A doctor’s perspective

Saturday, September 01, 2018 12:16 PM

AMA president, CMS leaders’ Grand Junction visit prompts editorial by largest newspaper in Western Colorado

by The Grand Junction Daily Sentinel editorial board

Editor’s Note: The following editorial was published in the Sept. 5, 2018 edition of the Grand Junction Daily Sentinel, the largest daily newspaper in western Colorado, with distribution in six counties. 2018 marked 120 years of publication since the newspaper’s founding in 1893.

If you’re frustrated being a patient in today’s health-care environment, try being a doctor – especially a primary care physician.

Doctors are trained in a hospital setting, which is actually alien to their mission of keeping people healthy through prevention. They learn through exposure to failures in the system that land people in the hospital, often from chronic, yet preventable conditions like adult-onset diabetes and high blood pressure.

Once they fulfill their residency requirements to practice on their own, federal laws against self-dealing create hurdles to form a team-based system of care utilizing shared resources that is actually proving to lower costs and deliver care more efficiently than hospitals.

Adherence to long-held ethical guidelines, like making sure patients don’t suffer undue pain, have contributed to an opioid epidemic that the system doesn’t have the capacity to treat. Doctors spend half as much time seeing patients as they do logging data meant to measure quality – but doesn’t. And Medicaid patients, with their low reimbursement rates, create a financial challenge that many doctors take on as a matter of conscience to avoid creating a two-tiered system of care in this country. These are just a few observations that doctors representing the Colorado Medical Society and the American Medical Association shared with the Sentinel’s editorial board Wednesday.

“The AMA’s overarching mission is to promote the art and science of medicine and the betterment of public health,” said AMA President Barabra L. McAneny, MD. But Wednesday’s discussion focused on three key areas:

• Confronting the increasing chronic disease burden. The AMA wants to eliminated preventable cases of type 2 diabetes, help all adults meet their blood pressure goals, and end the opioid epidemic.
• Removing barriers to care and emphasize patient-physician relationships over paperwork. The AMA supported the Affordable Care Act, in part because it improved access to care. It continues to work for Medicaid expansion and make it a more robust system.
• Reimagining medical education. “The AMA commits to speeding research into practice – making medical knowledge easy to consume, medical technology easy to use, medical evidence easy to apply and medical education easy to access across a lifetime.”

McAneney, an oncologist practicing in Albuquerque, makes these visits all over the country, comparing strengths of local health-care systems. She said she’s “fascinated” by the Grand Valley’s “mainstreamed” Medicaid model – an example of how “all health care is local.” There’s no one-size-fits-all model to making health care affordable and accessible.

Representatives of the Colorado Medical Society touted efforts to lower the number of opioids being prescribed in the state and the growing number of physicians accessing prescription drug monitoring programs, or PDMPs to curtail instance of “doctor shopping.”

“Even if we do everything we can to reduce prescribing opioids and increase takeback locations, we may still see the death rate continue to climb for the next six or seven years,” said CMS President M. Robert Yakely, MD.

More addiction specialists are needed in the state, along with more treatment centers. Medical schools should adopt curriculum about opioid use and addiction. Insurance companies should cover the expense of alternatives to pills, such as physical therapy.

Citizens can do their part by getting rid of pain meds in their medicine cabinets. And society must stop stigmatizing those who grow dependent on opioids “and recognize that opioid-use disorder is a chronic relapsing disease and not a moral failing,”  McAneny said.

Meanwhile, doctors are encouraged by how Colorado’s business community is pushing for non-legislative ways to lower costs.

“They’ve taken the reins, which is good from our perspective,” said past CMS president Dave Downs, MD. “They have the legs to move things through.”