AMA President Research Articles

Jesse Ehrenfeld: AMA President striving to improve health equity

Jesse Ehrenfeld: AMA President striving to improve health equity

Outgoing AMA President and Psychiatrist Vows to Work for Equity and Justice

Outgoing AMA President and Psychiatrist Vows to Work for Equity and Justice

AMA President Talks Life During COVID, Opioids, and Physician Burnout

AMA President Talks Life During COVID, Opioids, and Physician Burnout

AMA President Harris to Share Insights at Opening Session

AMA President Harris to Share Insights at Opening Session

AMA President Patrice Harris, M.D., M.A., to Speak at 2020 Annual Meeting

AMA President Patrice Harris, M.D., M.A., to Speak at 2020 Annual Meeting

AMA Identifies Six State Strategies for Ending Opioid Epidemic

Back to table of contents Previous article Next article ProfessionalFull AccessAMA Identifies Six State Strategies for Ending Opioid EpidemicMark MoranMark MoranSearch for more papers by this authorPublished Online:30 Sep 2019https://doi.org/10.1176/appi.pn.2019.10a20AbstractThe report highlights tools and strategies devised by states that have already achieved success in reducing opioid deaths and turning the tide of the epidemic.Network adequacy—whether health plans have enough health care professionals in their network to meet demand—and enforcement of parity laws are among the keys to addressing the opioid epidemic, according to an analysis by the AMA and Manatt Health, a health care consulting firm.The “National Roadmap on State-Level Efforts to End the Opioid Epidemic: Leading Edge Practices and Next Steps” analyzes the response to the epidemic in four states—Colorado, Mississippi, North Carolina, and Pennsylvania—and highlights six strategies that appear to be critical to success. The two already noted—enforcement of parity laws and network adequacy—are also among APA’s top legislative priorities.“States have to be willing to use their oversight to enforce parity laws,” psychiatrist and AMA President Patrice Harris, M.D., M.A., told Psychiatric News. “The work APA has been doing in this area to develop tools that physicians can use to evaluate whether states are complying with parity has been invaluable.” Harris is also chair of the AMA Task Force to Reduce Opioid Abuse.Complementary to parity enforcement is ensuring that health plans have adequate numbers of mental health professionals in their networks. This is likely to require payment reforms, collaborative care models, and other efforts to bolster and support the nation’s treatment workforce for opioid use disorder (OUD), according to the report.Four other effective strategies identified in the roadmap are the following:Improving access to evidence-based treatment for opioid use disorder. Remove prior authorization requirements and other barriers to medication for addiction treatment (MAT) for OUD—and ensure MAT is affordable.Expanding pain management options. Enhance access to comprehensive pain care, including nonopioid and nonpharmacologic options.Improving access to naloxone. Reduce harm by expanding access to the overdose-reversing drug and coordinating care for patients in crisis.Evaluating policy success and barriers. Evaluate policies and outcomes to identify what is working and build on successful efforts, and identify policies and programs that might need to be revised or rescinded.“We are at a crossroads in our nation’s efforts to end the opioid epidemic, and states are being creative on how they respond,” Harris said in a statement. “It is time to end delays and barriers to treatment; time for payers, pharmacy benefit managers, and pharmacy chains to revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to help all patients access evidence-based care for pain and substance use disorders. Physicians must continue to demonstrate leadership, but unless and until these actions occur, the progress we are making will not stop patients from dying.”Joel Ario, managing partner at Manatt Health Strategies and former insurance commissioner in Oregon and Pennsylvania, added: “These recommendations are already proving effective in leading states. If state policymakers want to have a tangible impact on improving patient care, these are the policies that are showing real promise. This is not hypothetical—this is what is needed to end the epidemic.”The recommendations by the AMA and Manatt emerged from four key themes identified in an earlier analysis of strategies in the four states. The broad themes include the following:Vigorous state oversight and enforcement. State regulators can have a significant impact on reducing barriers and improving patient care, and some have used these tools to increase access to evidence-based treatment. Regulators have successfully held payers and others accountable for restricting access by using prior authorization for MAT. Additionally, states have found success by enforcing state and federal insurance parity laws, benefitting patients needing treatment for mental or substance use disorders.Medicaid expansion. Medicaid often provides more comprehensive care for substance use disorders than the commercial insurance market, often by removing barriers to MAT and providing greater access to nonopioid pain care. Expanding Medicaid in states that have not yet done so would establish a strong foundation to help even more patients.Long-term funding. Grants are being used to advance many best practices, but to continue saving lives, states need long-term, sustainable funding. Without reliable funding streams, programs that are showing promise to reduce overdose and death—and to connect patients to treatment—might simply disappear.Measuring success. Some states are evaluating policies and programs to determine what works. Most of these evaluations are just beginning. Comprehensive analysis is essential to focus resources on successful interventions and to revise or drop policies that are having unintended consequences. ■The AMA report is posted here. ISSUES NewArchived

Psychiatrist Patrice Harris, M.D., M.A., Inaugurated 174th AMA President

Psychiatrist Patrice Harris, M.D., M.A., Inaugurated 174th AMA President

Judge Blocks Abortion ‘Gag Rule’ for Title X Providers

Back to table of contents Previous article Next article Government NewsFull AccessJudge Blocks Abortion ‘Gag Rule’ for Title X ProvidersLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:9 May 2019https://doi.org/10.1176/appi.pn.2019.5b26AbstractThe Trump administration’s “gag rule” on abortion referrals or counseling for health care professionals who accept federal Title X funding was blocked in federal court April 29.A federal district court judge in Oregon blocked a Trump administration rule that would have barred health care professionals accepting federal funding from counseling women on abortion.iStock/Worawee Meepian“At the heart of these rules is an arrogant assumption that the government is better suited to direct women’s health care than their providers,” said Judge Michael McShane of the U.S. District Court in the District of Oregon, before announcing his plans to issue a preliminary injunction to block the rule from taking effect.Federal laws have long prohibited the use of taxpayer funds to pay for most abortions, but the Trump administration’s new policy, which had been set to take effect May 3, would go much further. It would have barred health care professionals who counsel patients on or refer them for abortion from receiving Title X funding, a program for low-income women under the Public Health Service Act. It also included a costly new requirement that clinics be physically and financially separate from facilities that provide abortions and added new requirements around involving families in the family planning decisions of minors.Title X is the only federal reproductive-health services program for low-income and underinsured women. Each year it provides more than 4 million women with family planning and contraceptive care, preventive health screenings for breast and cervical cancers, and treatment for sexually transmitted infections.Since the rule was issued in February (Psychiatric News, March 29, 2019), half a dozen lawsuits have been filed around the country, including one by the AMA and Planned Parenthood that called the policy a government-imposed “gag rule” and said it would be illegal and unethical and threaten the health care of millions of women. Planned Parenthood, which serves 41% of patients served by the Title X program, said it will leave the program if Trump’s rule takes effect. California also filed suit, as did 20 Democrat-led states and the District of Columbia.APA joined with 17 other physician leaders and medical specialty organizations representing 4.3 million health care professionals to denounce the rule, saying it disregards the expertise of the medical and scientific communities and evidence-based standards.“To allow this gag rule to take effect would interfere with our fundamental right as physicians to discuss the full range of options for care with our patients based on their individual medical situation and personal wishes,” said Maureen Sayres Van Niel, M.D., president of APA’s Caucus of Women Psychiatrists and a reproductive psychiatrist in Cambridge, Mass. “This is a blatant attempt to politicize a fundamental right of women patients, and, like many other national medical associations, we condemn these efforts.”In 1996 Congress mandated that patients receiving information about their pregnancies through Title X receive “nondirective” counseling. And in 2010 Congress mandated that the Department of Health and Human Services cannot impose rules that create unreasonable barriers to care, interfere with doctors giving their patients a full range of options, restrict the ability of health care providers to disclose all relevant information to patients, or violate the ethical standards of health care professionals.“The gag rule blatantly violates Congress’ mandate by forcing doctors to withhold information from their patients and imposing unreasonable barriers to care,” Planned Parenthood wrote in a statement.Leana Wen, M.D., president of Planned Parenthood Federation of America, said this latest ruling represents a victory for patients and doctors.“Because of this, our patients across the country can still access life-saving health care,” she said. “However, while this is a victory for patients and doctors, this relief is preliminary, and we will continue to fight the Trump-Pence administration in court and in Congress to ensure our patients’ health and rights are protected.”AMA President Barbara L. McAneny, M.D., expressed similar sentiments. “Judge McShane got it exactly right when he called the new Title X rule a ‘ham-fisted’ approach to health care,” she said. “The judge repeatedly asked how the new gag rule would improve health outcomes. The government was unable to answer. The new rule would have placed obstacles to health care for low-income patients. We are pleased the judge shared the AMA’s concern about the physician-patient relationship.” ■The coalition’s statement can be accessed here. ISSUES NewArchived

New role for former AMA president.

Medical Journal of AustraliaVolume 209, Issue 2 p. C1-C1 Career New role for former AMA president Cate Swannell, Cate SwannellSearch for more papers by this author Cate Swannell, Cate SwannellSearch for more papers by this author First published: 16 July 2018 https://doi.org/10.5694/mja18.1607C1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume209, Issue2General practice issueJuly 2018Pages C1-C1 RelatedInformation

AMA Goes Beyond ‘Goldwater Rule’ In Ethics Guidelines on Media Interaction

AMA Goes Beyond ‘Goldwater Rule’ In Ethics Guidelines on Media Interaction

Proposed Anthem-Cigna Merger Terminated Following Appeals Court Ruling

Back to table of contents Previous article Next article Professional NewsFull AccessProposed Anthem-Cigna Merger Terminated Following Appeals Court RulingMark MoranMark MoranSearch for more papers by this authorPublished Online:26 May 2017https://doi.org/10.1176/appi.pn.2017.6a1AbstractOpposition to the Anthem-Cigna merger by APA and other medical and patient advocacy groups has been part of a broader concern about consolidation in the insurance industry and its effect on access to care.A proposed merger between health insurance giants Anthem and Cigna Inc. has finally hit a dead end.Anthem issued a statement last month terminating the proposed merger after a U.S. appeals court upheld a lower district court ruling blocking the merger on the grounds that it would have diminished competition and raised prices for consumers. Cigna exited the agreement in February after another district court ruling blocked the merger, and now the two companies are feuding over the terms of disengagement. “In light of [the appeals court] decision and Cigna’s refusal to support the merger, … Anthem has delivered to Cigna a notice terminating the Merger Agreement,” according to a statement from Anthem. “Cigna has failed to perform and comply in all material respects with its contractual obligations. As a result, Cigna is not entitled to a termination fee. On the contrary, Cigna’s repeated willful breaches of the Merger Agreement and its successful sabotage of the transaction has caused Anthem to suffer massive damages, claims which Anthem intends to vigorously pursue against Cigna.” The statement effectively puts an end to the merger, which was first proposed in September 2015. APA and other medical groups strongly opposed the Anthem-Cigna merger, as well as a potential consolidation between Aetna and Humana, also blocked by the courts. APA leaders met with officials from the Department of Justice about the dangers of the proposed mergers. They argued that the mergers would be detrimental to health care generally, but could especially be harmful to patients with mental illness because the mergers would diminish competition in setting rates and determining conditions of psychiatrist participation in health networks. APA also emphasized to the department that diminished access could result in violations of the federal Mental Health Parity and Addiction Equity Act.“The trend toward consolidation in the insurance market is a troubling one that threatens patient choice, which is critical in our health care system,” said then APA President Maria A. Oquendo, M.D., Ph.D. “We are pleased that the court sided with the Justice Department and agreed that the Anthem-Cigna merger would reduce competition and limit patients’ coverage options.”APA CEO and Medical Director Saul Levin, M.D., M.P.A., concurred. “The termination of the Anthem- Cigna merger ends a long chapter in which the AMA, along with APA and other medical specialties, fought to preserve competition in the health insurance market and prevent insurers from acquiring unprecedented market power that would have been detrimental to network adequacy and to patients,” Levin said. “APA will continue to advocate on behalf of patients and physicians to foster more competitive health insurance markets.”In the April 28 ruling by the U.S. Court of Appeals of the District of Columbia, Judge Judith Rogers, writing for the majority, said the U.S. District Court of the District of Columbia was correct in its February ruling that whatever market efficiencies might be achieved by consolidation were not sufficient to outweigh the harm to competition. “[W]e hold that the district court did not abuse its discretion in enjoining the merger based on Anthem’s failure to show the kind of extraordinary efficiencies necessary to offset the conceded anticompetitive effect of the merger in the 14 Anthem states: the loss of Cigna, an innovative competitor in a highly concentrated market,” the judge wrote. “Additionally, we hold that the district court did not abuse its discretion in enjoining the merger based on its separate and independent determination that the merger would have a substantial anticompetitive effect in the Richmond, Virginia, large group employer market.”Consolidation in the insurance market has been a growing concern among physician and patient advocacy groups in the past several years. In September 2015, soon after the merger was proposed, the AMA released “Competition in Health Insurance,” an annual analysis of insurance markets that showed nearly half of all states could see diminished competition in local health insurance markets if the Anthem-Cigna and Aetna-Humana mega-mergers were allowed to proceed.“The U.S. Court of Appeals of the District of Columbia sent a clear message to the health insurance industry: a merger that smothers competition and choice, raises premiums, and reduces quality and innovation is inherently harmful to patients and physicians,” said AMA President Andrew W. Gurman, M.D., in a statement in response to the appellate court ruling. ■The ruling by the U.S. Court of Appeals of the District of Columbia can be accessed here. “Competition inHealth Insurance” is available here. ISSUES NewArchived

AMA Survey Indicates M.D. Support for Measures to Address Opioid Epidemic

AMA Survey Indicates M.D. Support for Measures to Address Opioid Epidemic

Half of Medicare Payments Tied to Value, Quality by 2018

Half of Medicare Payments Tied to Value, Quality by 2018

Reflections of the current AMA President.

Reflections of the current AMA President.

AMA President: Hold Politicians Accountable for Health Care Decisions

AMA President: Hold Politicians Accountable for Health Care Decisions

AMA Approves Recommendations for Telemedicine

AMA Approves Recommendations for Telemedicine

AMA Acts on Medicare Payment as Congress Considers Legislation

Without reform of the Medicare payment formula, physicians will face very steep across-the-board payment cuts in January.

Lazarus Recounts Year as AMA President

The AMA's voice helped secure an important victory in Sutter v. Oxford Health Plans, allowing individual physicians to come together as a group to fight the unfair business practices of large health insurance companies.

AMA’s Psychiatrist President Hails Involvement of APA

Jeremy Lazarus, M.D., says that the high profile of psychiatry within the AMA has helped to sharpen that organization’s focus on mental health issues.

Conn. Community Will Need Ongoing MH Vigilance, Say Experts

Conn. Community Will Need Ongoing MH Vigilance, Say Experts