House of Delegates – Opening Session
James S. Gessner, M.D., MMS President
In recognizing Dr. Dimitri, I mentioned that one of his accomplishments during the last year was chairing the Search Committee for a new Executive Vice President, to succeed Corinne Broderick.
The Search Committee’s effort resulted in the appointment of Lois Dehls Cornell as our new Executive Vice President, who joined us on June 1 of this year.
Many of you have had the opportunity to meet Lois, but for those of you who may not have met her, I would like to introduce her to you today.
Executive leadership transitions can sometimes be difficult, but not here. Our transition has been seamless and smooth, and that’s to Lois’s credit, and we are fortunate to have someone with her experience, expertise, and enthusiasm.
Lois, as this is your first meeting of the House of Delegates, let me officially welcome you to the Massachusetts Medical Society. We look forward to working with you in the years ahead.
Those of you who follow the activities of our society in our member publications know that I have written about the importance and value of advocacy.
It is inherent in our mission statement and in our strategic direction: “to advocate for the shared interests of patients and our profession.”
Our members recognize full well the significance of this activity. For more than a decade, in survey after survey, they have rated advocacy as the principal responsibility of our medical society.
Advocacy on behalf of physicians and patients is what creates the real value of our membership in organized medicine, and I believe advocacy is becoming an even more critical function, as our health care system continues to undergo rapid and major changes, as new challenges in public health arise, and - most important - as our physician workforce is required to do more and more.
Your Medical Society has been engaged in significant advocacy activities over the last six months for both physicians and patients, and I would like to share with you what we have done on some key issues. The work on these, issues, I believe, reflect well on the importance of advocacy and its value to our members.
OPIOID EPIDEMIC
The first is the opioid epidemic affecting the Commonwealth as well as the nation. For more than a year and a half, our Medical Society has made this public health crisis a top priority.
As this crisis unfolded, physicians were squarely labeled as part of the problem because of our tendency to overprescribe, and in some quarters, that sentiment still exists.
Yet I think we have turned the tide. Physicians are now being recognized as part of the solution here in Massachusetts.
Government officials and the public now know that the physician’s challenge is to balance the risk of addiction versus ensuring adequate pain relief for their patients who truly need help.
The Surgeon General’s recent report – the first ever on substance abuse – will give greater significance to the opioid crisis and should further the perception that doctors do care.
From conducting forums to raising awareness, to creating prescribing guidelines and a dedicated website, to public information campaigns, to prescriber education, our medical society has reached out to physicians and patients alike.
We have demonstrated to government officials that physicians are willing and eager to respond to a public health crisis and to do whatever we can to help curb this epidemic.
We can take special pride in promoting prescriber education. More than 7,000 prescribers have taken nearly 21,000 of our continuing medical education courses in opioids and pain management since they were made free to all prescribers in May of 2015, and they remain in demand -- and free -- to this day.
In addition, we worked with state public health officials and the deans of the state’s four medical schools in establishing Medical Education Core Competencies for the Prevention and Management of Prescription Drug Misuse, to create awareness among the physicians of tomorrow about the risks and benefits of pain management.
Our collaboration and advocacy with state public health officials extended to improvements in what we believe is one of the best tools available to improve and monitor prescribing - the prescription monitoring program, now named the Massachusetts Prescription Awareness Tool, or MassPAT.
Today, we have a monitoring program that is much more user friendly, tied into neighboring states, and ready to be integrated into electronic health records.
Our advocacy on opioids extended to the federal level as well, as we worked with members of our Congressional delegation in pushing for ‘partial-fill’ legislation, a concept that originated within our medical society and one that would reduce the amount of drugs available for diversion.
The Reducing Unused Medications Act, championed by Senator Elizabeth Warren and Representative Katherine Clark, eventually became part of the Comprehensive Addiction and Recovery Act, passed overwhelmingly by Congress and signed into law by President Obama.
The law permitting partial-fill prescriptions is another in a long list of substantive efforts taken to address the opioid epidemic, and we are now preparing efforts to make the state law on ‘partial-fill’ prescriptions compatible with the Federal law, which we hope to be accomplished in the next state legislative session.
While our efforts on education and prevention will continue, we have also directed our energy to the area of treatment, with an October Summit on Medication-Assisted Treatment for substance use disorder, headlined by U.S. Senator Edward Markey as keynote speaker, who has recognized and is advocating for the need for more treatment.
The area of treatment for opioid addiction remains a critical public health concern, as the availability of and access to evidence-based treatment programs and providers are limited. More access to treatment on demand is essential, if we are to reduce the number of overdoses and provide hope to those suffering.
Our efforts to address this epidemic continue to expand, as both our Opioid Task Force and our Committee on Geriatric Medicine look into the growing problem of substance use disorder in nursing homes.
And in another new development addressing this issue, I would like to share with you progress on an important resolution from our 2016 Annual Meeting initiated by our student members and supported by the chairs of the Committees on Public Health … Ethics, Grievances and Professional Standards … Violence Intervention and Prevention … and Professional Liability … along with the MMS Office of the General Counsel and the Massachusetts Society of Addiction Medicine.
The resolution asked that the MMS perform an internal evidence-based study of the ethical, legal, and liability considerations and the feasibility of a medically-supervised injection facility in Massachusetts and that the Board of Trustees report back to the House of Delegates at the 2017 annual meeting with recommendations for an MMS advocacy position on medically supervised injection facilities.
That study has now been completed and was reviewed by the Task Force on Opioid Therapy and Physician Communication at its November 29th meeting.
The Task Force unanimously accepted the study’s five recommendations and appropriate committees are now reviewing the report in accordance with our governance structure.
Agreement exists that supervised places of treatment and medically-supervised injection facilities are in fact medical treatments, which offer an opportunity to engage some of the most vulnerable and difficult to reach individuals such as the homeless population who may prefer anonymity and often shun lifelong health contacts.
We are excited about this additional step in our efforts to attack the opioid crisis, and we look forward to action on this resolution by the House of Delegates at the 2017 annual meeting.
In summary, members can and should be justifiably proud of our society in our response to the epidemic.
It is not an exaggeration to say that the Massachusetts Medical Society has established itself as THE leading health care organization in the state addressing the opioid epidemic.
RECREATIONAL MARIJUANA
Ballot question 4 to allow the commercialization of recreational marijuana was one of the most hotly contested ballot questions of this election year. It was also one that the Massachusetts Medical Society was active in opposing, consistent with long-standing MMS policy.
Our opposition was based on the public health and safety implications that the passage of this law would create, specifically the threat to our young citizens despite the question’s age provision of 21.
We raised alarms about the lack of public health oversight, the absence of any revenue being dedicated to education, prevention, and treatment, and the dangers of marijuana edibles, particularly to children.
We became a member of the Campaign for a Safe and Healthy Massachusetts, a coalition of government, business, and health leaders in opposition to the passage of Question 4, and solicited specialty groups to join us in the opposition, and 11 did.
Among our efforts were a dedicated webpage, creation of materials for both physicians and patients, commentaries in newspapers across the Commonwealth, social media postings and advertising, and working with the Campaign in warning voters about the public health and safety effects of passage.
While the voters have spoken and recreational marijuana will now be permitted in the Commonwealth, MMS will continue its advocacy to ensure that public health oversight is provided, that the need for education, prevention, and treatment still exists, and that steps will be taken to ensure the safety of children.
PHYSICIAN PAYMENT
I began this presentation by stating something that each of us knows well: that the health care system is undergoing change. One of the fastest areas of that change has been physician payment, as the desire to control health care costs increases at all levels and reimbursement shifts to value-based payments.
Our advocacy efforts in this area were concentrated on two issues.
The first is MACRA, the Medicare Access and CHIP Reauthorization Act, which replaced the Sustained Growth Rate formula for Medicare Reimbursement.
The 2,400-page rule is perhaps the most revolutionary change in Medicare reimbursement since the inception of the program, and required advocacy efforts on both the national and state level.
Physicians were fortunate, however, in that CMS Acting Administrator Andrew Slavitt put physicians and patients at the center of his deliberations.
“CMS has lost the hearts and minds of America’s doctors,” Mr. Slavitt said, “and the MACRA rule presents an opportunity to win them back.”
He was ready to listen, and listen he did.
Our comments on the proposed rule amounted to the length of a short story – more than 22 pages and 6,000 words. And many of our comments were incorporated into the final rule.
Mr. Slavitt’s regional visit to speak with our Massachusetts physicians also proved fruitful, as did our exclusive interview with him, which we shared with physician groups across the country.
Through all of our advocacy efforts on MACRA we recognized the commitment of Mr. Slavitt to improving health care and, as I noted earlier, “putting physicians and patients at the center” of the discussion.
Our respect for him grew, to the point where we have nominated him for the AMA’s Dr. Nathan Davis Award, presented for outstanding government service. We nominated Mr. Slavitt because he established a new standard of communication at CMS, is dedicated to helping physicians care for patients, and is committed to getting federal policy right.
The adoption of a new Medicare payment program, with increased reporting requirements and a focus on quality, will require physicians to adapt to still more changes, but remember that our medical society’s advocacy made a difference in the outcome.
We have established a dedicated website on MACRA to help you with this transition and have more activities planned as well.
You will be hearing much more about MACRA as it nears implementation, including at our special Town Hall Forum later this evening.
The second area of advocacy I want to bring to your attention is something that did not happen. It involves physician payment in physician-lead, team-based health care and what is called “incident-to” billing.
Let me explain.
Our medical society has long supported physician-led, team-based care, using many different health care professionals.
“Incident-to” billing is the practice of billing selected services by team members under the physician’s National Provider Identification. It reflects the complexity of team-based care.
Under a proposed rule change, Tufts Health Plan intended to impose an arbitrary reduction of 15 percent in payment for services provided by team members in a physician’s practice, thus under-compensating physicians for the level of care given and thus no longer reimbursing them for their supervision and consultation. This was a major concern.
Through our society’s efforts, this cut was eliminated and full reimbursement restored.
These recent cases – MACRA at the federal level and “incident-to” billing on the state level – are prime examples of our advocacy efforts in creating value for members and may largely go unrecognized as such.
The point to remember is this: MMS advocacy makes a difference and creates value for our members.
MEMBER COMMUNICATIONS
The rapid changes in health care and the challenges posed by public health issues and threats necessarily require an increased capacity to communicate with our members and our patients. And the medical society is doing just that.
In September we launched a new version of e-Communities, with a new name of MMS Connect. This is a web-based communication tool, connected to our member database system that enables committee communication regarding issues, meetings, and documents. Since the re-launch, MMS Connect has seen a significant jump in activity, with more members logging on, creating new message threads, and making more unique contributions.
A micro-site was also in use by members prior to this meeting to comment on interim meeting resolutions.
We are also increasing our activity on social media sites such as Facebook and Twitter. Our ads on recreational marijuana on Facebook received a number of responses – both for and against – and for the first time, an MMS event – our Medication Assisted Treatment Summit – was the subject of live streaming on Twitter.
Finally, for those of you who like to keep up with the events occurring in health care, I call your attention to our MMS MediaWatch – a daily compilation of the major stories in health and medicine, locally, state-wide, and nationally. It is available by e-mail, or accessible on our website home page. For those wanting to stay abreast of what’s happening in Massachusetts health care and elsewhere, I highly recommend it. Whether for a listing of story headlines or for links to the articles themselves, it is well worth a visit.
PHYSICIAN WELLNESS
There is one final topic I would like to address, and that is physician wellness.
More and more, in the popular press and medical literature, we are seeing stories and reports of physician burnout and fatigue. Medical societies, a variety of health care organizations, and hospitals are showing growing concern over this issue.
MMS Leadership has recognized physician wellness as a critical issue facing our profession. We have talked with specialty groups and evaluated options for MMS to take to improve wellness and establish the proper work-life balance.
At this time, we are compiling resources and making them available through our Physician Practice Resource Center, and I urge you share these with your colleagues and take advantage of this service.
I’d like to call your attention to an upcoming MMS live webinar presented by the PPRC on January 25 from noon to 1 p.m.
Entitled “Running on Empty? Physicians' Path to Enjoying Life and Medicine More,” this CME accredited course will focus on the critical factors and predictors for physician wellness and offer strategies to handle the challenges of today’s medical practice.
In concluding my remarks, I wish to emphasize again the significance of our advocacy efforts, reminding you that the areas I have discussed here today are only a handful of examples of how our medical society advocates for physicians and patients.
The success of our advocacy is sometimes evident, as demonstrated by the positive results with opioids and the “incident-to” billing. Our efforts sometime fall short, as seen with recreational marijuana.
But with success or failure, the importance of advocacy is that the voice of the physician be heard, clearly and loudly, on behalf of our patients and our profession.
That, in itself, is the value of organized medicine and of membership in our society.
Thank you for your attention.
Mr. Speaker, that concludes my President’s Report.
