Imagine if you rounded up every man, woman and child in Sacramento, Calif., and evacuated the city. California's state capital, the sixth-largest city in the state and 35th-largest in the country, would have none of the nearly 500,000 people who live in an area covering more than 100 square miles.
From left to right, AAFP Board Chair Robert Wergin, M.D.; President-elect John Meigs, M.D.; and President Wanda Filer, M.D., M.B.A., field questions from an audience of enthusiastic family physicians during a Sept. 18 town hall meeting that preceded the opening of the 2016 Congress of Delegates in Orlando, Fla.
That's the scope of the gaping hole drug overdoses have left on the United States. Since 1999, the number of prescriptions written for opioids has quadrupled, and the number of overdose deaths related to those drugs has nearly kept pace. According to the CDC, almost half a million Americans died from drug overdoses from 2000 to 2014,(www.cdc.gov) and more than 60 percent of those deaths involved opioids.
AAFP officers and members had an impassioned discussion about the crisis Sept. 18 during a town hall meeting before the Congress of Delegates.
Academy President Wanda Filer, M.D., M.B.A., of York, Pa., who will transition to Board chair Sept. 21, said talking about the opioid crisis was "the biggest part of my year" as president. That included three meetings with the surgeon general and numerous media interviews about the issue.
- During a town hall meeting before the 2016 Congress of Delegates, AAFP officers and members spoke about the opioid crisis, the Medicare Access and CHIP Reauthorization Act, physician burnout and the Health is Primary campaign.
- Academy President Wanda Filer, M.D., M.B.A., said talking about the opioid crisis had been the biggest part of her year as president.
- Board Chair Robert Wergin, M.D., said the AAFP is developing resources to help members tackle physician burnout.
There are a lot of misconceptions, she said, about who is to blame for this national problem.
"There was a big push to say, 'It's family medicine,'" said Filer. "I didn't take that well. I told people about the fifth vital sign. There's lots of blame to go around."
David Hoelting, M.D., of Pender, Neb., placed the blame squarely on those who had profited from the surge in prescriptions that followed the introduction of the concept of pain as the fifth vital sign -- an indicator that, today, is increasingly used when evaluating physician performance.
"We have a situation right now with thousands of people addicted and thousands of people dying," he said. "Pharma needs to step up and say, 'OK, we made a mistake and we need to fix it.'"
AAFP President-elect John Meigs, M.D., of Brent, Ala., said it wasn't surprising that some tried to pin the blame on family medicine, because family physicians account for one in five U.S. office visits and provide comprehensive care to a wide range of patients.
"We're part of the problem," he said. "It's essential that we be part of solution."
David Hoelting, M.D., of Pender, Neb., says during a town hall meeting Sept. 18 in Orlando, Fla., that the pharmaceutical industry should be held accountable for its role in the nation's opioid crisis.
However, Meigs said no simple legislative mandate will solve it, so the Academy continues to oppose prescribing restrictions based on specialty, as well as mandated CME. He also noted that AAFP members have reported roughly 140,000 hours of pain-related CME in recent years.
The AAFP has taken several steps to address the opioid issue, including the creation of a member advisory committee, a toolkit, a call to action and support for the Surgeon General's Turn the Tide Rx initiative.
Although opioids have been a front-and-center issue this year, Lee Carter, M.D., of Huntingdon, Tenn., said the drug problem facing the country was broader than opioids and suggested that the Academy was focused on a "few trees of the forest."
"People are hurting and looking for something," Carter said. "If they don't have opioids, they'll use something else. We need to treat addiction."
Finally, Tricia Elliot, M.D., of League City, Texas, said integrating mental health services in primary care leads to better health outcomes, including treating addiction.
AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., said that addressing physician burnout is one the AAFP's strategic priorities, and the Academy is developing resources to help members tackle this issue.
Sterling Ransone, M.D., of Deltaville, Va., said the lack of interoperability and other flaws associated with electronic health records (EHRs) are key drivers of burnout. Ransone said physicians were promised that EHRs would provide greater efficiency and improved care, but vendors have failed to deliver.
Tricia Elliot, M.D., of League City, Texas, says during a town hall meeting that integrating mental health in primary care improves health outcomes.
Wergin said representatives of the Office of the National Coordinator for Health Information Technology have asked the Academy for feedback about interoperability. His answer: "'Make a rule,'" he said. "'You're the government.' Why don't they penalize vendors?"
Filer said the Academy has invested thousands of hours working on the Medicare Access and CHIP Reauthorization Act (MACRA). The final rule is expected from CMS by November.
Filer said the 960-page law is "complicated and convoluted," and the Academy has offered CMS some "tough language" about its concerns. That includes the 100-plus page letter Wergin sent the agency in June.
Filer encouraged family physicians to read a recent blog post by CMS Acting Administrator Andy Slavitt(blog.cms.gov) outlines four options for participating in the Quality Payment Program, which begins Jan. 1. The bottom line, she said, is that physicians should at least participate in one of the two lower levels of the flexible plan to avoid financial penalties.
"Things will be changing rapidly," she said.
Health is Primary
It has been nearly two years since the AAFP and seven sister family medicine organizations formed Family Medicine for America's Health(fmahealth.org) and announced a five-year strategic plan that included a focus on practice transformation, payment reform and achieving workforce goals.
AAFP EVP and CEO Doug Henley, M.D., said the initiative's communications campaign -- Health Is Primary(www.healthisprimary.org) -- has been tremendously successful. A recent survey showed that one in three Americans has heard of the campaign, which has garnered 1.4 billion media impressions.
With a new Congress and a new administration coming to Washington soon, Henley said the Health is Primary campaign likely will pivot more of its attention to policymakers in the coming year.
The Congress of Delegates begins today. Watch for full coverage of the proceedings in AAFP News.
2016 Congress of Delegates: Day One(storify.com)