The Senate Health, Education, Labor and Pensions (HELP) Committee Jan. 29 held a hearing titled, “Access to Care: Health Centers and Providers in Underserved Communities.” The hearing focused on the Sept. 30 expiration of mandatory funding for Community Health Centers (CHC), Teaching Health Centers (THC), National Health Service Corps (NHSC) and Indian Education programs, commonly referred to as the “primary care cliff.”

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The AMA has offered its support for S. 192 (PDF), the “Community and Public Health Programs Extension Act of 2019,” which provides five years of mandatory funding for the NHSC, the Teaching Health Center Graduate Medical Education (THCGME) program, the CHC and Indian Education programs.

The NHSC program provides funding for health workforce activities that offers scholarships and loan repayment to clinicians in exchange for their service in health professional shortage areas (HPSA). The THCGME program has helped increase the number of primary care medical and dental residents training in rural and underserved communities by providing graduate medical education funding specifically for training in outpatient health centers. Additionally, CHCs provide invaluable primary care services, largely in areas considered medically underserved.

With regards to GME positions, the Balanced Budget Act of 1997 imposed restrictions on Medicare funding for fellows and residents at existing and future residency training sites. Once established, new programs are subject to a cap-setting process to determine institutional limits on the per-resident funding amount, as well as the total number of positions funded.

The AMA also recently offered support for S. 348 (PDF), the “Resident Physician Shortage Reduction Act of 2019,” which seeks to address the growing physician shortage and strengthen the nation’s health care system by providing 15,000 additional Medicare-supported GME positions over five years.

In addition, the AMA has offered its support for H.R. 1358 (PDF), the “Advancing Medical Resident Training in Community Hospitals Act of 2019,” which would close a loophole in GME cap-setting criteria affecting hospitals who host small numbers of residents for temporary training assignments, also known as “resident rotators.”

Three authors of the Centers for Disease Control and Prevention’s (CDC) controversial 2016 guideline on opioid prescribing now say their advice has been misused in ways that can harm patients.

These misapplications “include inflexible application of recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages, resulting in sudden opioid discontinuation or dismissal of patients from a physician’s practice,” wrote the CDC’s Deborah Dowell, MD, MPH, Tamara Haegerich, PhD, and Roger Chou, MD, in a New England Journal of Medicine essay, “No Shortcuts to Safer Opioid Prescribing.”

Patrice A. Harris, MD, MA, President-elect of the AMA and chair of the AMA Opioid Task Force, noted in response that the CDC guideline recommendations have been “wrongly treated as hard-and-fast rules, leaving physicians unable to offer the best care for their patients.”

The guideline authors’ essay “underscores that patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than the guidelines or thresholds” outlined by government agencies, payers, pharmacy chains, pharmacy benefit managers (PBM) or other bodies, she added.

The misapplication of the CDC guideline has been so broad, said Dr. Harris, “that it will be hard to undo the damage.” She said the AMA is calling for a “detailed regulatory review of formulary and benefit design by payers and PBMs to ensure that patients have affordable, timely access to medically appropriate treatment, pharmacologic and nonpharmacologic.”

The AMA also will work with the CDC to help ensure that patients get “multidisciplinary, multimodal pain care based on medical science and effective clinical practice,” Dr. Harris said. The U.S. Agency for Healthcare Research and Quality, with CDC funding, is conducting systematic reviews to gauge the effectiveness of various treatments for acute and chronic pain.

The deadline for comments on the Office of the National Coordinator for Health IT’s (ONC) proposed rule, along with the CMS proposed rule, has been extended by 30 days. Comments are now due June 3. The AMA sent a letter to CMS and ONC (PDF) cautioning the agencies from moving too quickly with rulemaking. Those concerns were echoed by many other organizations (PDF). The proposals will have major impacts on interoperability and how data is exchanged between patients, health providers, payers, technology developers and other health care stakeholders. However, such rapid change in health care policy, technology and business practices may lead to unintended consequences for patient privacy and physician burden. To ensure that the rules are as successful as possible in meeting the administration’s goals, it is vital that stakeholders are given adequate time to provide comprehensive, thoughtful and detailed comments. AMA will share draft comments with the Federation ahead of the deadline.

ONC has also released for public comment draft two of the Trusted Exchange Framework and Common Agreement (TEFCA) to support network-to-network exchange of health information nationally. TEFCA outlines a common set of principles, terms and conditions to support the development of a common agreement to help enable nationwide exchange of electronic health information across disparate health information networks. The AMA provided comments on draft one of the TEFCA (PDF). The AMA is reviewing draft two and will be providing additional comments by the deadline on June 17.

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