In The News

New Documentary on Difficulties Faced by Patients With Chronic Pain

Dr. Lynn Webster of Utah recently produced a documentary about pain treatment. The documentary, “The Painful Truth,” can be found online and on public television stations across the country and provides insight into the difficulties patients run into when trying to find effective treatment for chronic pain.

The patients featured in “The Painful Truth” include some who are fearful of losing access to opioid treatment, as well as those who say some doctors have refused to treat them and pharmacies have balked at filling their prescriptions. The apprehension among some pain patients that they won’t be able to get opioids has been reported in several media outlets, including STAT.

Webster acknowledged that several of the patients in his documentary are “miserable” even while taking opioids, and the documentary makes the point that better treatments are desperately needed. For now, however, he said opioid medications are often the best of several flawed options.

“With all of the focus on opioid addiction, we are forgetting many people with pain who have benefited,” he said. “It’s the only thing that keeps them from suicide.”

Critical Article from STAT

I was a fan of the author David Armstrong when he wrote for Wall Street Journal. However, his recent article on Lynn Webster’s documentary starts out with guilt by association. Roughly a year ago, Lynn called me and asked for advice on how to promote this documentary. At that time, he was passionate about the way pain management patients and their physicians are being unfairly shunned by society.

Armstrong notes that Dr. Webster and several of the experts he quotes in the program have long-standing financial relationships with pain medicine makers. When asked why these relationships are not disclosed to viewers, Webster told STAT that he did not receive any drug industry funding for the documentary. He said it was funded entirely by himself and his wife.

“I am cognizant of that issue, but I think I dealt with it as carefully as I could,” he said in an interview. If viewers want to know whether any of the individual doctors associated with the documentary have financial relationships with pharmaceutical makers, Webster said they can search for that information on the web.

Dr. Webster Paid for the Documentary Himself

I encourage the media to call Lynn and hear why he did this documentary and paid for it out of his own pocket.  Yes, Lynn worked for industry but that is by no means his primary motivation to do this documentary. Go spend some time in a pain clinic and meet some patients who are truly in pain, this is by no means a binary issue.

“There are dozens of important stories about people with opioid addiction almost daily but rarely is there a story about people in pain,” Webster said in an email to STAT.

Does the Media Own Some Part of the Opioid Crisis?

It hit me recently that the Media needs to take some responsibility for the Opioid crisis, in 2004 when the Cox 2 inhibitors were slammed as “unsafe” there was no thought to what other alternative therapies that were available to alleviate pain.  Had the media or the medical community for that matter, paid just a little attention and thought, the best Cox 2 inhibitors would have been hugely successful and companies would have reaped the benefit, but the opioid crisis might never have happened.

Comments from Tom Fogarty, MD

We reached out to Tom Fogarty, Founder of the Fogarty Institute and inventor of the catheter, who stated,

Opioid addiction is a serious and worldwide problem that is ever increasing. The reasons are multi-factorial, unfortunately a minority of physicians are responsible for this. A doctor’s sole purpose is to relieve pain and suffering and the vast majority adhere to that doctrine. The minority who knowingly do not, should be investigated and corrected. Continued excessive use of opioid prescriptions (easily documented) should be followed by fines and some other forms of punishment imposed upon the responsible physician. Chronic addiction to opioids and other drugs should be handled by specialists in the field of pain management. Dr. Lynn Webster and others should be looked to for resolution of these problems. The majority should not be punished, that is our patients, by inappropriate laws or recommendations.

Viewpoints Should Not Be Discounted Because of Past Work History

It always bothers me when I see someone’s viewpoints discounted simply because they have worked for industry in the past. The author is capable of doing better work.

Further, Aaron Pruitt, director of content at MontanaPBS, said he was “not aware” of any financial connections between Webster and companies that make opioid pain relievers. “If there is some evidence of that, I have seen nothing,” he said. After being directed to public disclosures of those relationships, Pruitt wrote in an email, “As far as I can tell, he has been working with companies to find safer, less addictive treatments for patients.”

In a pitch to television stations offered the documentary, the distributors write that “NETA and MontanaPBS have carefully reviewed The Painful Truth, and the credentials of Dr. Webster. We have found Dr. Webster to be one of the country’s experts on pain treatment, a past president of the American Academy of Pain Medicine, and an advocate for the safe prescription of opioids.”

Disclosure: the company I own, Rockpointe, receives grants from pharmaceutical and device manufacturers for accredited educational programs.

AHRQ Works: Building Bridges Between Research and Practice

Accelerating learning and innovation in health care delivery is what AHRQ does—every day. AHRQ tools take the "what" and translate it into the “how” by providing research-backed, practical tools that doctors and nurses can use to improve care.

Read More: AHRQ Works: Building Bridges Between Research and Practice

Read and share this infographic about forgetfulness

Many people worry about becoming forgetful as they age. They think it is the first sign of Alzheimer’s disease. But forgetfulness can be a normal part of aging. Check out this infographic to see examples of mild forgetfulness versus signs of serious memory problems, like Alzheimer’s disease. Be sure to talk to your doctor if you have concerns.

Addressing Public Health Crises: Suicide and Opioid Addiction are Preventable

April 3, 2017
By: Judy Sarasohn, HHS (Public Affairs)

During National Public Health Week, April 3-9, we celebrate the progress we’ve made helping people live healthier lives and those public health professionals who have helped us make that progress. But one hallmark of public health is life expectancy, and the United States just experienced a drop in overall life expectancy for the first time since 1993. This was due in part to increases in two of the nation’s most heart-breaking and yet preventable public health issues facing us: the increasing rate of suicide and the increasing misuse of opioid drugs.

Read More: Addressing Public Health Crises: Suicide and Opioid Addiction are Preventable

Download New Resources to Guide Advanced Illness Care

National Quality Partners (NQP) announces two new resources to ensure high-quality, person-centered advanced illness care.

NQP’s Case Study, Integrating Personal Preferences in Advanced Illness Care, follows Hazel, a 63-year-old-woman diagnosed with advanced lung cancer as she transitions through the healthcare system, from inpatient and post-acute care to palliative and hospice care. The case study illustrates how measures can support the six key preferences of person-centered advanced illness care identified in the NQP issue brief. More than 400 people participated in the March 15 launch of this case study. Listen to and share the virtual forum recording.

According to JAMA, 68% of physicians report feeling inadequately trained to discuss end-of-life care with patients. NQP’s Fact Sheet, Strategies for Change—A Collaborative Journey to Transform Advanced Illness Care, gives physicians, clinicians, and other providers questions to help guide conversations with patients, their families, and caregivers and further support person-centered advanced illness care.

NQP’s Advanced Illness Care Action Team (PDF) has issued a national call to action for healthcare systems, communities, policymakers, and other stakeholders to ensure that individuals with advanced illness, their families, and caregivers are at the center of care decisions. Learn more about this initiative.

HHS Launches Webpage Highlighting Administrative Actions to Empower Patients

March 20, 2017 

This week the Health and Human Services Department launched a new page on HHS.gov highlighting the regulatory and administrative actions the Department is taking to relieve the burden of the current healthcare law and support a patient-centered healthcare system.

“We’re taking action to improve choices for patients, stabilize the individual and small-group insurance markets, and expand access to more affordable coverage,” said Secretary Tom Price, M.D. “This page will be the place to go for updates on our ongoing efforts.”

The actions are part of a broader plan to repeal and replace the Affordable Care Act.

Click here to see the newly launched webpage explaining the Department’s actions.
New measures will be announced as soon as is allowable by law. In particular, future actions will:

  • Lower costs and increase choices by providing relief from the burdensome regulations and fostering competition in insurance markets;
  • Work to ensure a stable transition period;
  • Offer states greater flexibility of their Medicaid programs to meet the needs of their most vulnerable populations; and
  • Increase the opportunities for patients to get the care they need when they need it.

Visit the Educational Resources Page for New Materials on the Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) recently posted new resources to the Quality Payment Program website to help clinicians successfully participate in the first year of the Quality Payment Program.

CMS encourages these clinicians to visit the website to review the new materials and information, including:

MIPS Measures for Cardiologists –  This brand new resource provides a non-exhaustive sample of measures for Quality, Advancing Care Information, and Improvement Activities that may apply to cardiologists participating in MIPS.

Alternative Payment Models (APMs) in the Quality Payment Program – Includes a comprehensive list of all APMs operated by CMS, including Advanced APMs and MIPS APMs for the Quality Payment Program.

Support for Small Practices – Contains contact information for the local, experienced organizations that will help clinicians in small and rural practices participate in the Quality Payment Program.

Review Draft Measure Packages for Electronic Clinical Quality Measures Used in CMS Quality Reporting Programs

The Centers for Medicare & Medicaid Services invites vendors and stakeholders to review and provide feedback on draft electronic clinical quality measure (eCQM) measure packages that include logic and header changes for eCQMs under consideration for CMS quality reporting and payment programs. This opportunity will allow CMS to learn from EHR vendors who have the technical capabilities to test the Health Quality Measures Format (HQMF) code by directly consuming machine readable XML files for eCQMs. Testing will help CMS to identify instances in which XML code produces errors so that issues can be resolved prior to posting the fully specified measures this spring. The measures in both HTML and XML formats will be available through March 28, 2017.

The draft measure packages are now available on the ONC CQM Issue Tracker via the following tickets:

  • Eligible hospital and critical access hospital measures (CQM-2550)
  • Eligible professional and eligible clinician measures (CQM-2551)

The updated eCQMs will be posted in Spring 2017 and will reflect 4.3 of the Quality Data Model (QDM). Measures will not be eligible for 2018 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.

Please report questions and comments regarding the draft measure packages to the ONC CQM Issue Tracker tickets listed above.

Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management

March 15, 2017

Today, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) and the Federal Office of Rural Health Policy at the Health Resources and Service Administration (HRSA) introduced Connected Care, an educational initiative to raise awareness of the benefits of chronic care management (CCM) services for Medicare beneficiaries with multiple chronic conditions and to provide health care professionals with support to implement CCM programs. Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities as well as rural populations, who tend to have higher rates of chronic disease.

Two-thirds of Medicare beneficiaries have two or more chronic conditions, and one-third have four or more chronic conditions. Many health care professionals are providing these patients with chronic care management, non-face-to-face services such as reviewing test results or coordinating with other providers,but are not aware of the separate payments under the Medicare Physician Fee Schedule and are not receiving the full separate payments that are now available for CCM services under Medicare Part B.

“This important initiative builds on our efforts to help providers care for patients with multiple chronic conditions. We are excited to be working with the Health Resources and Services Administration to reach vulnerable populations,” said Cara James, PhD, Director of the Centers for Medicare & Medicaid Services Office of Minority Health.

As part of the Connected Care education initiative, CMS and HRSA or FORHP developed new resources to help educate patients and provide information for health care professionals. Some of the resources include:

• A toolkit for health care professionals with detailed information about CCM, and resources to help providers implement CCM;

• A partner toolkit that includes downloadable resources and suggested activities to get involved in the Connected Care initiative; and

Patient education resources, including a poster and postcard that can be used in a clinical or community setting.

All resources are available online at go.cms.gov/ccm and can be ordered at no cost.

“We are thrilled to be joining CMS to educate health care professionals and patients about the value of chronic care management with the goal of improving overall patient care for millions of Americans and reducing overall health care costs,” said Tom Morris, Associate Administrator, Federal Office of Rural Health Policy at the Health Resources and Services Administration.

By offering CCM services, health care professionals can deliver the coordinated care their patients need and deserve and help patients stay on track by getting support between visits.

For more information on how to get involved with the CCM initiative and learn more about chronic care management, visit go.cms.gov/ccm

Later today @ 3pm ET —A webinar will be held to kick-off our new initiative on chronic care management. You may register for this webinar today at bit.ly/ConnectedCareWebinar.

Secretary Price Statement on CBO Report

March 13, 2017

Health and Human Services Secretary Tom Price, M.D., released the following statement today on the Congressional Budget Office (CBO) report on the American Health Care Act:

"The CBO report's coverage numbers defy logic. They project that zeroing out the individual mandate – allowing Americans to choose whether to have insurance – will result in 14 million Americans opting out of coverage in one year. For there to be the reductions in coverage they project in just the first year, they assume five million Americans on Medicaid will drop off of health insurance for which they pay very little, and another nine million will stop participating in the individual and employer markets. These types of assumptions do not translate to the real world, and they do not accurately estimate the effects of this bill.

"The CBO report also does not incorporate two-thirds of the healthcare reform plan President Trump has called for – specifically the regulatory relief HHS can provide and the additional legislative reforms Congress is and will be pursuing. Our three-pronged approach will free patients to purchase coverage that works best for them at a price they can afford. Doctors and patients understand that, especially under current law, having coverage is not the same thing as having access to the care one wants or needs. Our approach will provide Americans with relief from the collapsing healthcare law, which never delivered on the benefits projected by the Congressional Budget Office in the first place."

Offering states flexibility to increase market stability and affordable choices

Providing opportunity through Section 1332 State Innovation Waivers

March 13, 2017

Today, the Department of Health and Human Services (HHS), in partnership with the Department of the Treasury, suggested ways to help foster healthcare innovation by giving states greater flexibility.

"States need the flexibility to develop innovative healthcare models that will improve patient access to care, increase affordability and choices offered, lower premiums, and improve market stability," said Health and Human Services Secretary Tom Price, M.D. "Today's letter highlights State Innovation Waivers as opportunities for states to modify existing laws or create something entirely new to meet the unique needs of their communities."

Read more about today's announcement.