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Physicians can now bill Medicare $86 for up to 30 minutes of counseling given to patients about end-of-life planning, but many doctors may need training to have those talks. (Phil Galewitz, 3/16)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Cakewalk'" by Rina Piccolo.
Here's today's health policy haiku:
CDC ISSUES NEW GUIDELINES ON PAIN PILL PRESCRIPTIONS
We are waking up
To dangers of opioids,
CDC head says.
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Summaries of the News
The recommendations are nonbinding, and initial versions have faced push back from critics who worry patients will not get the pain relief they need.
The New York Times: C.D.C. Painkiller Guidelines Aim To Reduce Addiction Risk
In an effort to curb what many consider the worst public health drug crisis in decades, the federal government on Tuesday published the first national standards for prescription painkillers, recommending that doctors try pain relievers like ibuprofen before prescribing the highly addictive pills, and that they give most patients only a few days’ supply. The release of the new guidelines by the Centers for Disease Control and Prevention ends months of arguments with pain doctors and drug industry groups, which had bitterly opposed the recommendations on the grounds that they would create unfair hurdles for patients who legitimately have long-term pain. (Tavernise, 3/15)
The Associated Press: CDC Guidelines Aim to Curb Painkiller Prescribing
Prescription painkillers should not be a first choice for treating common ailments like back pain and arthritis, according to new federal guidelines designed to reshape how doctors prescribe drugs like OxyContin and Vicodin. Amid an epidemic of addiction and abuse tied to these powerful opioids drugs, the Centers for Disease Control and Prevention is urging primary care doctors to try physical therapy, exercise and over-the-counter pain medications before turning to painkillers for chronic pain. Opioid drugs include medications like morphine and oxycodone as well as illegal narcotics like heroin. (3/15)
STAT: CDC Issues Sweeping New Guidelines To Restrict Opioid Prescribing
Many state lawmakers have responded to the crisis by introducing bills to restrict prescribing. And the Food and Drug Administration is pushing drug makers to develop more tamper-resistant products. But the CDC guidelines, while voluntary, arguably represent the most sweeping effort to address the problem. (Silverman, 3/15)
The Washington Post: CDC Warns Doctors About The Dangers Of Prescribing Opioid Painkillers
This first national guidance on the subject is nonbinding, and doctors cannot be punished for failing to comply. But the head of the Centers for Disease Control and Prevention, which issued the guidelines, said the effort was critical to bringing about “a culture shift for patients and doctors.” “We are waking up as a society to the fact that these are dangerous drugs,” Director Tom Frieden said in an interview. “Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risks involved.” (Demirjian and Bernstein, 3/15)
The Wall Street Journal: CDC Issues Guidelines To Limit Opioid Painkiller Prescriptions
The CDC also recommends limiting opioid prescriptions for patients suffering short-term, acute pain to three days or less in most conditions, and says that more than seven days’ worth of opioid drugs “will rarely be needed.” “If you’re prescribing an opiate to a patient for the first time, that’s a momentous decision,” CDC Director Tom Frieden said in an interview. “That may change that patient’s life for the worse forever. So you’ve really got to think carefully before doing it.” (McKay, 3/15)
The Milwaukee Journal-Sentinel: CDC Makes 'Urgent' Call To Rein In Opioid Prescriptions
"We know of no other medication routinely used for a nonfatal condition that kills so frequently," CDC Director Tom Frieden said. More than 40 Americans die each day from prescription opioid overdoses, he said. "We must act now," Frieden said. "Overprescribing opioid, largely for chronic pain, is a key driver of America's drug-overdose epidemic." (Fauber and Stephenson, 3/15)
Los Angeles Times: CDC Issues New Pain Pill Guidelines Amid Epidemic Of Overdose Deaths
Prescriptions and sales of opium-derived painkillers have quadrupled since 1999. In 2014, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to a record of roughly 19,000. (McCoppin, 3/15)
The Connecticut Mirror: Feds Release Opioid Prescription Guidelines
The 12 guidelines, which the CDC has worked on for two years, are voluntary and have been opposed by pharmaceutical companies and doctors who say they could interfere with the treatment of patients with chronic pain. (Radelat, 3/15)
Modern Healthcare: CDC Opioid Prescribing Guidelines Unlikely To Affect Physicians' Practices
In long-awaited final guidelines for prescribing opioid pain medications, federal health officials mostly kept in place recommendations that were criticized by some as restricting access to pain relieving drugs. And so the effort to change opioid prescribing practices among primary-care physicians, who prescribe nearly half of all opioid prescriptions, is likely to face challenges. (Ross Johnson, 3/15)
The Hill: CDC Urges Doctors To Curtail Opioid Use
The action from the CDC comes after years of study within the organization, and in the middle of a presidential race where opioid abuse has become a major issue. (Sullivan, 3/15)
Members of a congressional oversight committee blasted Susan Hedman's testimony. "You screwed up and you ruined people's lives," said Rep. Jason Chaffetz, R-Utah, chairman of the House Oversight and Government Reform Committee.
The New York Times: House Panel Denounces E.P.A. Actions In Flint Crisis
Members of a congressional oversight committee excoriated a former Environmental Protection Agency official on Tuesday for not responding more forcefully when she learned last year that Flint, Mich., was not adding a chemical to its new water supply that would have prevented the city’s pipes from corroding and leaching lead. The former official, Susan Hedman, testified that limited enforcement options had kept her from acting more aggressively to order corrosion control, saying, “I don’t think E.P.A. did anything wrong, but I do believe we could have done more.” But committee members from both parties reacted furiously to her explanation, casting Ms. Hedman, who resigned in January as director of the E.P.A. regional office in charge of Michigan, as one of the primary villains in Flint’s water crisis and heaping contempt on her for more than four hours. (Goodnough, 3/15)
The Washington Post: Ex-EPA Official Defends Agency’s Work In Flint Water Crisis At Capitol Hill Hearing
Marc Edwards, the Virginia Tech scientist who exposed the tainted water when government agencies failed to do so, called Hedman’s remarks “completely unacceptable and criminal.” Edwards, appearing on the panel with Hedman and two others, said the EPA official was was guilty of “willful blindness,” was “unremorseful” and was “completely unrepentant and unable to learn from [her] mistakes.” “I guess being a government agency means you never have to say you’re sorry,” Edwards said. (Bernstein, 3/15)
The Hill: Former EPA Official: Agency Did Nothing Wrong In Flint
[Hedman] took the brunt of complaints from lawmakers and local experts that the EPA did not do enough to prevent the water crisis in Flint despite the agency knowing of the risk. Records show the EPA knew in early 2015 that Flint’s water had dangerously high lead levels, but it did not take formal action, beyond pushing Michigan officials to address the matter, until January 2016. Hedman told lawmakers Tuesday that those allegations are “false.” She said the agency moved quickly to alert local officials about the corrosion problem before it developed into a crisis. Under state supervision, the city changed its water supply to the Flint River in 2014 as a cost-saving move. But the water wasn't properly treated to travel through lead pipes, and the toxic metal leached into the supply. (Henry, 3/15)
The Associated Press: Ex-Officials Point Fingers At Hearing On Flint Water Crisis
Hedman stepped down Feb. 1 over what she called "false allegations" that portrayed her as sitting on the sidelines during the crisis and that she "downplayed concerns raised by an EPA scientist about lead in the water." (Lardner and Daly, 3/16)
In other news on the water crisis —
Detroit Free Press: Flint Water Crisis Will Tax Schools, Raise Student Needs
Flint children impacted by lead exposure will need help for years to come — help that may tax a school district struggling financially and academically. Already, nearly 15% of the 5,400 kids in Flint Community Schools have been identified with special education needs. Of that number, 22% have been identified with a cognitive impairment — a percentage that's far higher than the county and state averages. (Higgins, 3/15)
NPR: Before Flint, Lead-Contaminated Water Plagued Schools Across U.S.
Across the country, it's hard to know whether there's lead in school water. [Researcher and activist Yanna Lambrinidou of Virginia Tech] says for the vast majority of schools, there is no requirement to test for lead. Even if a school finds lead, there's no mandate to fix it or tell parents. "What we see again and again is that the people who first discovered the contamination were parents whose children were diagnosed with elevated blood lead levels," Lambrinidou says. Three times over the past decade, she says, Congress has declined to pass legislation that would have required schools to test for lead and make the results public. (Ludden, 3/16)
Sen. Orrin Hatch, R-Utah, is launching a "fact-finding exercise" investigating the practice of a surgeon performing on more than one patient.
The Boston Globe: Overlapping Surgeries To Face US Senate Inquiry
The chairman of a powerful US Senate committee has asked 20 hospital systems, including the parent company of Massachusetts General Hospital, to provide detailed records about the controversial practice of allowing surgeons to operate on more than one patient at a time. (Saltzman and Abelson, 3/13)
The Cleveland Clinic: Cleveland Clinic Queried In U.S. Senate Review Of Concurrent Surgeries
The Cleveland Clinic is being queried about its use of concurrent surgeries – one surgeon operating on two patients simultaneously – as part of a U.S. Senate inquiry into the effectiveness and transparency of the practice nationally, a spokeswoman at the hospital confirmed. The U.S. Senate Finance Committee has asked the Clinic to provide detailed information on how many concurrent surgeries its physicians have performed during each of the last five years, as well as internal surveys on the safety and effectiveness of the practice. (Ross, 3
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