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Malnutrition Exacerbated Outcomes in Frail Elderly Patients Treated for PAD
Frailty increasingly has been seen as a factor in procedural outcomes, including vascular surgery. Nutrition factors among older adults have also become an issue of concern, and older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. In Friday’s Scientific Session 6, Laura Drudi, MD, of McGill University, Montreal, will report on a study that she and her colleagues performed to determine the association between preprocedural nutritional status and all-cause mortality in patients being treated for PAD.
Dr. Drudi will report on their post hoc analysis of the FRAILED (Frailty Assessment in Lower Extremity arterial Disease) prospective cohort, which comprised two centers recruiting patients during July 1, 2015–Oct.1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled.
Trained observers used the Mini Nutritional Assessment (MNA)–Short Form to assess the patients before their procedures. Scores less than or equal to 7 on a 14-point scale were considered malnourished, with scores of 8-11 indicated that patients were at risk for malnutrition.
The modified Essential Frailty Toolset (mEFT) was simultaneously used to measure frailty, with scores of 3 or less on a 5-point scale considered frail. The primary endpoint of the study was all-cause mortality at 12 months after the procedure. Dr. Drudi will report on the results of the cohort of 148 patients (39.2% women) with a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. Among these patients, 59 (40%) had claudication and 89 (60%) had chronic limb-threatening ischemia. A total of 98 (66%) patients underwent endovascular revascularization and 50 (34%) underwent open or hybrid revascularization.
Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12 months. Mini Nutritional Assessment–Short Form scores were modestly but significantly correlated with the mEFT scores (Pearson’s R = –0.48; P less than .001).
”We found that patients with malnourishment or at risk of malnourishment had a 2.5-fold higher crude 1-year mortality, compared with those with normal nutritional status,” said Dr. Drudi.
In the 41% of patients deemed frail, malnutrition was associated with all-cause mortality (adjusted odds ratio, 2.08 per point decrease in MNA scores); whereas in the nonfrail patients, MNA scores had little or no effect on mortality (adjusted OR, 1.05).
“Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals,” Dr. Drudi concluded.
Friday, June 21
1:30-3:00 p.m.
Gaylord National, Potomac A/B
S6: Scientific Session 6: RS16
Frailty increasingly has been seen as a factor in procedural outcomes, including vascular surgery. Nutrition factors among older adults have also become an issue of concern, and older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. In Friday’s Scientific Session 6, Laura Drudi, MD, of McGill University, Montreal, will report on a study that she and her colleagues performed to determine the association between preprocedural nutritional status and all-cause mortality in patients being treated for PAD.
Dr. Drudi will report on their post hoc analysis of the FRAILED (Frailty Assessment in Lower Extremity arterial Disease) prospective cohort, which comprised two centers recruiting patients during July 1, 2015–Oct.1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled.
Trained observers used the Mini Nutritional Assessment (MNA)–Short Form to assess the patients before their procedures. Scores less than or equal to 7 on a 14-point scale were considered malnourished, with scores of 8-11 indicated that patients were at risk for malnutrition.
The modified Essential Frailty Toolset (mEFT) was simultaneously used to measure frailty, with scores of 3 or less on a 5-point scale considered frail. The primary endpoint of the study was all-cause mortality at 12 months after the procedure. Dr. Drudi will report on the results of the cohort of 148 patients (39.2% women) with a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. Among these patients, 59 (40%) had claudication and 89 (60%) had chronic limb-threatening ischemia. A total of 98 (66%) patients underwent endovascular revascularization and 50 (34%) underwent open or hybrid revascularization.
Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12 months. Mini Nutritional Assessment–Short Form scores were modestly but significantly correlated with the mEFT scores (Pearson’s R = –0.48; P less than .001).
”We found that patients with malnourishment or at risk of malnourishment had a 2.5-fold higher crude 1-year mortality, compared with those with normal nutritional status,” said Dr. Drudi.
In the 41% of patients deemed frail, malnutrition was associated with all-cause mortality (adjusted odds ratio, 2.08 per point decrease in MNA scores); whereas in the nonfrail patients, MNA scores had little or no effect on mortality (adjusted OR, 1.05).
“Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals,” Dr. Drudi concluded.
Friday, June 21
1:30-3:00 p.m.
Gaylord National, Potomac A/B
S6: Scientific Session 6: RS16
Frailty increasingly has been seen as a factor in procedural outcomes, including vascular surgery. Nutrition factors among older adults have also become an issue of concern, and older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. In Friday’s Scientific Session 6, Laura Drudi, MD, of McGill University, Montreal, will report on a study that she and her colleagues performed to determine the association between preprocedural nutritional status and all-cause mortality in patients being treated for PAD.
Dr. Drudi will report on their post hoc analysis of the FRAILED (Frailty Assessment in Lower Extremity arterial Disease) prospective cohort, which comprised two centers recruiting patients during July 1, 2015–Oct.1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled.
Trained observers used the Mini Nutritional Assessment (MNA)–Short Form to assess the patients before their procedures. Scores less than or equal to 7 on a 14-point scale were considered malnourished, with scores of 8-11 indicated that patients were at risk for malnutrition.
The modified Essential Frailty Toolset (mEFT) was simultaneously used to measure frailty, with scores of 3 or less on a 5-point scale considered frail. The primary endpoint of the study was all-cause mortality at 12 months after the procedure. Dr. Drudi will report on the results of the cohort of 148 patients (39.2% women) with a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. Among these patients, 59 (40%) had claudication and 89 (60%) had chronic limb-threatening ischemia. A total of 98 (66%) patients underwent endovascular revascularization and 50 (34%) underwent open or hybrid revascularization.
Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12 months. Mini Nutritional Assessment–Short Form scores were modestly but significantly correlated with the mEFT scores (Pearson’s R = –0.48; P less than .001).
”We found that patients with malnourishment or at risk of malnourishment had a 2.5-fold higher crude 1-year mortality, compared with those with normal nutritional status,” said Dr. Drudi.
In the 41% of patients deemed frail, malnutrition was associated with all-cause mortality (adjusted odds ratio, 2.08 per point decrease in MNA scores); whereas in the nonfrail patients, MNA scores had little or no effect on mortality (adjusted OR, 1.05).
“Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals,” Dr. Drudi concluded.
Friday, June 21
1:30-3:00 p.m.
Gaylord National, Potomac A/B
S6: Scientific Session 6: RS16
Everyone Can Participate in Gala Silent Auction
After months of planning, the day is finally here! Friday evening, 500 people will be living the high life at the “Vascular Spectacular” gala, celebrating the specialty and each other.
But everyone, no matter where they are in the world, may participate in the gala’s Silent Auction, right until it closes this evening.
In fact, bidding on nearly 70 items began in late May. Here’s how to join in the fun:
• Sign up on vam19gala.givesmart.com and peruse the selections.
• Place a bid. All bidders will be identified by name.
• If desired, monitor the bidding, by setting up notifications to learn when someone else ups the ante.
• Continue to bid until the auction closes during the gala itself.
• Wait for your prizes to be mailed to you — and know you have contributed to continuing the important work of the SVS Foundation.
The live auction takes place at the gala in its entirety and only those present can bid.
The Gala Committee is comprised of Drs. Cynthia Shortell and Benjamin Starnes, cochairs; and Enrico Ascher, William Jordan Jr., Melina Kibbe, Richard Lynn, Matthew Mell, Ben Pearce, Amy Reed, Russell Samson, William Shutze, Mal Sheahan, Maureen Sheehan and Anton Sidawy.
What’s available? Dr. Clem Darling’s “Darling Magical Whiskery Tour” to sample top-tier whiskey in the mutually agreed-upon city; a stay in Lake Tahoe, a beach-front condo in Florida and a spacious townhome at the entrance to Rehoboth Beach, Del.; wildlife photos; fine art; jewelry; fine wine; portraits for people and pets; sports-related items; Maui Jim sunglasses; free admission to attractions from coast to coast and more. There are even one-on-one sessions with a number of vascular surgeons.
In addition, Cydar Medical is offering a one-year subscription to Cydar EV Fusion Imaging, the world’s first AI-powered image fusion platform, valued at $50,000.
All proceeds benefit the SVS Foundation.
After months of planning, the day is finally here! Friday evening, 500 people will be living the high life at the “Vascular Spectacular” gala, celebrating the specialty and each other.
But everyone, no matter where they are in the world, may participate in the gala’s Silent Auction, right until it closes this evening.
In fact, bidding on nearly 70 items began in late May. Here’s how to join in the fun:
• Sign up on vam19gala.givesmart.com and peruse the selections.
• Place a bid. All bidders will be identified by name.
• If desired, monitor the bidding, by setting up notifications to learn when someone else ups the ante.
• Continue to bid until the auction closes during the gala itself.
• Wait for your prizes to be mailed to you — and know you have contributed to continuing the important work of the SVS Foundation.
The live auction takes place at the gala in its entirety and only those present can bid.
The Gala Committee is comprised of Drs. Cynthia Shortell and Benjamin Starnes, cochairs; and Enrico Ascher, William Jordan Jr., Melina Kibbe, Richard Lynn, Matthew Mell, Ben Pearce, Amy Reed, Russell Samson, William Shutze, Mal Sheahan, Maureen Sheehan and Anton Sidawy.
What’s available? Dr. Clem Darling’s “Darling Magical Whiskery Tour” to sample top-tier whiskey in the mutually agreed-upon city; a stay in Lake Tahoe, a beach-front condo in Florida and a spacious townhome at the entrance to Rehoboth Beach, Del.; wildlife photos; fine art; jewelry; fine wine; portraits for people and pets; sports-related items; Maui Jim sunglasses; free admission to attractions from coast to coast and more. There are even one-on-one sessions with a number of vascular surgeons.
In addition, Cydar Medical is offering a one-year subscription to Cydar EV Fusion Imaging, the world’s first AI-powered image fusion platform, valued at $50,000.
All proceeds benefit the SVS Foundation.
After months of planning, the day is finally here! Friday evening, 500 people will be living the high life at the “Vascular Spectacular” gala, celebrating the specialty and each other.
But everyone, no matter where they are in the world, may participate in the gala’s Silent Auction, right until it closes this evening.
In fact, bidding on nearly 70 items began in late May. Here’s how to join in the fun:
• Sign up on vam19gala.givesmart.com and peruse the selections.
• Place a bid. All bidders will be identified by name.
• If desired, monitor the bidding, by setting up notifications to learn when someone else ups the ante.
• Continue to bid until the auction closes during the gala itself.
• Wait for your prizes to be mailed to you — and know you have contributed to continuing the important work of the SVS Foundation.
The live auction takes place at the gala in its entirety and only those present can bid.
The Gala Committee is comprised of Drs. Cynthia Shortell and Benjamin Starnes, cochairs; and Enrico Ascher, William Jordan Jr., Melina Kibbe, Richard Lynn, Matthew Mell, Ben Pearce, Amy Reed, Russell Samson, William Shutze, Mal Sheahan, Maureen Sheehan and Anton Sidawy.
What’s available? Dr. Clem Darling’s “Darling Magical Whiskery Tour” to sample top-tier whiskey in the mutually agreed-upon city; a stay in Lake Tahoe, a beach-front condo in Florida and a spacious townhome at the entrance to Rehoboth Beach, Del.; wildlife photos; fine art; jewelry; fine wine; portraits for people and pets; sports-related items; Maui Jim sunglasses; free admission to attractions from coast to coast and more. There are even one-on-one sessions with a number of vascular surgeons.
In addition, Cydar Medical is offering a one-year subscription to Cydar EV Fusion Imaging, the world’s first AI-powered image fusion platform, valued at $50,000.
All proceeds benefit the SVS Foundation.
Learn About Starting a Vascular Training Program
Starting a vascular surgery integrated program or fellowship can be a daunting process. There exist a number of misconceptions about required case volume, program affiliations, and required number of faculty.
Requirements for creating such programs have recently been lightened. And the SVS and the Association of Program Directors in Vascular Surgery have a number of initiatives in place to help.
SVS will host an informational session for anyone interested in starting a program from 9:30 to 10:30 a.m. Friday, June 14, in National Harbor 4. Most of the session will be interactive, with experienced program directors offering participants useful information and practical advice.
Starting a vascular surgery integrated program or fellowship can be a daunting process. There exist a number of misconceptions about required case volume, program affiliations, and required number of faculty.
Requirements for creating such programs have recently been lightened. And the SVS and the Association of Program Directors in Vascular Surgery have a number of initiatives in place to help.
SVS will host an informational session for anyone interested in starting a program from 9:30 to 10:30 a.m. Friday, June 14, in National Harbor 4. Most of the session will be interactive, with experienced program directors offering participants useful information and practical advice.
Starting a vascular surgery integrated program or fellowship can be a daunting process. There exist a number of misconceptions about required case volume, program affiliations, and required number of faculty.
Requirements for creating such programs have recently been lightened. And the SVS and the Association of Program Directors in Vascular Surgery have a number of initiatives in place to help.
SVS will host an informational session for anyone interested in starting a program from 9:30 to 10:30 a.m. Friday, June 14, in National Harbor 4. Most of the session will be interactive, with experienced program directors offering participants useful information and practical advice.
CMS seeks answers on prior authorization, other hassles to eliminate
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
National Survey Examines the Extent, Effects of Pain in Vascular Surgeons
Work-related pain and disability have been reported in the literature among various surgical specialties and can influence surgeon productivity and burnout. In Friday’s Scientific Session 4, Max Wohlauer, MD, of the University of Colorado, Denver, will report on a study that he and his colleagues performed to identify the prevalence and severity of pain symptoms in vascular surgeons.
Dr. Wohlauer will report on their survey, which was emailed to 2,910 members of the Society for Vascular Surgery. Pain was reported using the 0–10 Borg’s CR-10 scale, with 0 = no pain, 3 = moderate, 4 = somewhat strong, 5 = strong, and 10 = maximum pain.
Dr. Wohlauer and his colleagues received responses from 775 (26.6%) of the vascular surgeons; with retirees excluded from the study. Among those actively working, the mean age was 51.4 years, and the surgeons had a mean of 17.2 years in practice; 83.6% of the respondents were men.
According to the survey, after a full day of open surgery, the majority of vascular surgeons reported being in a somewhat strong amount of pain (mean score 4.4), while after a full day of endovascular procedures, most vascular surgeons reported being in a moderate amount of pain (mean score 3.9).
Pain following a day of open surgery was highest in the neck (45%) and lower back (39%);after endovascular procedures, respondents reported pain to be most severe in the lower back (44%) and neck (24%). Surgeons performing endovenous procedures report the lowest pain scores (mean 2.0).
In terms of treatment, 242 (36.9%) vascular surgeons reported having sought medical care for work-related issues, with 61 (8.3%) taking time away from the operating room. A total of 72 surgeons (10%) reported requiring surgery and other procedures (including traction), and 22 (3%) had been placed on short- or long-term disability.
In total, 193 (26.2%) of surgeons report pain severe enough that it interfered with sleep, with 9 (1.2%) leaving their career because of disability from work-related pain, and high work-related physical discomfort was significantly associated with Maslach Burnout Inventory single-item measure of burnout for open surgery, endovascular, and endovenous procedures, according to Dr. Wohlauer.
Altogether, 334 (50.6%) of the vascular surgeons surveyed reported that physical discomfort will affect the longevity of their career. This is borne out by the fact that, of the 39 respondents no longer practicing surgery, 26% (10) retired because of disability from work-related pain.
“Our study shows that the majority of practicing vascular surgeons are in pain after a day of operating. Work-related disability is significantly diminishing the workforce. Addressing work-related pain serves to improve the lives and careers of vascular surgeons, while enhancing surgical longevity would help address the current national workforce shortage,” Dr. Wohlauer concluded.
Friday
8-9:30 a.m.
Gaylor National, Potomac A/B
S4: Scientific Session 4: SS12
Work-related pain and disability have been reported in the literature among various surgical specialties and can influence surgeon productivity and burnout. In Friday’s Scientific Session 4, Max Wohlauer, MD, of the University of Colorado, Denver, will report on a study that he and his colleagues performed to identify the prevalence and severity of pain symptoms in vascular surgeons.
Dr. Wohlauer will report on their survey, which was emailed to 2,910 members of the Society for Vascular Surgery. Pain was reported using the 0–10 Borg’s CR-10 scale, with 0 = no pain, 3 = moderate, 4 = somewhat strong, 5 = strong, and 10 = maximum pain.
Dr. Wohlauer and his colleagues received responses from 775 (26.6%) of the vascular surgeons; with retirees excluded from the study. Among those actively working, the mean age was 51.4 years, and the surgeons had a mean of 17.2 years in practice; 83.6% of the respondents were men.
According to the survey, after a full day of open surgery, the majority of vascular surgeons reported being in a somewhat strong amount of pain (mean score 4.4), while after a full day of endovascular procedures, most vascular surgeons reported being in a moderate amount of pain (mean score 3.9).
Pain following a day of open surgery was highest in the neck (45%) and lower back (39%);after endovascular procedures, respondents reported pain to be most severe in the lower back (44%) and neck (24%). Surgeons performing endovenous procedures report the lowest pain scores (mean 2.0).
In terms of treatment, 242 (36.9%) vascular surgeons reported having sought medical care for work-related issues, with 61 (8.3%) taking time away from the operating room. A total of 72 surgeons (10%) reported requiring surgery and other procedures (including traction), and 22 (3%) had been placed on short- or long-term disability.
In total, 193 (26.2%) of surgeons report pain severe enough that it interfered with sleep, with 9 (1.2%) leaving their career because of disability from work-related pain, and high work-related physical discomfort was significantly associated with Maslach Burnout Inventory single-item measure of burnout for open surgery, endovascular, and endovenous procedures, according to Dr. Wohlauer.
Altogether, 334 (50.6%) of the vascular surgeons surveyed reported that physical discomfort will affect the longevity of their career. This is borne out by the fact that, of the 39 respondents no longer practicing surgery, 26% (10) retired because of disability from work-related pain.
“Our study shows that the majority of practicing vascular surgeons are in pain after a day of operating. Work-related disability is significantly diminishing the workforce. Addressing work-related pain serves to improve the lives and careers of vascular surgeons, while enhancing surgical longevity would help address the current national workforce shortage,” Dr. Wohlauer concluded.
Friday
8-9:30 a.m.
Gaylor National, Potomac A/B
S4: Scientific Session 4: SS12
Work-related pain and disability have been reported in the literature among various surgical specialties and can influence surgeon productivity and burnout. In Friday’s Scientific Session 4, Max Wohlauer, MD, of the University of Colorado, Denver, will report on a study that he and his colleagues performed to identify the prevalence and severity of pain symptoms in vascular surgeons.
Dr. Wohlauer will report on their survey, which was emailed to 2,910 members of the Society for Vascular Surgery. Pain was reported using the 0–10 Borg’s CR-10 scale, with 0 = no pain, 3 = moderate, 4 = somewhat strong, 5 = strong, and 10 = maximum pain.
Dr. Wohlauer and his colleagues received responses from 775 (26.6%) of the vascular surgeons; with retirees excluded from the study. Among those actively working, the mean age was 51.4 years, and the surgeons had a mean of 17.2 years in practice; 83.6% of the respondents were men.
According to the survey, after a full day of open surgery, the majority of vascular surgeons reported being in a somewhat strong amount of pain (mean score 4.4), while after a full day of endovascular procedures, most vascular surgeons reported being in a moderate amount of pain (mean score 3.9).
Pain following a day of open surgery was highest in the neck (45%) and lower back (39%);after endovascular procedures, respondents reported pain to be most severe in the lower back (44%) and neck (24%). Surgeons performing endovenous procedures report the lowest pain scores (mean 2.0).
In terms of treatment, 242 (36.9%) vascular surgeons reported having sought medical care for work-related issues, with 61 (8.3%) taking time away from the operating room. A total of 72 surgeons (10%) reported requiring surgery and other procedures (including traction), and 22 (3%) had been placed on short- or long-term disability.
In total, 193 (26.2%) of surgeons report pain severe enough that it interfered with sleep, with 9 (1.2%) leaving their career because of disability from work-related pain, and high work-related physical discomfort was significantly associated with Maslach Burnout Inventory single-item measure of burnout for open surgery, endovascular, and endovenous procedures, according to Dr. Wohlauer.
Altogether, 334 (50.6%) of the vascular surgeons surveyed reported that physical discomfort will affect the longevity of their career. This is borne out by the fact that, of the 39 respondents no longer practicing surgery, 26% (10) retired because of disability from work-related pain.
“Our study shows that the majority of practicing vascular surgeons are in pain after a day of operating. Work-related disability is significantly diminishing the workforce. Addressing work-related pain serves to improve the lives and careers of vascular surgeons, while enhancing surgical longevity would help address the current national workforce shortage,” Dr. Wohlauer concluded.
Friday
8-9:30 a.m.
Gaylor National, Potomac A/B
S4: Scientific Session 4: SS12
From Our President
Society for Vascular Surgery President Michel S. Makaroun, MD, will reflect on his presidency during the 2019 Presidential Address, on Friday, June 14, from 11:15 a.m. to 12:15 p.m. President-Elect Kim Hodgson, MD, will introduce Dr. Makaroun, beginning at 11 a.m.
Dr. Makaroun is professor of surgery and clinical translational science at the University of Pittsburgh. He is the chair of vascular surgery and codirector of the University of Pittsburgh Medical Center Heart and Vascular Institute.
His address, “I am in Favor of Progress ... It is Change I Do Not Like,” will take place in Ballroom A/B.
Society for Vascular Surgery President Michel S. Makaroun, MD, will reflect on his presidency during the 2019 Presidential Address, on Friday, June 14, from 11:15 a.m. to 12:15 p.m. President-Elect Kim Hodgson, MD, will introduce Dr. Makaroun, beginning at 11 a.m.
Dr. Makaroun is professor of surgery and clinical translational science at the University of Pittsburgh. He is the chair of vascular surgery and codirector of the University of Pittsburgh Medical Center Heart and Vascular Institute.
His address, “I am in Favor of Progress ... It is Change I Do Not Like,” will take place in Ballroom A/B.
Society for Vascular Surgery President Michel S. Makaroun, MD, will reflect on his presidency during the 2019 Presidential Address, on Friday, June 14, from 11:15 a.m. to 12:15 p.m. President-Elect Kim Hodgson, MD, will introduce Dr. Makaroun, beginning at 11 a.m.
Dr. Makaroun is professor of surgery and clinical translational science at the University of Pittsburgh. He is the chair of vascular surgery and codirector of the University of Pittsburgh Medical Center Heart and Vascular Institute.
His address, “I am in Favor of Progress ... It is Change I Do Not Like,” will take place in Ballroom A/B.
A large employer ‘frames’ the Medicare-for-all debate
EASTON, PA. — Walk into a big-box retailer such as Walmart or Michaels and you’re likely to see MCS Industries’ picture frames, decorative mirrors, or kitschy wall décor.
Adjacent to a dairy farm a few miles west of downtown Easton, MCS is the nation’s largest maker of such household products. But MCS doesn’t actually make anything here anymore. It has moved its manufacturing operations to Mexico and China, with the last manufacturing jobs departing this city along the Delaware River in 2005. MCS now has about 175 U.S. employees and 600 people overseas.
“We were going to lose the business because we were no longer competitive,” CEO Richard Master explained. And one of the biggest impediments to keeping labor costs in line, he said, has been the increasing expense of health coverage in the United States.
Today, he’s at the vanguard of a small but growing group of business executives who are lining up to support a Medicare-for-all national health program.
In February, Master stood with Rep. Pramila Jayapal (D-Wash.) outside the Capitol after she introduced her Medicare-for-all bill. “This bill removes an albatross from the neck of American business, puts more money in consumer products and will boost our economy,” he said.
As health costs continue to grow, straining employer budgets and slowing wage growth, others in the business community are beginning to take the option more seriously.
While the influential U.S. Chamber of Commerce and other large business lobbying groups strongly oppose increased government involvement in health care, the resolve of many in the business community – especially among smaller firms – may be shifting.
“There is growing momentum among employers supporting single-payer,” said Dan Geiger, codirector of the Business Alliance for a Healthy California, which has sought to generate business support for a universal health care program in California. About 300 mostly small employers have signed on.
“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction,” he said.
Mr. Geiger acknowledged the effort still lacks support from any Fortune 500 company CEOs. He said large businesses are hesitant to get involved in this political debate and many don’t want to lose the ability to attract workers with generous health benefits. “There is also a lingering distrust of the government, and they think they can offer coverage better than the government,” he said.
In addition, some in the business community are hesitant to sign on to Medicare-for-all with many details missing, such as how much it would increase taxes, said Ellen Kelsay, chief strategy officer for the National Business Group on Health, a leading business group focused on health benefits.
Democrats propel the debate
For decades, a government-run health plan was considered too radical an idea for serious consideration. But Medicare-for-all has been garnering more political support in recent months, especially after a progressive wave helped Democrats take control of the House this year. Several 2020 Democratic presidential candidates, including Sens. Bernie Sanders and Elizabeth Warren, strongly back it.
The labor unions and consumer groups that have long endorsed a single-payer health system hope that the embrace of it by employers such as Mr. Master marks another turning point for the movement.
Supporters of the concept say the health system overall would see savings from a coordinated effort to bring down prices and the elimination of many administrative costs or insurance company profits.
“It’s critical for our success to engage employers, particularly because our current system is hurting employers almost as much as it is patients,” said Melinda St. Louis, campaign director of Medicare-for-all at Public Citizen, a consumer-rights group based in Washington.
Mr. Master, a former Washington lawyer, worked on Democratic Sen. George McGovern’s presidential campaign before returning to Pennsylvania in 1973 to take over his father’s company, which made rigid paper boxes. In 1980, he founded MCS, which pioneered the popular front-loading picture frame and steamless fog-free mirrors for bathrooms. The company has grown into a $250 million corporation.
Mr. Master frequently travels to Washington and around the country to talk with business leaders as he seeks to build political support for a single-payer health system.
In the past 4 years, he has produced several documentary videos on the topic. In 2018, he formed the Business Initiative for Health Policy, a nonprofit group of business leaders, economists, and health policy experts trying to explain the financial benefits of a single-payer system.
Dan Wolf, CEO of Cape Air, a Hyannis, Mass.–based regional airline that employs 800 people calls himself “a free-market guy.” But he also supports Medicare-for-all. He said Mr. Master helps turn the political argument over single-payer into a practical one.
“It’s about good business sense and about caring for his employees and their well-being,” he said, adding that employers should no longer be straddled with the cost and complexity of health care.
“It makes no more sense for an airline to understand health policy for the bulk of its workers than for a health facility to have to supply all the air transportation for its employees,” he said.
Employers also are an important voice in the debate because 156 million Americans get employer-paid health care, making it by far the single-largest form of coverage.
Mr. Master said his company has tried various methods to control costs with little success, including high deductibles, narrow networks of providers and wellness plans that emphasize preventive medicine.
Insurers who are supposed to negotiate lower rates from hospitals and doctors have failed, he added, and too many premium dollars go to covering administrative costs. Only by having the federal government set rates can the United States control costs of drugs, hospitals, and other health services, he said.
“Insurance companies are not watching the store and don’t have incentives to hold down costs in the current system,” he said.
Glad the boss is trying to make a difference
What’s left of MCS in Pennsylvania is a spacious corporate office building housing administrative staff, designers, and a giant distribution center piled high with carton boxes from floor to ceiling.
MCS pays an average of $1,260 per month for each employee’s health care, up from $716 in 2009, the company said. In recent years, the company has reduced out-of-pocket costs for employees by covering most of their deductibles.
Medicare-for-all would require several new taxes to raise money, but Mr. Master said such a plan would mean savings for his company and employees.
MCS employees largely support Mr. Master’s attempt to fix the health system even if they are not all on board with a Medicare-for-all approach, according to interviews with several workers in Easton.
“I think it’s a good idea,” said Faith Wildrick, a shipper at MCS who has worked for the company 26 years. “If the other countries are doing it and it is working for them, why can’t it work for us?”
Ms. Wildrick said that even with insurance her family struggles with health costs as her husband, Bill, a former MCS employee, deals with liver disease and needs many diagnostic tests and prescription medications. Their annual deductible has swung from $4,000 several years ago to $500 this year as the company has worked to lower employees’ out-of-pocket costs.
“I’m really glad someone is fighting for this and trying to make a difference,” said Ms. Wildrick.
Jessica Ehrhardt, the human resources manager at MCS, said the effort to reduce employees’ out-of-pocket health costs means the company must pay higher health costs. That results in less money for salary increases and other benefits, she added.
Asked about Medicare-for-all, Ms. Ehrhardt said, “It’s a drastic solution, but something needs to happen.”
For too long, Mr. Master said, the push for a single-payer health system has been about ideology.
“The movement has been about making health care a human right and that we have a right to universal health care,” he said. “What I am saying is this is prudent for our economy and am trying to make the business and economic case.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
EASTON, PA. — Walk into a big-box retailer such as Walmart or Michaels and you’re likely to see MCS Industries’ picture frames, decorative mirrors, or kitschy wall décor.
Adjacent to a dairy farm a few miles west of downtown Easton, MCS is the nation’s largest maker of such household products. But MCS doesn’t actually make anything here anymore. It has moved its manufacturing operations to Mexico and China, with the last manufacturing jobs departing this city along the Delaware River in 2005. MCS now has about 175 U.S. employees and 600 people overseas.
“We were going to lose the business because we were no longer competitive,” CEO Richard Master explained. And one of the biggest impediments to keeping labor costs in line, he said, has been the increasing expense of health coverage in the United States.
Today, he’s at the vanguard of a small but growing group of business executives who are lining up to support a Medicare-for-all national health program.
In February, Master stood with Rep. Pramila Jayapal (D-Wash.) outside the Capitol after she introduced her Medicare-for-all bill. “This bill removes an albatross from the neck of American business, puts more money in consumer products and will boost our economy,” he said.
As health costs continue to grow, straining employer budgets and slowing wage growth, others in the business community are beginning to take the option more seriously.
While the influential U.S. Chamber of Commerce and other large business lobbying groups strongly oppose increased government involvement in health care, the resolve of many in the business community – especially among smaller firms – may be shifting.
“There is growing momentum among employers supporting single-payer,” said Dan Geiger, codirector of the Business Alliance for a Healthy California, which has sought to generate business support for a universal health care program in California. About 300 mostly small employers have signed on.
“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction,” he said.
Mr. Geiger acknowledged the effort still lacks support from any Fortune 500 company CEOs. He said large businesses are hesitant to get involved in this political debate and many don’t want to lose the ability to attract workers with generous health benefits. “There is also a lingering distrust of the government, and they think they can offer coverage better than the government,” he said.
In addition, some in the business community are hesitant to sign on to Medicare-for-all with many details missing, such as how much it would increase taxes, said Ellen Kelsay, chief strategy officer for the National Business Group on Health, a leading business group focused on health benefits.
Democrats propel the debate
For decades, a government-run health plan was considered too radical an idea for serious consideration. But Medicare-for-all has been garnering more political support in recent months, especially after a progressive wave helped Democrats take control of the House this year. Several 2020 Democratic presidential candidates, including Sens. Bernie Sanders and Elizabeth Warren, strongly back it.
The labor unions and consumer groups that have long endorsed a single-payer health system hope that the embrace of it by employers such as Mr. Master marks another turning point for the movement.
Supporters of the concept say the health system overall would see savings from a coordinated effort to bring down prices and the elimination of many administrative costs or insurance company profits.
“It’s critical for our success to engage employers, particularly because our current system is hurting employers almost as much as it is patients,” said Melinda St. Louis, campaign director of Medicare-for-all at Public Citizen, a consumer-rights group based in Washington.
Mr. Master, a former Washington lawyer, worked on Democratic Sen. George McGovern’s presidential campaign before returning to Pennsylvania in 1973 to take over his father’s company, which made rigid paper boxes. In 1980, he founded MCS, which pioneered the popular front-loading picture frame and steamless fog-free mirrors for bathrooms. The company has grown into a $250 million corporation.
Mr. Master frequently travels to Washington and around the country to talk with business leaders as he seeks to build political support for a single-payer health system.
In the past 4 years, he has produced several documentary videos on the topic. In 2018, he formed the Business Initiative for Health Policy, a nonprofit group of business leaders, economists, and health policy experts trying to explain the financial benefits of a single-payer system.
Dan Wolf, CEO of Cape Air, a Hyannis, Mass.–based regional airline that employs 800 people calls himself “a free-market guy.” But he also supports Medicare-for-all. He said Mr. Master helps turn the political argument over single-payer into a practical one.
“It’s about good business sense and about caring for his employees and their well-being,” he said, adding that employers should no longer be straddled with the cost and complexity of health care.
“It makes no more sense for an airline to understand health policy for the bulk of its workers than for a health facility to have to supply all the air transportation for its employees,” he said.
Employers also are an important voice in the debate because 156 million Americans get employer-paid health care, making it by far the single-largest form of coverage.
Mr. Master said his company has tried various methods to control costs with little success, including high deductibles, narrow networks of providers and wellness plans that emphasize preventive medicine.
Insurers who are supposed to negotiate lower rates from hospitals and doctors have failed, he added, and too many premium dollars go to covering administrative costs. Only by having the federal government set rates can the United States control costs of drugs, hospitals, and other health services, he said.
“Insurance companies are not watching the store and don’t have incentives to hold down costs in the current system,” he said.
Glad the boss is trying to make a difference
What’s left of MCS in Pennsylvania is a spacious corporate office building housing administrative staff, designers, and a giant distribution center piled high with carton boxes from floor to ceiling.
MCS pays an average of $1,260 per month for each employee’s health care, up from $716 in 2009, the company said. In recent years, the company has reduced out-of-pocket costs for employees by covering most of their deductibles.
Medicare-for-all would require several new taxes to raise money, but Mr. Master said such a plan would mean savings for his company and employees.
MCS employees largely support Mr. Master’s attempt to fix the health system even if they are not all on board with a Medicare-for-all approach, according to interviews with several workers in Easton.
“I think it’s a good idea,” said Faith Wildrick, a shipper at MCS who has worked for the company 26 years. “If the other countries are doing it and it is working for them, why can’t it work for us?”
Ms. Wildrick said that even with insurance her family struggles with health costs as her husband, Bill, a former MCS employee, deals with liver disease and needs many diagnostic tests and prescription medications. Their annual deductible has swung from $4,000 several years ago to $500 this year as the company has worked to lower employees’ out-of-pocket costs.
“I’m really glad someone is fighting for this and trying to make a difference,” said Ms. Wildrick.
Jessica Ehrhardt, the human resources manager at MCS, said the effort to reduce employees’ out-of-pocket health costs means the company must pay higher health costs. That results in less money for salary increases and other benefits, she added.
Asked about Medicare-for-all, Ms. Ehrhardt said, “It’s a drastic solution, but something needs to happen.”
For too long, Mr. Master said, the push for a single-payer health system has been about ideology.
“The movement has been about making health care a human right and that we have a right to universal health care,” he said. “What I am saying is this is prudent for our economy and am trying to make the business and economic case.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
EASTON, PA. — Walk into a big-box retailer such as Walmart or Michaels and you’re likely to see MCS Industries’ picture frames, decorative mirrors, or kitschy wall décor.
Adjacent to a dairy farm a few miles west of downtown Easton, MCS is the nation’s largest maker of such household products. But MCS doesn’t actually make anything here anymore. It has moved its manufacturing operations to Mexico and China, with the last manufacturing jobs departing this city along the Delaware River in 2005. MCS now has about 175 U.S. employees and 600 people overseas.
“We were going to lose the business because we were no longer competitive,” CEO Richard Master explained. And one of the biggest impediments to keeping labor costs in line, he said, has been the increasing expense of health coverage in the United States.
Today, he’s at the vanguard of a small but growing group of business executives who are lining up to support a Medicare-for-all national health program.
In February, Master stood with Rep. Pramila Jayapal (D-Wash.) outside the Capitol after she introduced her Medicare-for-all bill. “This bill removes an albatross from the neck of American business, puts more money in consumer products and will boost our economy,” he said.
As health costs continue to grow, straining employer budgets and slowing wage growth, others in the business community are beginning to take the option more seriously.
While the influential U.S. Chamber of Commerce and other large business lobbying groups strongly oppose increased government involvement in health care, the resolve of many in the business community – especially among smaller firms – may be shifting.
“There is growing momentum among employers supporting single-payer,” said Dan Geiger, codirector of the Business Alliance for a Healthy California, which has sought to generate business support for a universal health care program in California. About 300 mostly small employers have signed on.
“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction,” he said.
Mr. Geiger acknowledged the effort still lacks support from any Fortune 500 company CEOs. He said large businesses are hesitant to get involved in this political debate and many don’t want to lose the ability to attract workers with generous health benefits. “There is also a lingering distrust of the government, and they think they can offer coverage better than the government,” he said.
In addition, some in the business community are hesitant to sign on to Medicare-for-all with many details missing, such as how much it would increase taxes, said Ellen Kelsay, chief strategy officer for the National Business Group on Health, a leading business group focused on health benefits.
Democrats propel the debate
For decades, a government-run health plan was considered too radical an idea for serious consideration. But Medicare-for-all has been garnering more political support in recent months, especially after a progressive wave helped Democrats take control of the House this year. Several 2020 Democratic presidential candidates, including Sens. Bernie Sanders and Elizabeth Warren, strongly back it.
The labor unions and consumer groups that have long endorsed a single-payer health system hope that the embrace of it by employers such as Mr. Master marks another turning point for the movement.
Supporters of the concept say the health system overall would see savings from a coordinated effort to bring down prices and the elimination of many administrative costs or insurance company profits.
“It’s critical for our success to engage employers, particularly because our current system is hurting employers almost as much as it is patients,” said Melinda St. Louis, campaign director of Medicare-for-all at Public Citizen, a consumer-rights group based in Washington.
Mr. Master, a former Washington lawyer, worked on Democratic Sen. George McGovern’s presidential campaign before returning to Pennsylvania in 1973 to take over his father’s company, which made rigid paper boxes. In 1980, he founded MCS, which pioneered the popular front-loading picture frame and steamless fog-free mirrors for bathrooms. The company has grown into a $250 million corporation.
Mr. Master frequently travels to Washington and around the country to talk with business leaders as he seeks to build political support for a single-payer health system.
In the past 4 years, he has produced several documentary videos on the topic. In 2018, he formed the Business Initiative for Health Policy, a nonprofit group of business leaders, economists, and health policy experts trying to explain the financial benefits of a single-payer system.
Dan Wolf, CEO of Cape Air, a Hyannis, Mass.–based regional airline that employs 800 people calls himself “a free-market guy.” But he also supports Medicare-for-all. He said Mr. Master helps turn the political argument over single-payer into a practical one.
“It’s about good business sense and about caring for his employees and their well-being,” he said, adding that employers should no longer be straddled with the cost and complexity of health care.
“It makes no more sense for an airline to understand health policy for the bulk of its workers than for a health facility to have to supply all the air transportation for its employees,” he said.
Employers also are an important voice in the debate because 156 million Americans get employer-paid health care, making it by far the single-largest form of coverage.
Mr. Master said his company has tried various methods to control costs with little success, including high deductibles, narrow networks of providers and wellness plans that emphasize preventive medicine.
Insurers who are supposed to negotiate lower rates from hospitals and doctors have failed, he added, and too many premium dollars go to covering administrative costs. Only by having the federal government set rates can the United States control costs of drugs, hospitals, and other health services, he said.
“Insurance companies are not watching the store and don’t have incentives to hold down costs in the current system,” he said.
Glad the boss is trying to make a difference
What’s left of MCS in Pennsylvania is a spacious corporate office building housing administrative staff, designers, and a giant distribution center piled high with carton boxes from floor to ceiling.
MCS pays an average of $1,260 per month for each employee’s health care, up from $716 in 2009, the company said. In recent years, the company has reduced out-of-pocket costs for employees by covering most of their deductibles.
Medicare-for-all would require several new taxes to raise money, but Mr. Master said such a plan would mean savings for his company and employees.
MCS employees largely support Mr. Master’s attempt to fix the health system even if they are not all on board with a Medicare-for-all approach, according to interviews with several workers in Easton.
“I think it’s a good idea,” said Faith Wildrick, a shipper at MCS who has worked for the company 26 years. “If the other countries are doing it and it is working for them, why can’t it work for us?”
Ms. Wildrick said that even with insurance her family struggles with health costs as her husband, Bill, a former MCS employee, deals with liver disease and needs many diagnostic tests and prescription medications. Their annual deductible has swung from $4,000 several years ago to $500 this year as the company has worked to lower employees’ out-of-pocket costs.
“I’m really glad someone is fighting for this and trying to make a difference,” said Ms. Wildrick.
Jessica Ehrhardt, the human resources manager at MCS, said the effort to reduce employees’ out-of-pocket health costs means the company must pay higher health costs. That results in less money for salary increases and other benefits, she added.
Asked about Medicare-for-all, Ms. Ehrhardt said, “It’s a drastic solution, but something needs to happen.”
For too long, Mr. Master said, the push for a single-payer health system has been about ideology.
“The movement has been about making health care a human right and that we have a right to universal health care,” he said. “What I am saying is this is prudent for our economy and am trying to make the business and economic case.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
Opioid prescriptions declined 33% over 5 years
Fewer opioid retail prescriptions are being filled, according to a new report issued by the American Medical Association Opioid Task Force.
Opioid prescribing declined by 33% over a 5-year period based on the total number of opioid retail prescriptions filled. Total prescriptions declined from 251.8 million in 2013 to 168.8 million in 2018, according to the report.
The numbers come as the most recent data from the Centers for Disease Control and Prevention show a leveling of deaths involving prescription opioids. The CDC data were most recently updated in January 2019 and cover the period 1999-2017.
A closer look shows that deaths involving prescription opioids, but not other synthetic narcotics, peaked in 2011 and have generally declined since then. Deaths involving other synthetic narcotics, however, have been rising, offsetting the reduction and keeping the total number of deaths involving opioids relatively stable between 2016 and 2017.
Other data released by the AMA Opioid Task Force show that physicians are increasing their use of state-level prescription drug monitoring programs (PDMPs).
In 2017, there were 1.5 million physicians registered to use state PDMPs. That number rose to 1.97 million in 2019. And the physicians are using PDMPs. In 2018, physicians made 460 million PDMP queries, up 56% from 2017 and up 651% from 2014.
More education about opioid prescribing is being sought, with 700,000 physicians completing CME training and accessing other training related to opioid prescribing, pain management, screening for substance use disorders, and other related topics.
While the report does show positive trends, the task force is calling for more action, including more access to naloxone and better access to mental health treatment.
The report notes that more than 66,000 physicians and other health professionals have a federal waiver to prescribe buprenorphine, up more than 28,000 since 2016.
A number of policy recommendations are made in the report, including removing inappropriate administrative burdens or barriers that delay access to medications used in medication-assisted treatment (MAT); removing barriers to comprehensive pain care and rehabilitation programs, and reforming the civil and criminal justice system to help ensure access to high-quality, evidence-based care for opioid use disorder.
“We are at a crossroads in our nation’s efforts to end the opioid epidemic,” AMA Opioid Task Force Chair Patrice A. Harris, MD, stated in the report. “It is time to end delays and barriers to medication-assisted treatment – evidence based care proven to save lives; time for payers, [pharmacy benefit managers] and pharmacy chains to reevaluate and revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to commit to helping all patients access evidence-based care for pain and substance use disorders.”
Dr. Harris continued: “Physicians must continue to demonstrate leadership, but unless these actions occur, the progress we are making will not stop patients from dying.”
Fewer opioid retail prescriptions are being filled, according to a new report issued by the American Medical Association Opioid Task Force.
Opioid prescribing declined by 33% over a 5-year period based on the total number of opioid retail prescriptions filled. Total prescriptions declined from 251.8 million in 2013 to 168.8 million in 2018, according to the report.
The numbers come as the most recent data from the Centers for Disease Control and Prevention show a leveling of deaths involving prescription opioids. The CDC data were most recently updated in January 2019 and cover the period 1999-2017.
A closer look shows that deaths involving prescription opioids, but not other synthetic narcotics, peaked in 2011 and have generally declined since then. Deaths involving other synthetic narcotics, however, have been rising, offsetting the reduction and keeping the total number of deaths involving opioids relatively stable between 2016 and 2017.
Other data released by the AMA Opioid Task Force show that physicians are increasing their use of state-level prescription drug monitoring programs (PDMPs).
In 2017, there were 1.5 million physicians registered to use state PDMPs. That number rose to 1.97 million in 2019. And the physicians are using PDMPs. In 2018, physicians made 460 million PDMP queries, up 56% from 2017 and up 651% from 2014.
More education about opioid prescribing is being sought, with 700,000 physicians completing CME training and accessing other training related to opioid prescribing, pain management, screening for substance use disorders, and other related topics.
While the report does show positive trends, the task force is calling for more action, including more access to naloxone and better access to mental health treatment.
The report notes that more than 66,000 physicians and other health professionals have a federal waiver to prescribe buprenorphine, up more than 28,000 since 2016.
A number of policy recommendations are made in the report, including removing inappropriate administrative burdens or barriers that delay access to medications used in medication-assisted treatment (MAT); removing barriers to comprehensive pain care and rehabilitation programs, and reforming the civil and criminal justice system to help ensure access to high-quality, evidence-based care for opioid use disorder.
“We are at a crossroads in our nation’s efforts to end the opioid epidemic,” AMA Opioid Task Force Chair Patrice A. Harris, MD, stated in the report. “It is time to end delays and barriers to medication-assisted treatment – evidence based care proven to save lives; time for payers, [pharmacy benefit managers] and pharmacy chains to reevaluate and revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to commit to helping all patients access evidence-based care for pain and substance use disorders.”
Dr. Harris continued: “Physicians must continue to demonstrate leadership, but unless these actions occur, the progress we are making will not stop patients from dying.”
Fewer opioid retail prescriptions are being filled, according to a new report issued by the American Medical Association Opioid Task Force.
Opioid prescribing declined by 33% over a 5-year period based on the total number of opioid retail prescriptions filled. Total prescriptions declined from 251.8 million in 2013 to 168.8 million in 2018, according to the report.
The numbers come as the most recent data from the Centers for Disease Control and Prevention show a leveling of deaths involving prescription opioids. The CDC data were most recently updated in January 2019 and cover the period 1999-2017.
A closer look shows that deaths involving prescription opioids, but not other synthetic narcotics, peaked in 2011 and have generally declined since then. Deaths involving other synthetic narcotics, however, have been rising, offsetting the reduction and keeping the total number of deaths involving opioids relatively stable between 2016 and 2017.
Other data released by the AMA Opioid Task Force show that physicians are increasing their use of state-level prescription drug monitoring programs (PDMPs).
In 2017, there were 1.5 million physicians registered to use state PDMPs. That number rose to 1.97 million in 2019. And the physicians are using PDMPs. In 2018, physicians made 460 million PDMP queries, up 56% from 2017 and up 651% from 2014.
More education about opioid prescribing is being sought, with 700,000 physicians completing CME training and accessing other training related to opioid prescribing, pain management, screening for substance use disorders, and other related topics.
While the report does show positive trends, the task force is calling for more action, including more access to naloxone and better access to mental health treatment.
The report notes that more than 66,000 physicians and other health professionals have a federal waiver to prescribe buprenorphine, up more than 28,000 since 2016.
A number of policy recommendations are made in the report, including removing inappropriate administrative burdens or barriers that delay access to medications used in medication-assisted treatment (MAT); removing barriers to comprehensive pain care and rehabilitation programs, and reforming the civil and criminal justice system to help ensure access to high-quality, evidence-based care for opioid use disorder.
“We are at a crossroads in our nation’s efforts to end the opioid epidemic,” AMA Opioid Task Force Chair Patrice A. Harris, MD, stated in the report. “It is time to end delays and barriers to medication-assisted treatment – evidence based care proven to save lives; time for payers, [pharmacy benefit managers] and pharmacy chains to reevaluate and revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to commit to helping all patients access evidence-based care for pain and substance use disorders.”
Dr. Harris continued: “Physicians must continue to demonstrate leadership, but unless these actions occur, the progress we are making will not stop patients from dying.”
Medicaid expansion associated with lower cardiovascular mortality
Counties in states that expanded Medicaid coverage under the Affordable Care Act have experienced a significantly smaller increase in cardiovascular mortality rates among middle-aged adults, compared with counties in states that did not expand coverage, according to findings from a new study.
In expansion-state counties, the change in cardiovascular mortality was stable between the pre-expansion (2010-2013) and postexpansion (2014-2016) periods, at 146.5-146.4 deaths per 100,000 residents per year, compared with mortality rates in nonexpansion counties during the same periods (176.3-180.9 deaths per 100,000), Sameed Ahmed M. Khatana, MD, and colleagues wrote in JAMA Cardiology.
“After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states,” Dr. Khatana, of the University of Pennsylvania, Philadelphia, and colleagues wrote..
That translated into 2,039 fewer total deaths per year in residents aged between 45 and 64 years from cardiovascular causes after Medicaid expansion, the authors noted.
In all, 29 states, plus Washington, D.C., were included in the expansion group, and 19 states were in the nonexpansion (control) group. During the study period, from 2010 to 2016, the number of expansion counties ranged between 912 and 931, and for the nonexpansion counties, between 985 and 1,029. About half of the residents in each group were women. The percentage of black residents was lower in expansion states, but the percentage of Hispanic residents did not differ. Compared with nonexpansion counties, expansion counties also had a lower prevalence of diabetes (8.5% vs. 9.7% in the nonexpansion counties), obesity (26.2% vs. 29.1%), and smoking (17.1 vs. 18.9%); a lower mean percentage of poor residents (14.4% vs 16.6%; all with P less than .001); and a higher median household income.
Expansion counties also fared better when it came to health insurance coverage. In 2010, 14.6% of their residents had no coverage, compared with 19.5% of residents in nonexpansion counties. During the study period, the decrease in the percentage of middle-aged residents without health coverage was larger in expansion than in nonexpansion counties (7.3% vs. 5.6%, respectively), as was the decrease in low-income residents without coverage (19.8% vs. 13.5%).
However, the authors cautioned that, given the observational nature of the study, they were “not able to make a causal association between expansion of Medicaid eligibility and differences in the cardiovascular mortality rates between the two groups of counties. It is possible that there were other unmeasured time varying factors that can explain the observed association.”
Despite that limitation of the study, which observed adults in all income categories and was not limited to low-income residents, the researchers noted that, given the association between Medicaid expansion and cardiovascular mortality rates, as well as the “high burden of cardiovascular risk factors among individuals without insurance and those with lower socioeconomic status,” policy makers might consider the results in future discussions about changes to eligibility for and expansion of Medicaid.
Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
SOURCE: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.
Counties in states that expanded Medicaid coverage under the Affordable Care Act have experienced a significantly smaller increase in cardiovascular mortality rates among middle-aged adults, compared with counties in states that did not expand coverage, according to findings from a new study.
In expansion-state counties, the change in cardiovascular mortality was stable between the pre-expansion (2010-2013) and postexpansion (2014-2016) periods, at 146.5-146.4 deaths per 100,000 residents per year, compared with mortality rates in nonexpansion counties during the same periods (176.3-180.9 deaths per 100,000), Sameed Ahmed M. Khatana, MD, and colleagues wrote in JAMA Cardiology.
“After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states,” Dr. Khatana, of the University of Pennsylvania, Philadelphia, and colleagues wrote..
That translated into 2,039 fewer total deaths per year in residents aged between 45 and 64 years from cardiovascular causes after Medicaid expansion, the authors noted.
In all, 29 states, plus Washington, D.C., were included in the expansion group, and 19 states were in the nonexpansion (control) group. During the study period, from 2010 to 2016, the number of expansion counties ranged between 912 and 931, and for the nonexpansion counties, between 985 and 1,029. About half of the residents in each group were women. The percentage of black residents was lower in expansion states, but the percentage of Hispanic residents did not differ. Compared with nonexpansion counties, expansion counties also had a lower prevalence of diabetes (8.5% vs. 9.7% in the nonexpansion counties), obesity (26.2% vs. 29.1%), and smoking (17.1 vs. 18.9%); a lower mean percentage of poor residents (14.4% vs 16.6%; all with P less than .001); and a higher median household income.
Expansion counties also fared better when it came to health insurance coverage. In 2010, 14.6% of their residents had no coverage, compared with 19.5% of residents in nonexpansion counties. During the study period, the decrease in the percentage of middle-aged residents without health coverage was larger in expansion than in nonexpansion counties (7.3% vs. 5.6%, respectively), as was the decrease in low-income residents without coverage (19.8% vs. 13.5%).
However, the authors cautioned that, given the observational nature of the study, they were “not able to make a causal association between expansion of Medicaid eligibility and differences in the cardiovascular mortality rates between the two groups of counties. It is possible that there were other unmeasured time varying factors that can explain the observed association.”
Despite that limitation of the study, which observed adults in all income categories and was not limited to low-income residents, the researchers noted that, given the association between Medicaid expansion and cardiovascular mortality rates, as well as the “high burden of cardiovascular risk factors among individuals without insurance and those with lower socioeconomic status,” policy makers might consider the results in future discussions about changes to eligibility for and expansion of Medicaid.
Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
SOURCE: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.
Counties in states that expanded Medicaid coverage under the Affordable Care Act have experienced a significantly smaller increase in cardiovascular mortality rates among middle-aged adults, compared with counties in states that did not expand coverage, according to findings from a new study.
In expansion-state counties, the change in cardiovascular mortality was stable between the pre-expansion (2010-2013) and postexpansion (2014-2016) periods, at 146.5-146.4 deaths per 100,000 residents per year, compared with mortality rates in nonexpansion counties during the same periods (176.3-180.9 deaths per 100,000), Sameed Ahmed M. Khatana, MD, and colleagues wrote in JAMA Cardiology.
“After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states,” Dr. Khatana, of the University of Pennsylvania, Philadelphia, and colleagues wrote..
That translated into 2,039 fewer total deaths per year in residents aged between 45 and 64 years from cardiovascular causes after Medicaid expansion, the authors noted.
In all, 29 states, plus Washington, D.C., were included in the expansion group, and 19 states were in the nonexpansion (control) group. During the study period, from 2010 to 2016, the number of expansion counties ranged between 912 and 931, and for the nonexpansion counties, between 985 and 1,029. About half of the residents in each group were women. The percentage of black residents was lower in expansion states, but the percentage of Hispanic residents did not differ. Compared with nonexpansion counties, expansion counties also had a lower prevalence of diabetes (8.5% vs. 9.7% in the nonexpansion counties), obesity (26.2% vs. 29.1%), and smoking (17.1 vs. 18.9%); a lower mean percentage of poor residents (14.4% vs 16.6%; all with P less than .001); and a higher median household income.
Expansion counties also fared better when it came to health insurance coverage. In 2010, 14.6% of their residents had no coverage, compared with 19.5% of residents in nonexpansion counties. During the study period, the decrease in the percentage of middle-aged residents without health coverage was larger in expansion than in nonexpansion counties (7.3% vs. 5.6%, respectively), as was the decrease in low-income residents without coverage (19.8% vs. 13.5%).
However, the authors cautioned that, given the observational nature of the study, they were “not able to make a causal association between expansion of Medicaid eligibility and differences in the cardiovascular mortality rates between the two groups of counties. It is possible that there were other unmeasured time varying factors that can explain the observed association.”
Despite that limitation of the study, which observed adults in all income categories and was not limited to low-income residents, the researchers noted that, given the association between Medicaid expansion and cardiovascular mortality rates, as well as the “high burden of cardiovascular risk factors among individuals without insurance and those with lower socioeconomic status,” policy makers might consider the results in future discussions about changes to eligibility for and expansion of Medicaid.
Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
SOURCE: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.
FROM JAMA CARDIOLOGY
Key clinical point:
Major finding: Counties in expansion states had 4.3 fewer deaths from cardiovascular causes per 100,000 residents per year after Medicaid expansion, compared with counties in nonexpansion states.
Study details: In this longitudinal, observational study from 2010 to 2016, researchers used a difference-in-difference approach with county-level data for adults from 48 states (excluding Massachusetts and Wisconsin) and Washington, D.C., who were aged between 45 and 64 years. The county-level data were obtained from the Centers for Disease Control and Prevention’s Online Data for Epidemiologic Research mortality database.
Disclosures: Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
Source: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.