November 16, 2017
Welcome back, readers! It’s been another exciting few weeks in Congress, and I’m excited to share the news from some of the events I attended recently. This week, I’ll give you brief updates on the opioid crisis and veterans’ health. Since we have a lot to talk about, let’s dive right in!
Update on the Opioid Crisis
On November 1st, the President’s Commission on Combating Drug Abuse and the Opioid Crisis released their final recommendations. The report expands upon the interim recommendations released by the Commission this past July, on which AACOM submitted comments. In these comments, AACOM highlighted efforts by the nation’s osteopathic medical schools and osteopathic medical education community to combat the opioid epidemic and the issue of substance abuse across the country.
The final report starts with an in-depth look at the historical factors contributing to the development of the crisis. Did you know there was a smaller-scale opioid crisis about 100 years ago? I didn’t before reading this report. After reviewing the root causes of the current epidemic, the Commission offered 56 specific recommendations to the Administration, Congress, and relevant federal agencies regarding programs to expand, research to invest in, and legislative priorities to support. Some interesting points to note are:
- The Commission placed significant emphasis on improving patient education about painkillers. This was discussed from multiple angles. On one front, the Commission highlighted the need for patients receiving pain treatment to have a better understanding of their options, including alternatives to medication and awareness of the addictive potential of opioids. The Commission also expressed strong support for educational advertising campaigns to increase awareness of the dangers of addiction and diversion (when patients move from licit to illicit opioids), similar to the tobacco intervention not too long ago. Their concern centered largely around teens and young adults, but the Commission still recommended that marketing strategies be targeted to broad audiences.
- Expanding access to treatment was identified as a critical component for reversing the opioid epidemic. The Commission noted that changes in access could come in all different forms. Some examples they listed include increased telemedicine capabilities to reach rural populations, improved treatment strategies for inmates during and after incarceration to protect them from relapse and overdose when they are most vulnerable, and expanded mental health treatment opportunities for patients with both a substance use disorder and other mental health disease.
- The Commission repeatedly emphasized the need to view opioid and other substance use disorders as a disease rather than a crime. They stressed that patients with substance use disorders should not be treated through the law, and advocated expansion of drug courts to keep people struggling with addiction out of criminal courts. In this light, the report was highly focused on expanding mental health treatment and reducing the stigma of addiction.
The report is very comprehensive and offers much more than I’ve covered above, including appendices detailing the current programs in place to combat the opioid epidemic. I’m excited to see how this report shapes the future response to the opioid crisis, and I hope that someday we can look back to this point as a milestone in turning the tide on the opioid epidemic!
Veterans’ Health
Last week, I had the opportunity to attend a two-day meeting of the Veterans’ Rural Health Advisory Council (VRHAC). As a future physician, I was interested in their strategies for recruiting new health care providers to the U.S. Department of Veterans Affairs’ (VA) Veterans Health Administration hospitals; as the sister of a Marine and significant other of an Airman, I was interested in their mission to expand access to care to all veterans, regardless of location.
The Council’s meeting was specifically focused on workforce issues, as many veterans living in rural areas suffer from lack of access to care. The VRHAC spent most of the two-day meeting brainstorming ways to improve rural veterans’ health care access by expanding their health care workforce in both numbers and geographic location. The chairman of the Council announced on the first day of the meeting that the Secretary of the VA specifically asked for bold ideas for improvement from this advisory council, and encouraged committee members to dream big when making their recommendations. The Council members—most of whom were veterans themselves—passionately rose to this challenge. It was inspiring to witness and encouraging to note that this Council was ready to fight for the care of their rural veterans.
From a workforce perspective, the Council faced a two-pronged problem: how to recruit health care professionals to the VA in general, and how to recruit them to VA medical facilities in rural locations in particular. The Council acknowledged that salaries were generally lower through the VA than private hospital systems, so they worked to find ways to highlight the other benefits of the VA instead. Some of the unique aspects of VA employment to which they hoped to call attention included the excellent benefits given to workers and their families, the ability to use a widely integrated electronic records system that followed veterans over a lifetime to any VA facility, and the chance to work with cutting edge technologies in areas such as telemedicine. They also wanted to find a way to share the intangible benefits that VA service could provide—namely, the chance to work with a wonderful patient population and provide service to those who have served the country. They felt that these benefits would be better appreciated with actual experience in a VA during medical school, and sought to increase student and resident exposure to VA systems during their medical education. They also thought it would be helpful to create a database of information about medical students who did a rotation at the VA so that they could more easily follow up with them after graduation, once they were looking for employment.
Recruiting professionals to a rural location posed some unique challenges. Representatives from VA health professions recruitment programs noted that providers who leave rural sites often cite social isolation and lack of opportunities for their spouse and/or children as major reasons for moving to a more urban site. Rather than try to change these fundamental characteristics of rural living, the Council discussed at length how to better recruit health professionals from small or rural towns, with the thought that these future providers would then return to an area similar to their hometown to provide service. The Council worked to incorporate this idea of early rural recruitment into their final recommendations to provide to the Secretary of the VA.
I rotated through the VA in Leavenworth, Kansas, while completing my internal medicine rotation in my third year, so it was interesting to hear the Council’s discussions while picturing that small hospital in my mind’s eye. From my own personal experiences, I thought that they were right to highlight intangible benefits such as the great patient population, and were spot-on when identifying challenges specific to rural locations. Attracting medical professionals to rural areas is not a goal unique to the VA, so I’m sure that their recommendations and the successes that result from them will be of great interest to other health care organizations in the future!
That’s All, Folks
That wraps up another OHPI blog! As always, thank you for your readership. You can always reach out to me if you’re interested in the events I attended or reports I discussed, because there are way more details to these issues than what I have time to include here! I’ll be back in two weeks for my fourth (and final!) OHPI blog, so stay tuned for one more edition.
October 27, 2017
Wow! Somehow my time as an Osteopathic Health Policy Intern (OHPI) is already halfway over. I guess time flies when you’re having fun! These past two weeks continued to be packed with interesting meetings and daily excitement from the Hill as the battle to reform health care continues. Let me give you the important updates.
The Opioid Crisis
Yesterday, President Trump officially declared the opioid crisis a national public health emergency. This designation is important because it opens new avenues for funding and legislation that will hopefully expedite efforts to combat the substance use disorder epidemic. The full impact of this announcement is not yet apparent, so for this post I’m going to focus instead on what has evolved over the last few weeks.
First and foremost: You can play a role in helping curb the opioid epidemic. October 28th (this Saturday!) is National Take Back Day, where any and all unused medications can be returned to a pharmacy, no questions asked, and will be disposed of properly there. Find a participating pharmacy or learn more about National Take Back Day.
Many of you probably watched the recent 60 Minutes episode that focused on the far-reaching effects the opioid crisis has had across America. Early last week, I had the opportunity to attend a meeting hosted by the Washington Post (who co-produced the episode and did much of the investigative journalism behind the scenes), which focused on how people across private organizations, government bodies, and local initiatives have collaborated to address the opioid crisis. Representatives from health care and government organizations shared their thoughts on what progress has been made and what needs to be done in the future.
The meeting was specifically influenced by the recent 60 Minutes episode, and much of the questioning focused on the fallout caused by a bill enacted in April 2016 called the Ensuring Patient Access and Effective Drug Enforcement Act. This bill, reporters argued, makes it much harder for the Drug Enforcement Administration to effectively prevent opioid trafficking. After learning more about its impact, all three Senators present at the meeting expressed support for the repeal of the legislation.
The meeting also featured testimonials from a family that was affected by the crisis and an interview with the CEO of Leidos that centered around how large companies can play a role in helping their employees deal with this epidemic. Both the CEO and the family agreed that, from a private sector perspective, it seemed like the main reason this epidemic was still raging across the country was because everyone thought of it as “someone else’s problem.” One mother who spoke about her son’s battle with addiction said her family never knew how to handle what he was going through because problems like addiction “just didn’t affect families like ours.”
Leidos’ CEO pointed out that management tends to take the same view regarding their workers, which was true in his case until a few of his company’s employees were forthcoming enough to ask for help. Many more employees then came forward and discussed how they or a close friend or relative were affected by the epidemic, and sought help through their workplace. He said that employees spend the majority of their lives at work, so by extension, workplaces could be considered a viable place for employees to find health care resources. He called on CEOs of all companies to help de-stigmatize this epidemic by making prevention and addiction treatment resources easily available to their employees.
I also had the privilege of observing the fourth meeting of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by Governor Chris Christie. The meeting focused on insurance companies and their role in combating the opioid epidemic. Each company gave testimony about what they were doing to mitigate opioid use and abuse and offered their recommendations about legislative and regulatory changes that would make it easier for them to partner with providers and patients. One challenge that all insurers highlighted was the difficulty they had in obtaining information about prescribing or use habits that would help them identify patients at increased risk for addiction earlier on. Many also noted the difficulty in transferring prescription drug monitoring program information across state lines.
Governor Christie acknowledged the work each company had done so far, but stated that the Commission’s report was going to call on each of them to do much more in the future. The Commission members were particularly interested in insurer coverage of mental health services and alternative treatments for pain, and they implored the insurers to play a bigger role in creating access to preventive and treatment services for patients struggling with addiction.
The Commission is set to release its final report on November 1st, so I’ll give you many more updates in the next blog!
Loan Repayment Programs
Each AACOM OHPI has the opportunity to work on a policy project during our time in DC. My interest centers around why medical students choose to enter primary care (or, more importantly, why they don’t) and, on a related theme, how to reduce health care disparities by improving specialty and geographic distribution of providers. While there are a whole host of factors that play into these decisions, one major reason that young doctors eschew primary care in favor of specialty medicine is money.
This may sound greedy or self-serving, but the reality is that the average osteopathic medical student graduates with nearly $250,000 in debt, and many have debt loads that are even higher. To put it in perspective, that’s a decent-sized house in the suburban Midwest, or about seven brand new Jeep Wranglers (my favorite car). Those in primary care specialties have a lower average earning potential, therefore asking someone shouldering a small house’s worth of debt to forego half a million dollars per year in salary can be challenging.
I want to pause here and offer the caveat that, in my opinion, most medical students don’t enter medicine for the money. Most students choose their specialty based solely on interest and love of the patient population. However, there is a significant segment of the student population that is torn between equal love for multiple specialties and, when it comes down to it, end up choosing the field that will provide best for them and their family. The question I’m working to answer is: how do we get these “swing voters” to decide on a primary care field?
One answer is loan repayment programs that help reduce debt burdens on young doctors. There are many federal programs available that offer loan relief in exchange for service in a particular region, often a medically underserved area. The programs are generally available only to students who plan to practice in a primary care field. Medical students can take advantage of loan repayment programs available through the National Health Service Corps, Indian Health Service, and National Institutes of Health, to name a few.
Last week, I had the chance to participate in a webinar put on by AACOM Government Relations staff around its grassroots campaign, ED to MED, which works to highlight graduate and medical student debt issues and advocates for policies that support these students. One program we discussed, in particular, was the Public Service Loan Forgiveness Program, or PSLF. The PSLF Program allows young professionals to make income-based payments on their loan balance for 10 years if they work for a non-profit or a government entity, after which the remainder of their loan balance is forgiven. The program is not only for doctors--it’s open to students from many service-oriented fields including teachers, social workers, nurses, and more.
Many federal agencies, such as the U.S. Department of Health and Human Services and the Health Resources and Services Administration, have stated their vested interest in programs that develop the primary care workforce. However, as you might imagine, programs like these are prone to being cut from the budget because of their associated costs and the nebulous, long-term nature of their benefits. Grassroots campaigns like ED to MED are crucial for protecting programs like the PSLF so that future students can make decisions about their career based on personal interests and workforce needs, rather than being directed by their loan burden. If you’re interested in ED to MED, you should read more about the campaign here: www.edtomed.com.
We’ll Wrap It Up Here
I could talk much, much more about the primary care workforce, loan forgiveness, and the opioid crisis, but I’ll save some topics for next time! I’ve enjoyed sharing my DC experience with all of you readers so far, and I hope you’re finding this information helpful.
Thanks for reading, and as always, stay healthy my friends!
October 20, 2017
A Little Introduction
Hi readers! My name is Katie Kaeppler and I’m a 4th year medical student from Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM). Most importantly, I have the awesome privilege of being the new Osteopathic Health Policy Intern (OHPI) here at AACOM for the next two months! My medical passion lies in pediatrics (which you probably could tell by the excessive use of exclamation points), a field that lends itself well to policy work because the health of children is so heavily dependent on their environment.
My advocacy interests originated while doing volunteer work in Kenya, when I met a little girl who came to the clinic to receive surgery for correction of club feet. Her parents told me they knew of another family with a little boy who suffered from the same condition, but he would never receive treatment because his family couldn’t afford the journey to the clinic. I was frustrated to know that the little boy’s bright future was going to be ruined by a simple lack of access. That experience made me realize that medical care was about so much more than medicine itself, and marked the beginning of my interest in effecting change at a higher level.
My interest continued to develop through my work in management for an Electronic Medical Records company before starting medical school, where I realized it was important for physicians to know how to stand up not only for their patients, but also for themselves. Once I reached medical school, l learned a lot about policy and management through KCU’s DO/MBA dual-degree program, but I knew that an on-the-ground experience would be the best way to turn my background learning into real-life lessons I could use in my future career.
I’m excited to arrive in D.C. at a time when there are so many important health care issues being discussed, and I can’t wait to share some of my experiences as an OHPI through this blog! But that’s enough about me. Let me tell you about what I’ve seen so far.
The Opioid Crisis
On the third day of my internship, I attended the Senate Health, Education, Labor, and Pensions Committee’s hearing on the federal response to the ongoing opioid crisis. This hearing was the first in a series of hearings designed to give the Senate greater insight into what has been done to combat the opioid crisis so far, what has been working, and what still needs improvement.
Expert witnesses gave testimonies and answered individual Senators’ questions about their field of expertise. The expert panel consisted of representatives from the U.S. Food and Drug Administration, U.S. Health and Human Services, the National Institutes of Health, and the Centers for Disease Control and Prevention. These agencies have played major roles in the fight against the growing number of opioid addictions and overdose deaths, and highlighted some major points, including:
- The need to develop better non-opioid alternatives to treat pain, either through novel drugs that are non-addictive or work on non-opioid pain relief pathways, or non-medicinal options such as acupuncture, massage, or devices such as implantable neural stimulators.
- The need to address that, based on witness testimony, about 20% of people newly exposed to opioids for acute pain still use opioids a year later.
- The need to shift perception of addiction from a criminal act to an illness. Multiple Senators emphasized the need to remove the stigma of addiction and allow it to be treated as a true illness rather than a failure of character.
It was encouraging to hear the amount of passion each person expressed in combating this problem. Each of the Senators shared how the opioid crisis has affected their state, and there was a palpable sense of urgency in doing more and funneling funding towards the right places to attack this problem from all angles.
Graduate Medical Education (a.k.a. Residency!)
If any of you readers are fourth-year students like me, your brain is currently focused on one thing: residency. This past week I had the opportunity to attend a full-day conference that centered around improving graduate medical education, or GME. Attendees ranged from representatives of the American Council of Graduate Medical Education and the National Board of Medical Examiners to residents and program directors. The goal of the conference was to come up with reasonable, actionable recommendations for how to better evaluate the quality of current GME programs and, based on those recommendations, discuss future directions that programs should consider taking.
One of my main takeaways from this conference was the emphasis the entire group put on the need to measure outcomes rather than inputs. I know that sounds like typical diluted government-speak, but the translation is very important. Essentially, conference attendees realized that it was much more important to answer questions such as, “Do residents feel prepared for practice when they graduate?” or, “Do graduates of certain GME programs have better clinical outcomes than others?” than it was to use the current evaluation measures, which focus on hours spent doing certain activities or specific numbers of procedures completed. In short, many people realized that it was more important to look at how residents were doing than what residents were doing. This has important implications for residents and programs going forward, so I’ll keep you all updated on any changes that are made based on the recommendations that resulted from the conference.
Another GME-related topic that we’ve been keeping our eye on is the reauthorization of GME programs done through teaching health centers, or THCGME. These programs were designed to fill gaps in care in rural and underserved areas, as well as increase residency positions available to new graduates. Congress recently authorized a three-month funding extension for teaching health centers to keep the hospitals afloat. Without congressional action, the program would have expired on September 30th. The House of Representatives is now considering a bill that would extend THCGME funding through September 30, 2019.
Many hospitals have been forced to undergo layoffs or reductions in services due to the uncertainty of continued funding after the start of the new year. At a webinar I attended last Friday, the National Association for Community Health Centers shared data about how this unexpected “funding cliff” has affected their member hospitals. Many hospitals have been forced to undergo layoffs or reductions in services due to the uncertainty of continued funding after the start of the new year. However, the group shared encouraging news as well. They applauded the many physicians, nurses, and other hospital staff who contacted their legislators about this issue, and talked about the important new legislation that has been drafted in response to their hard work.
Two bills that would reauthorize funding for two more years for community health centers and many of the programs they support, including THCGME, are working their way through the House and the Senate with bipartisan support. I’ll keep you posted as these bills undergo many markups and changes in the next few weeks!
Some Parting Thoughts
These first few weeks have been a whirlwind, but they have been wonderful. In the hearings I’ve attended so far, I was surprised by how much Senators were impacted by personal stories. It reinforced to me the importance of contacting your legislators and sharing your own thoughts. Because of this experience, I plan to be much more active in advocacy going forward. I’m excited to see how future conversations on the opioid crisis and so many more issues go in the coming weeks.
Hopefully you’ve enjoyed this first post! If you have, look for another one in about two weeks. I’ll give you updates on the issues we already talked about, and the insider scoop on some new ones as well. Until then, stay healthy my friends!