Health Policy Report: Medical Policy-Making 2012
The 2012 SFMS delegation to the California Medical Association’s (CMA) annual House of Delegates meeting took a wide range of proposed resolutions for consideration by the statewide gathering. We had resolutions before each of the hearing reference committees (and some members on the actual committees—Lawrence Cheung chaired one, and Keith Loring and Roger Eng were members of others). Each resolution, some with modification, moved important health care issues forward in the areas of health care delivery, health care mandates, and pharmaceutical industry issues, including medication disposal and insurance coverage. Our roster of policy proposals this year, with outcomes, included:
Tracking Prescriptions to Curtail Medication Abuse (Rokeach, Loring, Turner): CMA supports the development of a fully functional, Web-based prescription drug monitoring program (PDMP), whether it be an improved CURES (Controlled Substances Review and Evaluation System) program or a new one that should be fully funded, including through a fee-per-prescription paid by manufacturers and suppliers of drugs monitored.
Reducing Overutilization: Physician Leadership (Denys, Fung, Eng): CMA supports physician-led, evidence-based efforts to improve appropriate use of medical services and will educate physicians, hospitals, health care leaders, and patients about the need for physician-led, evidence-based efforts to improve appropriate use of medical services. This resolution originally referred to the “Choosing Wisely” effort that will be the topic of the January/February 2013 edition of San Francisco Medicine.
"Pay for Delay" Practices on Generic Medications (Susens): CMA will ask AMA to support federal legislation that makes tactics delaying conversion of medications to generic status, also known as “pay for delay,” illegal in the United States. As noted in a recent NEJM piece, that might already be the case!
Increasing Utilization of POLST Orders (Newman, Schickedanz, Lopato): CMA encourages physicians to become educated about all aspects of the POLST form and to integrate discussions about, and use, POLST in all appropriate instances where medical services are provided to patients at the end of life. Surprisingly to many, this was perhaps the most hotly debated resolution of the year, as our original allowed for nurse practitioners to fill out POLST forms for physician confirmation, as is done in some other states.
Medical Mandates for Insurance Coverage and Medi-Cal (Chan): CMA supports the principle that mandated coverage for private insurers should also apply to publicly financed entities, when appropriate; and will advocate that the state legislature must budget for the increased cost to Medi-Cal and enrollees of the California Health Benefit Exchange when passing mandated coverage.
Public Policy Positions and CMA Affiliation (Maa, Udovic-Constant, Fung, Fouras, Curran): Following some confusion and consternation related to the California tobacco tax proposition last year, CMA bylaws or other appropriate rules would be amended to require an individual member of a county medical association/CMA who takes a visible public position on any proposed legislation, proposition, or other public policy and who lists any affiliation with organized medicine to publicly disclose the fact that his or her opinion is not in agreement with the formal position taken by the association, if this is in fact the case.
Advance Directives for Medicare Patients (Follansbee, Leung, Andereck): CMA urges the Centers for Medicare and Medicaid Services (CMS) to explore options for encouraging every beneficiary to complete an advance directive, and CMA/AMA and CMS will develop benchmark goals for percent of enrollees completing an advance directive, and make the results publicly available.
Promoting Quality and Transparency in Graduate Medical Education (Schickedanz): CMA supports efforts to urgently address the anticipated imbalance between the number of medical school graduates and available residency training positions; and greater transparency at all levels in the calculation, distribution, and tracking of graduate medical education (GME) funding; and will petition the Centers for Medicare and Medicaid Services to address perceived disparities in the distribution of GME funding.
Medication Take-Back Programs (Follansbee, Turner): CMA now supports medication collection or “take-back” programs, funded in whole or in part by the pharmaceutical industry, that help keep unused medications out of the environment and out of the hands of potential overdose victims or drug abusers.
Cell Phone Use in Cars (Udovic-Constant, Fouras): CMA will support public education efforts regarding the dangers of distracted driving, particularly activities that take drivers’ eyes off the road, and will ask the AMA to do likewise. Our original was more forceful, asking for more severe penalties and even bans.
There was much more, with something of interest to every specialty, practice setting, and personality.