|ACPM Headlines 10/2/15|
In this Issue
Policy and Practice
Research and Reports
1. PRESIDENT’S COLUMN: ACPM AND ACLM END MERGER TALKS
The leadership of ACPM and the leadership of the American College of Lifestyle Medicine (ACLM) have agreed to end their pursuit of a merger between the two organizations. The decision follows more than 18 months of discussions, information gathering and exchange, negotiations, and legal review and input.
Discussions with ACLM about a potential merger began in earnest in February 2014 and centered later that spring on a set of agreed-upon principles that included: (1) capitalizing on the alignment between lifestyle medicine and preventive medicine to create a more unified voice for the field of lifestyle medicine; and (2) committing to leverage both the evidence underlying, and popular appeal of, lifestyle medicine to benefit both organizations and enhance their impact. While there were other principles, I believe these two were the bedrock philosophies that drove the merger discussions. I also believe that both organizations were unwavering in their belief in those principles to the very end of the negotiations. However, as is the case with many failed mergers, irreconcilable differences in organizational cultures and in specific approaches to how those principles would be met through a legal merger agreement were the ultimate undoing of the deal. Specifically, organizational independence, flexibility, governance, and identity or branding were key issues at the heart of the two organizations’ inability to reach a formal accord.
Fortunately, I’m pleased to say the two organizations ended our talks amicably (which is not always the case with failed mergers) and are continuing a dialogue around other ways to strengthen collaboration and build organizational ties. Namely, the two organizations are about to finalize a "teaming agreement” on marketing and distribution of a comprehensive lifestyle medicine curriculum for physicians and other health professionals. Beyond that, we are hoping to develop a broader affiliation agreement focusing on membership recruitment and service, the two organizations’ annual meetings, industry partnerships and sponsorships, and program development.
While the attempt at unification of the two organizations did not succeed, we believe the process was a beginning, not an end. Both organizations learned a great deal about each other, identified mutual goals and areas of synergy, and will be stronger for the experience.
We are continuing our journey to "Establish ACPM as the leading national specialty society for advancing community-level promotion of healthy lifestyles and lifestyle medicine” (Strategic Initiative # 2), and working closely with ACLM and you, our members and colleagues in preventive medicine, to make it happen. If you have any thoughts you would like to share about our relationship with ACLM and our role in advancing the practice of lifestyle medicine, please share them with me or Mike Barry. I look forward to your input.
Blumenthal, MD, MPH, FACPM
The U.S. Department of Health and Human Services (HHS) held a 2-day meeting with representatives from all fifty states and the District of Columbia to address prevention of opioid overdose and opioid use disorder. HHS will expand access to Medication Assisted Treatment (MAT) by revising regulations related to prescribing buprenorphine, which is used to treat opioid dependence. Additionally, $1.8 million will be made available to rural communities in thirteen states so that healthcare professionals and emergency responders can have access to naloxone, a drug that reverses opioid overdose. These programs are part of HHS’s department-wide initiative to address opioid overdose and misuse.
The evidence-based initiative focuses on three areas: increasing use of naloxone, increasing access to MAT, and informing opioid prescribing practices. President Obama has requested $133 million in new funding in his FY 2016 budget to treat and prevent opioid misuse and abuse.
Overdoses and deaths from prescription opioid and heroin is an escalating public health crisis. In 2013, 16,200 people died from prescription opioid overdose with more than 145,000 people dying from these overdoses in the last decade. Heroin deaths have risen sharply, more than doubling between 2010 and 2013.
In response to the continued difficulty some preventive medicine physicians experience when applying for an unrestricted medical license upon moving to a new state, ACPM Board of Regents member Wendy Braund, MD, MPH traveled to Pennsylvania to testify before the state Board of Medicine and advance ACPM’s position that the practice of population-based medicine should be considered the practice of medicine.
Dr. Braund in her testimony noted that, "We have physicians trained in Preventive Medicine being certified by a member board of the American Board of Medical Specialties (ABMS), the world’s gold standard organization for physician board certification; we have the largest organization representing physicians in the United States supporting the unrestricted licensure of physicians who are engaged in the practice of medicine that does not include direct patient care (AMA resolution H-275.921); we have the organization that is responsible for defining training guidelines and accrediting post-MD education programs in the United States stating that the assessing of populations to diagnose, treat and prevent disease and the providing of clinical decision support and information for such care is the practice of clinical medicine; and we have the board of medicine in the most populous state in the United States clarifying for its physicians that medical decision making, even without seeing or examining the patient, is to be considered the "practice of medicine,” requiring an active medical license…ACPM and ABPM strongly recommend that the Pennsylvania Board of Medicine support the provision of full medical licensure for physicians engaged in the practice of population-based medicine. The Board should license Preventive Medicine physicians who have demonstrated their competence in their specialty just as it does other specialists who do not interact with individual patients.”
ACPM will continue to work with the Pennsylvania Board of Medicine and other state medical boards to ensure preventive medicine physicians are recognized and licensed as all other physicians.
4. WANTED: PREVENTIVE MEDICINE LEADERS! ACPM ACCEPTING AWARD AND BOARD NOMINATIONS
There are many exceptional leaders in preventive medicine worthy of recognition and/or ready to serve in an ACPM leadership capacity. You know some, and you may be one yourself. Please consider nominating a colleague for an ACPM award or yourself for a seat on the ACPM Board of Regents.
Annually, ACPM recognizes individuals for significant contributions, dedication and service to the College and preventive medicine. The Strategy and Board Development Committee is currently accepting nominations for the following:Distinguished Service Award,Ronald Davis Special Recognition Award,William Kane Rising Star Award, Donald Gemson Resident Award, and The Arnold P. Gold Foundation Humanism in Medicine Award.
Each of these awards will be presented as part of Preventive Medicine 2016 and highlight the significant contributions members of our preventive medicine community make each year. Please review the more detailed descriptions of each award and nominate someone today!
Additionally, the following Board of Regents terms will be expiring next year and nominations for these positions are being sought:
For additional information on both the awards and Board of Regents nominations, please visit www.acpm.org/awards.
Whether you give a one-time gift or donate on a monthly basis, your contribution is an investment in helping us achieve our shared goals of preventing disease and promoting health. Sustainers of Prevention give a little at a time to make a big difference and sustain ACPM’s work. Your donation of just $5 a month, about the price of a venti frappuccino or chai latte, helps us fund future programs. Be a part of ACPM’s monthly giving program and become a Sustainer of Prevention! Your recurring online donation is secure and flexible. You choose the amount you wish to give; you can change, suspend, or cancel your support at any time! Questions? Please contact Maureen Simmons, MA, CFRE, Chief Development Officer at firstname.lastname@example.org.
ACPM was one of the medical societies present when the American Society of Addiction Medicine released its new National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (National Practice Guideline). The National Practice Guideline will assist clinicians prescribing medications to patients with opioid addiction. It addresses the benefits of pharmacotherapies and their role in recovery, and provides guidance for evidence-based coverage standards by payers.
Federal and state government representatives, private payers, and patient advocates were on hand and impressed upon the participants the timeliness and importance of this resource. Research shows that currently 30% of treatment programs offer medications and less than half of the eligible patients in those programs receive medications.
ACPM staff actively participated in the stakeholder summit to discuss the best strategies to disseminate the National Practice Guideline to clinicians and other providers. The National Practice Guideline is the most current document that combines existing guidelines, current literature and a systematic process for developing practice recommendations. Free copies of the National Practice Guideline are available for use along with its associated products including a slide deck, pocket guide and an app.
ACPM has posted on its web site the October edition of its Health Systems Transformation Monthly Newsletter, which contains the latest updates on the value-based insurance design (VBID) model, State Innovation Models (SIM), Meaningful Use (MU), and grant opportunities to improve population health. The newsletter is one of a number of resources on ACPM’s recently updated webpage for members and others who are interested in health systems transformation (HST) and facilitating the integration of primary care and public health. ACPM defines health systems transformation as "Systems-based approaches to improving population, community, and individual health by incorporating and addressing the determinants of health and increasing the efficiency and effectiveness of health care.”
Please contact HST’s administrator to join the growing HST listserv, where you can interact with professionals on a wide variety of topics, including quality of care, payment and delivery reform, and preventive medicine leadership. Once you sign up, you will receive the monthly newsletter that highlights the latest developments in HST and other exciting opportunities for professional development and leadership. You can also sign up for Modern Healthcare’s day-long virtual conference on October 21, where many of these timely topics will be discussed.
ACPM Corporate Roundtable member, AstraZeneca, wants to remind you that Flu Season is here and ACPM members can order patient education materials at no cost to help raise awareness about influenza at Alliance & Advocacy. The site provides access to this unique program that offers patient education materials to help advocacy groups and other organizations deliver easy-to-read information for patients on influenza.
The Fight the Flu Patient Education Program offers informative and relevant patient education materials for families, patients, and healthcare workers. Materials highlight key facts about the flu and promote awareness of the importance of vaccination to prevent the spread of flu. Materials are delivered via an easy online ordering resource, available 24/7 at no charge and both in English and Spanish. Patient pieces include "Understand the Facts About Flu,” "Help Protect Yourself & Your Family From the Flu – Get Vaccinated,” and "Flu Vaccines For Healthcare Workers.”
For more information about the ACPM Corporate Roundtable please contact Maureen Simmons, MA, CFRE, Chief Development Officer at email@example.com.
9. FROM THE USPSTF: BEHAVIORAL AND PHARMA INTERVENTIONS FOR TOBACCO SMOKING CESSATION
The U.S. Preventive Service Task Force (USPSTF) has released final recommendations, with high levels of certainty for net benefit, for behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women. For non-pregnant adults, the USPSTF issued an "A” recommendation noting that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and pharmacotherapy approved by U.S. Food and Drug Administration (FDA) for cessation.
Likewise, for pregnant women, the USPSTF issued an "A” recommendation urging that clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation. The USPSTF issued an "I” recommendation for pharmacotherapy interventions for tobacco cessation in pregnant women noting that the current evidence is insufficient to assess the balance of benefits and harms.
Finally, the USPSTF issued an "I” recommendation for use of electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women, concluding that the current evidence is insufficient to assess the balance of risk and harms. The USPSTF recommends that clinicians direct patients who smoke tobacco to other cessation interventions with established effectiveness and safety protocols.
The U.S. Food and Drug Administration (FDA) has issued adraft guidance documentto help companies comply with the menu labeling final rule by December 1, 2016. According to the Center for Science in the Public Interest, "FDA guidance documents do not establish legally enforceable responsibilities, but rather describe the agency's current thinking on a topic and are recommendations unless specific regulatory or statutory requirements are cited. Comments should focus on how the FDA interpreted the final rule, as the guidance cannot be used to change the regulations."The deadline for comments is November 2nd.
The U.S. Food and Drug Administration (FDA) has issued orders to stop the further sale and distribution of four currently marketed R.J. Reynolds Tobacco Company cigarette products, including Camel Crush Bold, Pall Mall Deep Set Recessed Filter, Pall Mall Deep Set Recessed Filter Menthol, and Vantage Tech 13 cigarettes. The agency concluded that these products have different characteristics than the predicate products and that the manufacturer failed to show that the new products did not raise different questions of public health when compared, therefore not meeting requirements set forth in the Federal Food, Drug, and Cosmetic Act (FD&C Act).
The scientific basis for these four decisions included yields of harmful or potentially harmful constituents, higher levels of menthol, and/or the addition of new ingredients in the currently marketed products when compared to the predicate products.
12. LIFESTYLE-FOCUSED TEXT MESSAGING CAN REDUCE RISK
Semi-personalized text messages supporting lifestyle changes led to improvement in low-density lipoprotein cholesterol (LDL-C) levels, blood pressure, body mass index and smoking status in patients with coronary heart disease, according to a recent study published in The Journal of the American Medical Association. Since cardiovascular disease is the leading cause of death and disease globally, researchers are looking at novel, low-cost, evidence-based interventions as one possible solution.
The researchers randomly assigned patients with coronary heart disease into a control group where they received usual care and an intervention group where they received four text messages per week for six months, in addition to the usual care. After six months, levels of LDL-C, body mass index and systolic blood pressure were lower in the intervention group as opposed to the control group. There was also a lower percentage of smokers and a report of increase in physical activity in the intervention group at the end of six months. The majority of the participants reported that the text messages were useful, easy to understand and appropriate in frequency. The authors of the study added that further studies are needed to determine how long the results last and whether they result in improved clinical outcomes.
A report released by the National Academy of Medicine (formerly the Institute of Medicine), Improving Diagnosis in Health Care, reveals that most patients will experience at least one diagnostic error in their lifetime, whether an incorrect diagnosis or a diagnosis that is delayed. These errors contribute to approximately 10% of patient deaths and between 6% and 17% of hospital adverse events. The report highlights the prevalence of diagnostic errors and outlines how health care stakeholders can identify, resolve and reduce the incidence of diagnostic errors to improve patient safety.
Diagnostic errors are also the largest category of paid medical malpractice claims and are almost twice as likely to have resulted in a patient death compared with other claims. The report identifies eight recommendations to improve diagnosis, including how patients and health professionals can better communicate, as well as how diagnostic errors can serve as the catalyst for delivering safer care.
Electronic Health Records (EHRs) are transforming the practice of clinical medicine, but so far it is uncertain how well they are used to advanced public health goals, according to a review recently published in Population Health Management. Only a few population health surveillance systems have shown innovation in effective use of EHRs. The common challenges include incomplete coverage of a population, variable data quality, and lack of interoperability across data systems.
The review identifies opportunities and challenges of using EHR data for population health surveillance. As efforts increase to integrate data across healthcare delivery systems, large networks of patient information are increasingly made available.
Data retrieved from EHRs has the potential for real-time determination of the health status of a population, to target interventions to vulnerable populations, and to evaluate such interventions over a period of time. Public health interventions using EHRs can be particularly useful at the population level for monitoring risk factors and other indicators associated with managing chronic diseases.
A study by the University of Minnesota School of Public Health found that incentive-based employer wellness programs were effective in promoting fitness center attendance, but that their impact began to diminish after the first year.
On January 1, 2008, the university launched the incentive-based Fitness Rewards Program (FRP) to promote regular exercise among both employees and adult dependents covered by its health insurance plan. The FRP offered a monthly financial reward of $20 per adult member for utilizing a fitness center at least eight times per month. The study analyzed data from Minnesota employees from 2008-2010.
Results showed that among eligible employees, 42% initiated program participation and 24% earned the financial reward at least once between 2008 and 2010. On average, FRP participants utilized a fitness center for 7.0 months each year and earned the financial reward 4.5 months during the year. However, months of fitness center utilization and months of earning the financial reward dropped, on average, for participants in their second and third years of the program.
16. GLOBAL HEALTH & INNOVATION CONFERENCE
Yale University is hosting the Global Health & Innovation Conference on April 16-17, 2016. The world's leading and largest global health conference as well as the largest social entrepreneurship conference attracts 2,200 professionals and students from all fifty states and more than fifty-five countries. This thought-leading conference convenes leaders, change makers, professionals and students from all sectors of global health, international development, and social entrepreneurship. Register here.
Humana Physician Rotational Program
The Humana Physician Rotational Program, working within the Office of the Chief Medical Officer, is an exciting job opportunity for current and/or former residents. It is a program designed to help train the next generation of physician leaders.
Program highlights include:
Jackson Health Network Medical Director, Population Value/Public Health
This is a great opportunity to be part of healthcare transformation efforts in a leading-edge organization focused on building community-integrated health systems in a local setting. This position incorporates public health functions, community-based health improvement, and clinical integration/accountable care in a unique leadership opportunity.
The position reports to the Executive Director of Population Management and is responsible for providing strategic leadership to ensure successful ongoing alignment of community-based activities of Health Improvement Organization, clinical performance activities of Jackson Health Network, and functions within Allegiance Health (AH) related to value-based population health models. Responsible for facilitating integration between activities of key business units and community partners to support transformation to community-integrated health systems. Serves as part-time Medical Director of the Jackson County Health Department under the leadership of the Health Officer of AH/JCHD.
Coming soon! The Practical Playbook has updated and compiled the best of its online resources into a textbook. The Practical Playbook: Public Health and Primary Care Together is a roadmap for collaboration between primary care providers, public health professionals, and more. The textbook explores the steps public health and primary care professionals can take to improve population health in case studies, practical recommendations, data resources, and commentaries from national leaders in practice and academia. ACPM Fellow and Past President, Hugh Tilson, MD, DrPH, contributed to the update. (Available on Amazon)