
“A lot of the literature comes from oral synthesized agents,” she continued. “There’s a little bit of science about inhaled forms, but a lot of this is very different from what my patient got last week in a medical marijuana dispensary in Massachusetts.”
Results from a systematic review of 79 studies of cannabinoids for medical use in 6,462 study participants showed that, compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs. 20%; odds ratio, 3.82), reduction in pain (37% vs. 31%; OR, 1.41), a greater average reduction in numerical rating scale pain assessment (on a 0- to 10-point scale; weighted mean difference of –0.46), and average reduction in the Ashworth spasticity scale (–0.36) (JAMA 2015 Jun 23-30;313[24]:2456-73).
A separate meta-analysis of studies compared inhaled cannabis sativa to placebo for chronic painful neuropathy. The researchers found that those patients who used inhaled cannabis sativa were 3.2 times more likely to achieve a 30% or greater reduction in pain, compared with those in the placebo group (J. Pain 2015 Dec;16[12]:1221-32).
However, Dr. Grossman cautioned that the number of patients studied was fewer than 200, “so, you could argue that this is a body of knowledge where the jury is still out.”
According to a 2017 report from the National Academy of Sciences titled, “The Health Effects of Cannabis and Cannabinoids,” another area in which the knowledge base is less solid is the use of oral cannabinoids for chemotherapy-induced nausea and vomiting.
“There’s a reasonable amount of evidence showing that some of these are better than placebo for relief of these symptoms,” Dr. Grossman said. “That said, the jury’s out as to whether they are any better than our other antiemetic agents. And there are no studies comparing them to neurokinin-1 inhibitors, which are the newest class of drug often used by oncologists for this indication. There is also no good evidence about inhaled plant cannabis.”
Studies of oral cannabinoids for multiple-sclerosis–related spasticity have demonstrated a small improvement on patient-reported spasticity (less than 1 point on a 10-point scale), but there was no improvement in clinician-reported outcomes. At the same time, their use for weight loss/anorexia in HIV “is very limited, and there are no studies of plant-derived cannabis,” Dr. Grossman said.
According to the National Academy of Sciences report, some evidence supports the use of oral cannabinoids for short-term sleep outcomes in patients with chronic diseases such as fibromyalgia and MS. One small study of oral cannabinoid for anxiety found that it improved social anxiety symptoms on the public speaking test, but there have been no studies using inhaled cannabinoids/marijuana.
The health risks of medical marijuana are largely unknown, Dr. Grossman said, noting that most evidence on longer‐term health risks comes from epidemiologic studies of recreational cannabis users.
“Medical marijuana users tend to be older and tend to be sicker,” she said. “We don’t know anything about the long-term effects in that sicker population.”
Among healthier people, Dr. Grossman continued, cannabis use is associated with increased risk of cough, wheeze, and sputum/phlegm. “There’s also an increased risk of motor vehicle accidents,” she said. “That is certainly a concern in places where they’re legalizing marijuana.”
Cannabis use is associated with lower neonatal birth weight, case reports/series of unintentional pediatric ingestions, and a possible increase in suicidal ideation, suicide attempts, and completed suicides.
“The evidence is very limited regarding associations with myocardial infarction, stroke, COPD, and mortality,” she added. “We don’t really know.”
Dr. Grossman reported having no financial disclosures.
EXPERT ANALYSIS AT ACP INTERNAL MEDICINE
Is there clinical benefit to activity trackers?
SAN DIEGO – In the opinion of Ann R. Garment, MD, wearable activity trackers such as the Fitbit may have a role in improving the physical fitness of patients, but alone they do not promote moderate-to-vigorous physical activity or improve other health outcomes.
An estimated one in five Americans owns some type of wearable technology independent of their smartphones.
“However, these devices come with some challenges,” Dr. Garment, of New York University–Langone Medical Center’s division of general internal medicine, said at the annual meeting of the American College of Physicians. “First, you need to know how to use them. You have to power them up regularly. They can be expensive. And for those that interface with the Internet, there are privacy concerns.” 
A 2014 PricewaterhouseCoopers survey of 1,000 U.S. consumers found that 56% believe that their life expectancy will grow an additional 10 years by wearing a device that tracks vital signs, 46% believe that it will help them lose weight, and 42% believe that it will help them dramatically improve their athletic ability.
General guidelines call for 30-60 minutes per day of moderate-to-vigorous physical activity (MVPA) at a pace of 100 steps per minute, in at least 10-minute bouts of activity. However, many studies set a goal of 10,000 steps per day, which does not necessarily need to be done as MVPA.
To assess the impact of wearable technology on helping patients to achieve weight loss, researchers studied 471 patients who were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions (JAMA 2016 Sep 20;316[11]:1161-71).
At 6 months, the researchers randomized patients into either the standard intervention arm, which had access to materials on a website, telephone counseling sessions, and text message prompts; or to the enhanced intervention arm, which included all of those interventions plus the addition of a wearable device and accompanying web interface to monitor diet and physical activity.
In a separate, larger study, researchers randomly assigned 800 employees from 13 organizations in Singapore to one of four arms: control (no activity tracker or incentives), Fitbit Zip activity tracker without additional incentives, tracker plus charity incentives (money went to charity based on how much they exercised), or tracker plus cash incentives (money went to participants based on how much they exercised) (Lancet Diabetes Endocrinol. 2016 Dec;4[12]:983-95).
The researchers tied incentives to weekly steps, and the primary outcome was minutes of MVPA per week, measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months (end of intervention) and 12 months (after a 6-month postintervention follow-up period).
They found that the cash incentive was most effective at increasing MVPA at 6 months, but this effect was not sustained 6 months after the incentives were discontinued. At 12 months, the researchers “identified no evidence of improvements in health outcomes, either with or without incentives, calling into question the value of these devices for health promotion,” they wrote.
For her part, Dr. Garment concluded that activity trackers alone are not sufficient for increasing MVPA or improving health outcomes.
“Though it’s possible it would do better if it were coupled with other modalities or sustained incentives, we need more research before we can recommend it to our patients,” she said. “Perhaps one of the best things we can be doing for our health and recommending for our patients is to, in the words of food author Michael Pollan, ‘eat food, not too much, mostly plants.’ ”
Dr. Garment reported having no financial disclosures.
SAN DIEGO – In the opinion of Ann R. Garment, MD, wearable activity trackers such as the Fitbit may have a role in improving the physical fitness of patients, but alone they do not promote moderate-to-vigorous physical activity or improve other health outcomes.
An estimated one in five Americans owns some type of wearable technology independent of their smartphones.
“However, these devices come with some challenges,” Dr. Garment, of New York University–Langone Medical Center’s division of general internal medicine, said at the annual meeting of the American College of Physicians. “First, you need to know how to use them. You have to power them up regularly. They can be expensive. And for those that interface with the Internet, there are privacy concerns.”
A 2014 PricewaterhouseCoopers survey of 1,000 U.S. consumers found that 56% believe that their life expectancy will grow an additional 10 years by wearing a device that tracks vital signs, 46% believe that it will help them lose weight, and 42% believe that it will help them dramatically improve their athletic ability.
General guidelines call for 30-60 minutes per day of moderate-to-vigorous physical activity (MVPA) at a pace of 100 steps per minute, in at least 10-minute bouts of activity. However, many studies set a goal of 10,000 steps per day, which does not necessarily need to be done as MVPA.
To assess the impact of wearable technology on helping patients to achieve weight loss, researchers studied 471 patients who were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions (JAMA 2016 Sep 20;316[11]:1161-71).
At 6 months, the researchers randomized patients into either the standard intervention arm, which had access to materials on a website, telephone counseling sessions, and text message prompts; or to the enhanced intervention arm, which included all of those interventions plus the addition of a wearable device and accompanying web interface to monitor diet and physical activity.
In a separate, larger study, researchers randomly assigned 800 employees from 13 organizations in Singapore to one of four arms: control (no activity tracker or incentives), Fitbit Zip activity tracker without additional incentives, tracker plus charity incentives (money went to charity based on how much they exercised), or tracker plus cash incentives (money went to participants based on how much they exercised) (Lancet Diabetes Endocrinol. 2016 Dec;4[12]:983-95).
The researchers tied incentives to weekly steps, and the primary outcome was minutes of MVPA per week, measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months (end of intervention) and 12 months (after a 6-month postintervention follow-up period).
They found that the cash incentive was most effective at increasing MVPA at 6 months, but this effect was not sustained 6 months after the incentives were discontinued. At 12 months, the researchers “identified no evidence of improvements in health outcomes, either with or without incentives, calling into question the value of these devices for health promotion,” they wrote.
For her part, Dr. Garment concluded that activity trackers alone are not sufficient for increasing MVPA or improving health outcomes.
“Though it’s possible it would do better if it were coupled with other modalities or sustained incentives, we need more research before we can recommend it to our patients,” she said. “Perhaps one of the best things we can be doing for our health and recommending for our patients is to, in the words of food author Michael Pollan, ‘eat food, not too much, mostly plants.’ ”
Dr. Garment reported having no financial disclosures.
SAN DIEGO – In the opinion of Ann R. Garment, MD, wearable activity trackers such as the Fitbit may have a role in improving the physical fitness of patients, but alone they do not promote moderate-to-vigorous physical activity or improve other health outcomes.
An estimated one in five Americans owns some type of wearable technology independent of their smartphones.
“However, these devices come with some challenges,” Dr. Garment, of New York University–Langone Medical Center’s division of general internal medicine, said at the annual meeting of the American College of Physicians. “First, you need to know how to use them. You have to power them up regularly. They can be expensive. And for those that interface with the Internet, there are privacy concerns.”
A 2014 PricewaterhouseCoopers survey of 1,000 U.S. consumers found that 56% believe that their life expectancy will grow an additional 10 years by wearing a device that tracks vital signs, 46% believe that it will help them lose weight, and 42% believe that it will help them dramatically improve their athletic ability.
General guidelines call for 30-60 minutes per day of moderate-to-vigorous physical activity (MVPA) at a pace of 100 steps per minute, in at least 10-minute bouts of activity. However, many studies set a goal of 10,000 steps per day, which does not necessarily need to be done as MVPA.
To assess the impact of wearable technology on helping patients to achieve weight loss, researchers studied 471 patients who were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions (JAMA 2016 Sep 20;316[11]:1161-71).
At 6 months, the researchers randomized patients into either the standard intervention arm, which had access to materials on a website, telephone counseling sessions, and text message prompts; or to the enhanced intervention arm, which included all of those interventions plus the addition of a wearable device and accompanying web interface to monitor diet and physical activity.
In a separate, larger study, researchers randomly assigned 800 employees from 13 organizations in Singapore to one of four arms: control (no activity tracker or incentives), Fitbit Zip activity tracker without additional incentives, tracker plus charity incentives (money went to charity based on how much they exercised), or tracker plus cash incentives (money went to participants based on how much they exercised) (Lancet Diabetes Endocrinol. 2016 Dec;4[12]:983-95).
The researchers tied incentives to weekly steps, and the primary outcome was minutes of MVPA per week, measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months (end of intervention) and 12 months (after a 6-month postintervention follow-up period).
They found that the cash incentive was most effective at increasing MVPA at 6 months, but this effect was not sustained 6 months after the incentives were discontinued. At 12 months, the researchers “identified no evidence of improvements in health outcomes, either with or without incentives, calling into question the value of these devices for health promotion,” they wrote.
For her part, Dr. Garment concluded that activity trackers alone are not sufficient for increasing MVPA or improving health outcomes.
“Though it’s possible it would do better if it were coupled with other modalities or sustained incentives, we need more research before we can recommend it to our patients,” she said. “Perhaps one of the best things we can be doing for our health and recommending for our patients is to, in the words of food author Michael Pollan, ‘eat food, not too much, mostly plants.’ ”
Dr. Garment reported having no financial disclosures.
EXPERT ANALYSIS AT ACP INTERNAL MEDICINE
ABIM turns MOC page with open-book 2-year exams
SAN DIEGO – The way the president of the American Board of Internal Medicine, Richard J. Baron, MD, sees it, maintenance of certification is more important than ever, because trust in the medical profession “is under assault right now in all kinds of ways.”
So, to help “bring clarity to uncertainty,” ABIM is continuing its makeover of the maintenance of certification (MOC) process. Beginning in 2018, an open-book option to test every 2 years will be available for physicians who are certified in internal medicine and for those in the subspecialty of nephrology. These options become available to gastroenterologists in 2019.
Both the 10-year long-form assessment and the shorter 2-year assessment options will be open book, “meaning physicians will have access to an online reference while they’re taking the exam,” said Yul D. Ejnes, MD, who is a member of ABIM’s board of directors and serves on the ABIM’s internal medicine specialty board.
Known as the “Knowledge Check-In,” the 2-year assessment is a shorter, “lower stakes” option that can be taken at home, in an office, or at a testing facility. The check-ins will be scheduled 4-6 times per year, with 10-year exams remaining available twice per year. The open-book 2-year assessments will be about 3 hours in length.
“It’s a more continuous way of learning and assessing, because the way we’ll do feedback is going to change,” explained Dr. Ejnes, who practices in Cranston, R.I. “Specifically, you’ll know right away whether you were successful or not with the assessment, as opposed to having to wait a couple of months, which happens with the 10-year assessment. Then you’ll get more feedback later helping to identify areas where you may be a little weaker and need to work out things.”
“It remains to be seen whether this new system is an improvement for GI learners. AGA’s educators will compare the changes offered by ABIM against our principles for MOC reform,” said Timothy C. Wang, MD, AGAF, President of AGA. “Reforming the MOC process is a high and long-standing priority for AGA. We have pushed ABIM to offer a system that reflects the realities of practice and how adults learn – and we’ll continue to fight for these principles.”
In general, physicians will need to either take the 2-year assessments or pass the 10-year assessment within 10 years of their last pass of the 10-year exam. Those who fail two successive 2-year assessments will have to take the 10-year exam. However, unsuccessful performance on the 2-year assessment in 2018 will not have a negative impact on certification or MOC participation status.
“It won’t count as one of the two opportunities you have before you have to go to the 10-year exam,” Dr. Ejnes said. “It allows people to try it out and lets us learn from what happens and do whatever we need to do to make things better.”
Why a 2-year period instead of a 5-year option, for example? A shorter time frame will allow the ABIM to move to a more modular approach to test material, Dr. Ejnes explained. For now, the 2-year assessments will be breadth-of-discipline exams.
Physicians whose certification expires in 2017 will need to take the 10-year exam – as Dr. Ejnes noted he himself was forced to do. “You cannot wait until 2018,” he cautioned. “That’s important, because if you let your certification lapse, you can’t enter the certification pathway. The prerequisite is that you need to be in good standing with your certification.”
The open-book Knowledge Check-Ins and 10-year assessments are slated to expand to eight subspecialties in 2019 and nine more in 2020.
Linking MOC and trust
Speaking at the annual meeting of the American College of Physicians, Dr. Baron said that false and misleading information circulated widely on Facebook and other social media channels runs the gamut of health issues, from falsified studies about purported links between vaccines and autism and public health scares on impostor websites, to stories of miracle cures for any number of ailments.
“It’s not just vaccines people are questioning,” said Dr. Baron, ABIM’s president and CEO. “There are erosions of trust in government, and there’s the tenacity and power of wildly inaccurate information. You will be dealing with patients who tenaciously believe things that you know not to be true. You will need to find ways to build trust, credibility, and relationships based on their trusting that what you’re saying is really in their interest.”
U.S. physicians aren’t secure in the shaky trust landscape. In fact, globally, the United States ranks 24th in public trust level of physicians by country (N. Eng. J. Med. 2014 Oct 23;371[17]:1570-2).
“The confidence in the medical system today is lower than the confidence in police or in small business,” Dr. Baron said. “That’s [the view] people are bringing into your offices every day. I don’t think we can assume that deference and trust are given to doctors, that the privileged role that society affords us is something that we’re going to have forever. We all have to think how trust is built in the new world.”
Will patients value MOC?
During a question and answer session at the ACP session, Anne Cummings, MD, an internist who practices in Greenbrae, Calif., asked the ABIM for support in educating the general public about what it means to be treated by a board-certified physician.
“I had a naturopath tell me the other day that she had the same training as I had,” Dr. Cummings said. “I was floored, but I think that patients don’t know the difference [between board-certified and not board-certified].”
Dr. Baron agreed ABIM needs to do more to promote the value of certification among patients. But he also called on board-certified physicians to deliver the value message directly to their own patients.
Other attendees recommended that ABIM expand the number of ways physicians can earn MOC points, and they expressed concern about the time MOC takes away from their daily practice.
For regular updates on the MOC process, physicians can subscribe to the ABIM’s blog at transforming.abim.org.
SAN DIEGO – The way the president of the American Board of Internal Medicine, Richard J. Baron, MD, sees it, maintenance of certification is more important than ever, because trust in the medical profession “is under assault right now in all kinds of ways.”
So, to help “bring clarity to uncertainty,” ABIM is continuing its makeover of the maintenance of certification (MOC) process. Beginning in 2018, an open-book option to test every 2 years will be available for physicians who are certified in internal medicine and for those in the subspecialty of nephrology. These options become available to gastroenterologists in 2019.
Both the 10-year long-form assessment and the shorter 2-year assessment options will be open book, “meaning physicians will have access to an online reference while they’re taking the exam,” said Yul D. Ejnes, MD, who is a member of ABIM’s board of directors and serves on the ABIM’s internal medicine specialty board.
Known as the “Knowledge Check-In,” the 2-year assessment is a shorter, “lower stakes” option that can be taken at home, in an office, or at a testing facility. The check-ins will be scheduled 4-6 times per year, with 10-year exams remaining available twice per year. The open-book 2-year assessments will be about 3 hours in length.
“It’s a more continuous way of learning and assessing, because the way we’ll do feedback is going to change,” explained Dr. Ejnes, who practices in Cranston, R.I. “Specifically, you’ll know right away whether you were successful or not with the assessment, as opposed to having to wait a couple of months, which happens with the 10-year assessment. Then you’ll get more feedback later helping to identify areas where you may be a little weaker and need to work out things.”
“It remains to be seen whether this new system is an improvement for GI learners. AGA’s educators will compare the changes offered by ABIM against our principles for MOC reform,” said Timothy C. Wang, MD, AGAF, President of AGA. “Reforming the MOC process is a high and long-standing priority for AGA. We have pushed ABIM to offer a system that reflects the realities of practice and how adults learn – and we’ll continue to fight for these principles.”
In general, physicians will need to either take the 2-year assessments or pass the 10-year assessment within 10 years of their last pass of the 10-year exam. Those who fail two successive 2-year assessments will have to take the 10-year exam. However, unsuccessful performance on the 2-year assessment in 2018 will not have a negative impact on certification or MOC participation status.
“It won’t count as one of the two opportunities you have before you have to go to the 10-year exam,” Dr. Ejnes said. “It allows people to try it out and lets us learn from what happens and do whatever we need to do to make things better.”
Why a 2-year period instead of a 5-year option, for example? A shorter time frame will allow the ABIM to move to a more modular approach to test material, Dr. Ejnes explained. For now, the 2-year assessments will be breadth-of-discipline exams.
Physicians whose certification expires in 2017 will need to take the 10-year exam – as Dr. Ejnes noted he himself was forced to do. “You cannot wait until 2018,” he cautioned. “That’s important, because if you let your certification lapse, you can’t enter the certification pathway. The prerequisite is that you need to be in good standing with your certification.”
The open-book Knowledge Check-Ins and 10-year assessments are slated to expand to eight subspecialties in 2019 and nine more in 2020.
Linking MOC and trust
Speaking at the annual meeting of the American College of Physicians, Dr. Baron said that false and misleading information circulated widely on Facebook and other social media channels runs the gamut of health issues, from falsified studies about purported links between vaccines and autism and public health scares on impostor websites, to stories of miracle cures for any number of ailments.
“It’s not just vaccines people are questioning,” said Dr. Baron, ABIM’s president and CEO. “There are erosions of trust in government, and there’s the tenacity and power of wildly inaccurate information. You will be dealing with patients who tenaciously believe things that you know not to be true. You will need to find ways to build trust, credibility, and relationships based on their trusting that what you’re saying is really in their interest.”
U.S. physicians aren’t secure in the shaky trust landscape. In fact, globally, the United States ranks 24th in public trust level of physicians by country (N. Eng. J. Med. 2014 Oct 23;371[17]:1570-2).
“The confidence in the medical system today is lower than the confidence in police or in small business,” Dr. Baron said. “That’s [the view] people are bringing into your offices every day. I don’t think we can assume that deference and trust are given to doctors, that the privileged role that society affords us is something that we’re going to have forever. We all have to think how trust is built in the new world.”
Will patients value MOC?
During a question and answer session at the ACP session, Anne Cummings, MD, an internist who practices in Greenbrae, Calif., asked the ABIM for support in educating the general public about what it means to be treated by a board-certified physician.
“I had a naturopath tell me the other day that she had the same training as I had,” Dr. Cummings said. “I was floored, but I think that patients don’t know the difference [between board-certified and not board-certified].”
Dr. Baron agreed ABIM needs to do more to promote the value of certification among patients. But he also called on board-certified physicians to deliver the value message directly to their own patients.
Other attendees recommended that ABIM expand the number of ways physicians can earn MOC points, and they expressed concern about the time MOC takes away from their daily practice.
For regular updates on the MOC process, physicians can subscribe to the ABIM’s blog at transforming.abim.org.
SAN DIEGO – The way the president of the American Board of Internal Medicine, Richard J. Baron, MD, sees it, maintenance of certification is more important than ever, because trust in the medical profession “is under assault right now in all kinds of ways.”
So, to help “bring clarity to uncertainty,” ABIM is continuing its makeover of the maintenance of certification (MOC) process. Beginning in 2018, an open-book option to test every 2 years will be available for physicians who are certified in internal medicine and for those in the subspecialty of nephrology. These options become available to gastroenterologists in 2019.
Both the 10-year long-form assessment and the shorter 2-year assessment options will be open book, “meaning physicians will have access to an online reference while they’re taking the exam,” said Yul D. Ejnes, MD, who is a member of ABIM’s board of directors and serves on the ABIM’s internal medicine specialty board.
Known as the “Knowledge Check-In,” the 2-year assessment is a shorter, “lower stakes” option that can be taken at home, in an office, or at a testing facility. The check-ins will be scheduled 4-6 times per year, with 10-year exams remaining available twice per year. The open-book 2-year assessments will be about 3 hours in length.
“It’s a more continuous way of learning and assessing, because the way we’ll do feedback is going to change,” explained Dr. Ejnes, who practices in Cranston, R.I. “Specifically, you’ll know right away whether you were successful or not with the assessment, as opposed to having to wait a couple of months, which happens with the 10-year assessment. Then you’ll get more feedback later helping to identify areas where you may be a little weaker and need to work out things.”
“It remains to be seen whether this new system is an improvement for GI learners. AGA’s educators will compare the changes offered by ABIM against our principles for MOC reform,” said Timothy C. Wang, MD, AGAF, President of AGA. “Reforming the MOC process is a high and long-standing priority for AGA. We have pushed ABIM to offer a system that reflects the realities of practice and how adults learn – and we’ll continue to fight for these principles.”
In general, physicians will need to either take the 2-year assessments or pass the 10-year assessment within 10 years of their last pass of the 10-year exam. Those who fail two successive 2-year assessments will have to take the 10-year exam. However, unsuccessful performance on the 2-year assessment in 2018 will not have a negative impact on certification or MOC participation status.
“It won’t count as one of the two opportunities you have before you have to go to the 10-year exam,” Dr. Ejnes said. “It allows people to try it out and lets us learn from what happens and do whatever we need to do to make things better.”
Why a 2-year period instead of a 5-year option, for example? A shorter time frame will allow the ABIM to move to a more modular approach to test material, Dr. Ejnes explained. For now, the 2-year assessments will be breadth-of-discipline exams.
Physicians whose certification expires in 2017 will need to take the 10-year exam – as Dr. Ejnes noted he himself was forced to do. “You cannot wait until 2018,” he cautioned. “That’s important, because if you let your certification lapse, you can’t enter the certification pathway. The prerequisite is that you need to be in good standing with your certification.”
The open-book Knowledge Check-Ins and 10-year assessments are slated to expand to eight subspecialties in 2019 and nine more in 2020.
Linking MOC and trust
Speaking at the annual meeting of the American College of Physicians, Dr. Baron said that false and misleading information circulated widely on Facebook and other social media channels runs the gamut of health issues, from falsified studies about purported links between vaccines and autism and public health scares on impostor websites, to stories of miracle cures for any number of ailments.
“It’s not just vaccines people are questioning,” said Dr. Baron, ABIM’s president and CEO. “There are erosions of trust in government, and there’s the tenacity and power of wildly inaccurate information. You will be dealing with patients who tenaciously believe things that you know not to be true. You will need to find ways to build trust, credibility, and relationships based on their trusting that what you’re saying is really in their interest.”
U.S. physicians aren’t secure in the shaky trust landscape. In fact, globally, the United States ranks 24th in public trust level of physicians by country (N. Eng. J. Med. 2014 Oct 23;371[17]:1570-2).
“The confidence in the medical system today is lower than the confidence in police or in small business,” Dr. Baron said. “That’s [the view] people are bringing into your offices every day. I don’t think we can assume that deference and trust are given to doctors, that the privileged role that society affords us is something that we’re going to have forever. We all have to think how trust is built in the new world.”
Will patients value MOC?
During a question and answer session at the ACP session, Anne Cummings, MD, an internist who practices in Greenbrae, Calif., asked the ABIM for support in educating the general public about what it means to be treated by a board-certified physician.
“I had a naturopath tell me the other day that she had the same training as I had,” Dr. Cummings said. “I was floored, but I think that patients don’t know the difference [between board-certified and not board-certified].”
Dr. Baron agreed ABIM needs to do more to promote the value of certification among patients. But he also called on board-certified physicians to deliver the value message directly to their own patients.
Other attendees recommended that ABIM expand the number of ways physicians can earn MOC points, and they expressed concern about the time MOC takes away from their daily practice.
For regular updates on the MOC process, physicians can subscribe to the ABIM’s blog at transforming.abim.org.
Shelving of AHCA a win for patients, experts say
SAN DIEGO – The decision by House Republicans to withdraw the American Health Care Act on March 24, 2017 was a victory for the health care of all Americans, especially older, sicker, and poorer patients, according to Nitin S. Damle, MD.
“It was a terrible bill,” Dr. Damle, president of the American College of Physicians, said during a press briefing at the annual meeting of the ACP. “Fortunately it will not become law at this point, but the story doesn’t really end here. The Trump Administration needs to decide whether it’s going to help faithfully implement the Affordable Care Act or sabotage it, either by action or inaction. It’s also important that we turn the page and begin the hard work of engaging with the administration and Congress on a bipartisan agenda to improve American health care.”
The ACHA would have eliminated the federal requirement that insurers cover 10 categories of essential benefits including emergency care, maternity services, and hospitalization, leaving it to states to decide. It also eliminated the requirement that Medicaid cover the same essential benefits. According to Dr. Damle, the AHCA’s age-based tax credits “were too low and the deductibles were going to be too high for older people and poorer patients, because insurers would have been allowed to charge older patients up to five times more than younger patients for their coverage.” For example, the CBO found that under the bill a 64-year-old male who makes $26,500 a year would have to pay $14,600 out of pocket for insurance in the non-group market, compared to $1,700 under the existing ACA, a 750% increase.
“In my practice, I have many older and sicker patients who would have been left behind had this become law, patients with diseases like congestive heart failure, diabetes, chronic obstructive pulmonary disease from smoking who require frequent and ongoing monitoring of their medications, development of any complications from their disease, and sometimes even need home-based support,” Dr. Damle said.
Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP, described efforts to roll back the ACA as “unchartered” territory. “I have never in the past seen an administration trying to roll back coverage on millions of people,” he said. “This history of the US has been incremental expansion of coverage since the creation of Medicare and Medicaid in 1965.” He acknowledged certain shortcomings of the ACA, including uneven participation by insurers from state to state, and “deductibles may be too high, and premiums too high for some people. On the other hand, the ACA has achieved an historic reduction in the uninsured rate in the United States. More than 20 million people have gained coverage, and according to the CDC, only 8.2% of Americans are without health insurance, an historic low. It’s still too high, but we’re basically 92% of the way to universal coverage in the U.S.”
Mr. Doherty expressed concern that legislative efforts to roll back the ACA could re-emerge. “The Republicans are still talking about bringing it back,” he said. “You can’t take it for granted because Republicans have been promising repeal and replace [legislation] for seven years now, and I think they want to move forward. I think we have to remain vigilant. We have to put pressure on the [Trump] administration to make sure they faithfully execute the law, which they swore to do when they took office. Then we have to reach out and say there are problems that need to be addressed, bipartisan solutions to stabilize the [health insurance] markets and to address other issues like the crushing administrative burden on physicians. You have to start by accepting that the ACA is the law of the land. We need to build upon it and improve it, not repeal it.”
SAN DIEGO – The decision by House Republicans to withdraw the American Health Care Act on March 24, 2017 was a victory for the health care of all Americans, especially older, sicker, and poorer patients, according to Nitin S. Damle, MD.
“It was a terrible bill,” Dr. Damle, president of the American College of Physicians, said during a press briefing at the annual meeting of the ACP. “Fortunately it will not become law at this point, but the story doesn’t really end here. The Trump Administration needs to decide whether it’s going to help faithfully implement the Affordable Care Act or sabotage it, either by action or inaction. It’s also important that we turn the page and begin the hard work of engaging with the administration and Congress on a bipartisan agenda to improve American health care.”
The ACHA would have eliminated the federal requirement that insurers cover 10 categories of essential benefits including emergency care, maternity services, and hospitalization, leaving it to states to decide. It also eliminated the requirement that Medicaid cover the same essential benefits. According to Dr. Damle, the AHCA’s age-based tax credits “were too low and the deductibles were going to be too high for older people and poorer patients, because insurers would have been allowed to charge older patients up to five times more than younger patients for their coverage.” For example, the CBO found that under the bill a 64-year-old male who makes $26,500 a year would have to pay $14,600 out of pocket for insurance in the non-group market, compared to $1,700 under the existing ACA, a 750% increase.
“In my practice, I have many older and sicker patients who would have been left behind had this become law, patients with diseases like congestive heart failure, diabetes, chronic obstructive pulmonary disease from smoking who require frequent and ongoing monitoring of their medications, development of any complications from their disease, and sometimes even need home-based support,” Dr. Damle said.
Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP, described efforts to roll back the ACA as “unchartered” territory. “I have never in the past seen an administration trying to roll back coverage on millions of people,” he said. “This history of the US has been incremental expansion of coverage since the creation of Medicare and Medicaid in 1965.” He acknowledged certain shortcomings of the ACA, including uneven participation by insurers from state to state, and “deductibles may be too high, and premiums too high for some people. On the other hand, the ACA has achieved an historic reduction in the uninsured rate in the United States. More than 20 million people have gained coverage, and according to the CDC, only 8.2% of Americans are without health insurance, an historic low. It’s still too high, but we’re basically 92% of the way to universal coverage in the U.S.”
Mr. Doherty expressed concern that legislative efforts to roll back the ACA could re-emerge. “The Republicans are still talking about bringing it back,” he said. “You can’t take it for granted because Republicans have been promising repeal and replace [legislation] for seven years now, and I think they want to move forward. I think we have to remain vigilant. We have to put pressure on the [Trump] administration to make sure they faithfully execute the law, which they swore to do when they took office. Then we have to reach out and say there are problems that need to be addressed, bipartisan solutions to stabilize the [health insurance] markets and to address other issues like the crushing administrative burden on physicians. You have to start by accepting that the ACA is the law of the land. We need to build upon it and improve it, not repeal it.”
SAN DIEGO – The decision by House Republicans to withdraw the American Health Care Act on March 24, 2017 was a victory for the health care of all Americans, especially older, sicker, and poorer patients, according to Nitin S. Damle, MD.
“It was a terrible bill,” Dr. Damle, president of the American College of Physicians, said during a press briefing at the annual meeting of the ACP. “Fortunately it will not become law at this point, but the story doesn’t really end here. The Trump Administration needs to decide whether it’s going to help faithfully implement the Affordable Care Act or sabotage it, either by action or inaction. It’s also important that we turn the page and begin the hard work of engaging with the administration and Congress on a bipartisan agenda to improve American health care.”
The ACHA would have eliminated the federal requirement that insurers cover 10 categories of essential benefits including emergency care, maternity services, and hospitalization, leaving it to states to decide. It also eliminated the requirement that Medicaid cover the same essential benefits. According to Dr. Damle, the AHCA’s age-based tax credits “were too low and the deductibles were going to be too high for older people and poorer patients, because insurers would have been allowed to charge older patients up to five times more than younger patients for their coverage.” For example, the CBO found that under the bill a 64-year-old male who makes $26,500 a year would have to pay $14,600 out of pocket for insurance in the non-group market, compared to $1,700 under the existing ACA, a 750% increase.
“In my practice, I have many older and sicker patients who would have been left behind had this become law, patients with diseases like congestive heart failure, diabetes, chronic obstructive pulmonary disease from smoking who require frequent and ongoing monitoring of their medications, development of any complications from their disease, and sometimes even need home-based support,” Dr. Damle said.
Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP, described efforts to roll back the ACA as “unchartered” territory. “I have never in the past seen an administration trying to roll back coverage on millions of people,” he said. “This history of the US has been incremental expansion of coverage since the creation of Medicare and Medicaid in 1965.” He acknowledged certain shortcomings of the ACA, including uneven participation by insurers from state to state, and “deductibles may be too high, and premiums too high for some people. On the other hand, the ACA has achieved an historic reduction in the uninsured rate in the United States. More than 20 million people have gained coverage, and according to the CDC, only 8.2% of Americans are without health insurance, an historic low. It’s still too high, but we’re basically 92% of the way to universal coverage in the U.S.”
Mr. Doherty expressed concern that legislative efforts to roll back the ACA could re-emerge. “The Republicans are still talking about bringing it back,” he said. “You can’t take it for granted because Republicans have been promising repeal and replace [legislation] for seven years now, and I think they want to move forward. I think we have to remain vigilant. We have to put pressure on the [Trump] administration to make sure they faithfully execute the law, which they swore to do when they took office. Then we have to reach out and say there are problems that need to be addressed, bipartisan solutions to stabilize the [health insurance] markets and to address other issues like the crushing administrative burden on physicians. You have to start by accepting that the ACA is the law of the land. We need to build upon it and improve it, not repeal it.”
AT ACP INTERNAL MEDICINE
ABIM turns MOC page with open-book 2-year exams
SAN DIEGO – The way the president of the American Board of Internal Medicine, Richard J. Baron, MD, sees it, maintenance of certification is more important than ever, because trust in the medical profession “is under assault right now in all kinds of ways.”
So, to help “bring clarity to uncertainty,” ABIM is continuing its makeover of the maintenance of certification (MOC) process. Beginning in 2018, an open-book option to test every 2 years will be available for physicians who are certified in internal medicine and for those in the subspecialty of nephrology.
Similar maintenance of certification changes are scheduled to be rolled out to other medical specialties by 2020.
Known as the “Knowledge Check-In,” the 2-year assessment is a shorter, “lower stakes” option that can be taken at home, in an office, or at a testing facility. The check-ins will be scheduled 4-6 times per year, with 10-year exams remaining available twice per year. The open-book 2-year assessments will be about 3 hours in length.
“It’s a more continuous way of learning and assessing, because the way we’ll do feedback is going to change,” explained Dr. Ejnes, who practices in Cranston, R.I. “Specifically, you’ll know right away whether you were successful or not with the assessment, as opposed to having to wait a couple of months, which happens with the 10-year assessment. Then you’ll get more feedback later helping to identify areas where you may be a little weaker and need to work out things.”
In general, physicians will need to either take the 2-year assessments or pass the 10-year assessment within 10 years of their last pass of the 10-year exam. Those who fail two successive 2-year assessments will have to take the 10-year exam. However, unsuccessful performance on the 2-year assessment in 2018 will not have a negative impact on certification or MOC participation status.
“It won’t count as one of the two opportunities you have before you have to go to the 10-year exam,” Dr. Ejnes said. “It allows people to try it out and lets us learn from what happens and do whatever we need to do to make things better.”
Why a 2-year period instead of a 5-year option, for example? A shorter time frame will allow the ABIM to move to a more modular approach to test material, Dr. Ejnes explained. For now, the 2-year assessments will be breadth-of-discipline exams.
Physicians whose certification expires in 2017 will need to take the 10-year exam – as Dr. Ejnes noted he himself was forced to do. “You cannot wait until 2018,” he cautioned. “That’s important, because if you let your certification lapse, you can’t enter the certification pathway. The prerequisite is that you need to be in good standing with your certification.”
The open-book Knowledge Check-Ins and 10-year assessments are slated to expand to eight subspecialties in 2019 and nine more in 2020.
Linking MOC and trust
Speaking at the annual meeting of the American College of Physicians, Dr. Baron said that false and misleading information circulated widely on Facebook and other social media channels runs the gamut of health issues, from falsified studies about purported links between vaccines and autism and public health scares on impostor websites, to stories of miracle cures for any number of ailments.
“It’s not just vaccines people are questioning,” said Dr. Baron, ABIM’s president and CEO. “There are erosions of trust in government, and there’s the tenacity and power of wildly inaccurate information. You will be dealing with patients who tenaciously believe things that you know not to be true. You will need to find ways to build trust, credibility, and relationships based on their trusting that what you’re saying is really in their interest.”
U.S. physicians aren’t secure in the shaky trust landscape. In fact, globally, the United States ranks 24th in public trust level of physicians by country (N. Eng. J. Med. 2014 Oct 23;371[17]:1570-2).
“The confidence in the medical system today is lower than the confidence in police or in small business,” Dr. Baron said. “That’s [the view] people are bringing into your offices every day. I don’t think we can assume that deference and trust are given to doctors, that the privileged role that society affords us is something that we’re going to have forever. We all have to think how trust is built in the new world.”
Will patients value MOC?
During a question and answer session at the ACP session, Anne Cummings, MD, an internist who practices in Greenbrae, Calif., asked the ABIM for support in educating the general public about what it means to be treated by a board-certified physician.
“I had a naturopath tell me the other day that she had the same training as I had,” Dr. Cummings said. “I was floored, but I think that patients don’t know the difference [between board-certified and not board-certified].”
Dr. Baron agreed ABIM needs to do more to promote the value of certification among patients. But he also called on board-certified physicians to deliver the value message directly to their own patients.
Other attendees recommended that ABIM expand the number of ways physicians can earn MOC points, and they expressed concern about the time MOC takes away from their daily practice.
For regular updates on the MOC process, physicians can subscribe to the ABIM’s blog at transforming.abim.org.
SAN DIEGO – The way the president of the American Board of Internal Medicine, Richard J. Baron, MD, sees it, maintenance of certification is more important than ever, because trust in the medical profession “is under assault right now in all kinds of ways.”
So, to help “bring clarity to uncertainty,” ABIM is continuing its makeover of the maintenance of certification (MOC) process. Beginning in 2018, an open-book option to test every 2 years will be available for physicians who are certified in internal medicine and for those in the subspecialty of nephrology.
Similar maintenance of certification changes are scheduled to be rolled out to other medical specialties by 2020.
Known as the “Knowledge Check-In,” the 2-year assessment is a shorter, “lower stakes” option that can be taken at home, in an office, or at a testing facility. The check-ins will be scheduled 4-6 times per year, with 10-year exams remaining available twice per year. The open-book 2-year assessments will be about 3 hours in length.
“It’s a more continuous way of learning and assessing, because the way we’ll do feedback is going to change,” explained Dr. Ejnes, who practices in Cranston, R.I. “Specifically, you’ll know right away whether you were successful or not with the assessment, as opposed to having to wait a couple of months, which happens with the 10-year assessment. Then you’ll get more feedback later helping to identify areas where you may be a little weaker and need to work out things.”
In general, physicians will need to either take the 2-year assessments or pass the 10-year assessment within 10 years of their last pass of the 10-year exam. Those who fail two successive 2-year assessments will have to take the 10-year exam. However, unsuccessful performance on the 2-year assessment in 2018 will not have a negative impact on certification or MOC participation status.
“It won’t count as one of the two opportunities you have before you have to go to the 10-year exam,” Dr. Ejnes said. “It allows people to try it out and lets us learn from what happens and do whatever we need to do to make things better.”
Why a 2-year period instead of a 5-year option, for example? A shorter time frame will allow the ABIM to move to a more modular approach to test material, Dr. Ejnes explained. For now, the 2-year assessments will be breadth-of-discipline exams.
Physicians whose certification expires in 2017 will need to take the 10-year exam – as Dr. Ejnes noted he himself was forced to do. “You cannot wait until 2018,” he cautioned. “That’s important, because if you let your certification lapse, you can’t enter the certification pathway. The prerequisite is that you need to be in good standing with your certification.”
The open-book Knowledge Check-Ins and 10-year assessments are slated to expand to eight subspecialties in 2019 and nine more in 2020.
Linking MOC and trust
Speaking at the annual meeting of the American College of Physicians, Dr. Baron said that false and misleading information circulated widely on Facebook and other social media channels runs the gamut of health issues, from falsified studies about purported links between vaccines and autism and public health scares on impostor websites, to stories of miracle cures for any number of ailments.
“It’s not just vaccines people are questioning,” said Dr. Baron, ABIM’s president and CEO. “There are erosions of trust in government, and there’s the tenacity and power of wildly inaccurate information. You will be dealing with patients who tenaciously believe things that you know not to be true. You will need to find ways to build trust, credibility, and relationships based on their trusting that what you’re saying is really in their interest.”
U.S. physicians aren’t secure in the shaky trust landscape. In fact, globally, the United States ranks 24th in public trust level of physicians by country (N. Eng. J. Med. 2014 Oct 23;371[17]:1570-2).
“The confidence in the medical system today is lower than the confidence in police or in small business,” Dr. Baron said. “That’s [the view] people are bringing into your offices every day. I don’t think we can assume that deference and trust are given to doctors, that the privileged role that society affords us is something that we’re going to have forever. We all have to think how trust is built in the new world.”
Will patients value MOC?
During a question and answer session at the ACP session, Anne Cummings, MD, an internist who practices in Greenbrae, Calif., asked the ABIM for support in educating the general public about what it means to be treated by a board-certified physician.
“I had a naturopath tell me the other day that she had the same training as I had,” Dr. Cummings said. “I was floored, but I think that patients don’t know the difference [between board-certified and not board-certified].”
Dr. Baron agreed ABIM needs to do more to promote the value of certification among patients. But he also called on board-certified physicians to deliver the value message directly to their own patients.
Other attendees recommended that ABIM expand the number of ways physicians can earn MOC points, and they expressed concern about the time MOC takes away from their daily practice.
For regular updates on the MOC process, physicians can subscribe to the ABIM’s blog at transforming.abim.org.
SAN DIEGO – The way the president of the American Board of Internal Medicine, Richard J. Baron, MD, sees it, maintenance of certification is more important than ever, because trust in the medical profession “is under assault right now in all kinds of ways.”
So, to help “bring clarity to uncertainty,” ABIM is continuing its makeover of the maintenance of certification (MOC) process. Beginning in 2018, an open-book option to test every 2 years will be available for physicians who are certified in internal medicine and for those in the subspecialty of nephrology.
Similar maintenance of certification changes are scheduled to be rolled out to other medical specialties by 2020.
Known as the “Knowledge Check-In,” the 2-year assessment is a shorter, “lower stakes” option that can be taken at home, in an office, or at a testing facility. The check-ins will be scheduled 4-6 times per year, with 10-year exams remaining available twice per year. The open-book 2-year assessments will be about 3 hours in length.
“It’s a more continuous way of learning and assessing, because the way we’ll do feedback is going to change,” explained Dr. Ejnes, who practices in Cranston, R.I. “Specifically, you’ll know right away whether you were successful or not with the assessment, as opposed to having to wait a couple of months, which happens with the 10-year assessment. Then you’ll get more feedback later helping to identify areas where you may be a little weaker and need to work out things.”
In general, physicians will need to either take the 2-year assessments or pass the 10-year assessment within 10 years of their last pass of the 10-year exam. Those who fail two successive 2-year assessments will have to take the 10-year exam. However, unsuccessful performance on the 2-year assessment in 2018 will not have a negative impact on certification or MOC participation status.
“It won’t count as one of the two opportunities you have before you have to go to the 10-year exam,” Dr. Ejnes said. “It allows people to try it out and lets us learn from what happens and do whatever we need to do to make things better.”
Why a 2-year period instead of a 5-year option, for example? A shorter time frame will allow the ABIM to move to a more modular approach to test material, Dr. Ejnes explained. For now, the 2-year assessments will be breadth-of-discipline exams.
Physicians whose certification expires in 2017 will need to take the 10-year exam – as Dr. Ejnes noted he himself was forced to do. “You cannot wait until 2018,” he cautioned. “That’s important, because if you let your certification lapse, you can’t enter the certification pathway. The prerequisite is that you need to be in good standing with your certification.”
The open-book Knowledge Check-Ins and 10-year assessments are slated to expand to eight subspecialties in 2019 and nine more in 2020.
Linking MOC and trust
Speaking at the annual meeting of the American College of Physicians, Dr. Baron said that false and misleading information circulated widely on Facebook and other social media channels runs the gamut of health issues, from falsified studies about purported links between vaccines and autism and public health scares on impostor websites, to stories of miracle cures for any number of ailments.
“It’s not just vaccines people are questioning,” said Dr. Baron, ABIM’s president and CEO. “There are erosions of trust in government, and there’s the tenacity and power of wildly inaccurate information. You will be dealing with patients who tenaciously believe things that you know not to be true. You will need to find ways to build trust, credibility, and relationships based on their trusting that what you’re saying is really in their interest.”
U.S. physicians aren’t secure in the shaky trust landscape. In fact, globally, the United States ranks 24th in public trust level of physicians by country (N. Eng. J. Med. 2014 Oct 23;371[17]:1570-2).
“The confidence in the medical system today is lower than the confidence in police or in small business,” Dr. Baron said. “That’s [the view] people are bringing into your offices every day. I don’t think we can assume that deference and trust are given to doctors, that the privileged role that society affords us is something that we’re going to have forever. We all have to think how trust is built in the new world.”
Will patients value MOC?
During a question and answer session at the ACP session, Anne Cummings, MD, an internist who practices in Greenbrae, Calif., asked the ABIM for support in educating the general public about what it means to be treated by a board-certified physician.
“I had a naturopath tell me the other day that she had the same training as I had,” Dr. Cummings said. “I was floored, but I think that patients don’t know the difference [between board-certified and not board-certified].”
Dr. Baron agreed ABIM needs to do more to promote the value of certification among patients. But he also called on board-certified physicians to deliver the value message directly to their own patients.
Other attendees recommended that ABIM expand the number of ways physicians can earn MOC points, and they expressed concern about the time MOC takes away from their daily practice.
For regular updates on the MOC process, physicians can subscribe to the ABIM’s blog at transforming.abim.org.
AT ACP INTERNAL MEDICINE
VIDEO: Compassionate care, decriminalization crucial to mitigating addiction epidemic
SAN DIEGO – Health care providers need to practice compassionate care to achieve the best results when managing patients who are dealing with opioid addiction, according to a panel of experts who spoke at the annual meeting of the American College of Physicians.
Caring “compassionately is not enabling, [it’s] doing the right thing by the patient,” explained Chwen-Yuen Angie Chen, MD, of Stanford (Calif.) University. “You can practice compassionate care if you have a knowledge base. Knowledge is extremely powerful and enables you to follow evidence-based medicine, which is truly compassionate care.”
Dr. Chen spoke at length about addiction medicine during a press conference outlining the ACP’s new position paper on preventing and treating substance abuse, where she was joined by ACP President Nitin S. Damle, MD, and ACP Board of Regents Chair Thomas G. Tape, MD. All three emphasized the need for decriminalization and destigmatization of opioid abuse, and they called on physicians to guide patients through resources and compassionate care to help them overcome the affliction.
“We know that we need to either taper, detoxify, or reduce opioid dosing. We know that we ought not to coprescribe with sedatives. We know that, if you need addiction treatment, you get referred, and you don’t just get cut off,” explained Dr. Chen.
In a video interview, Dr. Chen talked about the key take-home messages of the position paper, and she explained other aspects of substance abuse that requires provider’s awareness.
Dr. Chen did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN DIEGO – Health care providers need to practice compassionate care to achieve the best results when managing patients who are dealing with opioid addiction, according to a panel of experts who spoke at the annual meeting of the American College of Physicians.
Caring “compassionately is not enabling, [it’s] doing the right thing by the patient,” explained Chwen-Yuen Angie Chen, MD, of Stanford (Calif.) University. “You can practice compassionate care if you have a knowledge base. Knowledge is extremely powerful and enables you to follow evidence-based medicine, which is truly compassionate care.”
Dr. Chen spoke at length about addiction medicine during a press conference outlining the ACP’s new position paper on preventing and treating substance abuse, where she was joined by ACP President Nitin S. Damle, MD, and ACP Board of Regents Chair Thomas G. Tape, MD. All three emphasized the need for decriminalization and destigmatization of opioid abuse, and they called on physicians to guide patients through resources and compassionate care to help them overcome the affliction.
“We know that we need to either taper, detoxify, or reduce opioid dosing. We know that we ought not to coprescribe with sedatives. We know that, if you need addiction treatment, you get referred, and you don’t just get cut off,” explained Dr. Chen.
In a video interview, Dr. Chen talked about the key take-home messages of the position paper, and she explained other aspects of substance abuse that requires provider’s awareness.
Dr. Chen did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN DIEGO – Health care providers need to practice compassionate care to achieve the best results when managing patients who are dealing with opioid addiction, according to a panel of experts who spoke at the annual meeting of the American College of Physicians.
Caring “compassionately is not enabling, [it’s] doing the right thing by the patient,” explained Chwen-Yuen Angie Chen, MD, of Stanford (Calif.) University. “You can practice compassionate care if you have a knowledge base. Knowledge is extremely powerful and enables you to follow evidence-based medicine, which is truly compassionate care.”
Dr. Chen spoke at length about addiction medicine during a press conference outlining the ACP’s new position paper on preventing and treating substance abuse, where she was joined by ACP President Nitin S. Damle, MD, and ACP Board of Regents Chair Thomas G. Tape, MD. All three emphasized the need for decriminalization and destigmatization of opioid abuse, and they called on physicians to guide patients through resources and compassionate care to help them overcome the affliction.
“We know that we need to either taper, detoxify, or reduce opioid dosing. We know that we ought not to coprescribe with sedatives. We know that, if you need addiction treatment, you get referred, and you don’t just get cut off,” explained Dr. Chen.
In a video interview, Dr. Chen talked about the key take-home messages of the position paper, and she explained other aspects of substance abuse that requires provider’s awareness.
Dr. Chen did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ACP INTERNAL MEDICINE
