Viewpoints: ‘Street Opioids’ — Not Prescriptions — Drive Drug Crisis; Open Up Research On Gun Violence
Editorial pages focus on these health topics and others.
The Myth Of What’s Driving The Opioid Crisis
As an addiction psychiatrist, I have watched with serious concern as the opioid crisis has escalated in the United States over the past several years, and overdose deaths have skyrocketed. ...I have also watched a false narrative about this crisis blossom into conventional wisdom: The myth that the epidemic is driven by patients becoming addicted to doctor-prescribed opioids, or painkillers like hydrocodone (e.g., Vicodin) and oxycodone (e.g., Percocet). (Sally Satel, 2/21)
Death By Gun Violence — A Public Health Crisis
(Editor's note: This week, JAMA republished this editorial from Nov. 14, 2017). The journals of the JAMA Network are dedicated to improving the health of people across the globe. We do so by addressing the most important public health problems harming people and publishing the best science that can be done. Research on gun violence is important, although Congress over the last 2 decades has placed limits on that science from being conducted. This attempt to suppress research into gun violence resulted in a 64% decline in the number of firearm studies per million citations in SCOPUS between 1998 and 2012. (Howard Bauchner, Frederick P. Rivara, Robert O. Bonow, Neil M. Bressler, Mary L. (Nora) Disis, Stephan Heckers, S. Andrew Josephson, Melina R. Kibbe, Jay F. Piccirillo, Rita F. Redberg, John S. Rhee, June K. Robinson, 2/21)
How Can We Remedy The Shortage Of Health Providers?
In a medical mecca like Boston, which is home to three medical schools and many world-class hospitals, you’d think that getting a timely appointment with a primary care physician or specialist would be a breeze. It isn’t. Finding a doctor is even harder in rural and underserved areas. Yet the public debate on health care remains focused on insurance and funding, and largely ignores the undersupply of health care professionals. Access to care means more than adequate insurance. (Jeffrey S. Flier, 2/21)
Organ Network Needs To Keep The Voice Of Children's Advocates
A key goal of the [United Network for Organ Sharing] Pediatric Committee is to develop evidence-based policies that improve children’s access to organ transplants. That work could be jeopardized by a recent proposal by UNOS leaders to convert the Pediatric Committee — the lone voice for children in transplantation — to an “expert council” that cannot sponsor policy changes. Under the proposal, advocates for children would be incorporated into larger, adult-focused committees. This troubling move might improve efficiency, but at the risk of decreasing children’s access to lifesaving organ transplants. (Evelyn K. Hsu and Jorge D. Reyes, 2/21)
People With Disabilities Are Rapidly Joining The Workforce
TV reflects and shapes how we think about each other, including our family and neighbors with disabilities. "Born This Way," "The Good Doctor" and "Speechless" offer role models with high expectations for inclusion and success. These positive TV depictions parallel a hopeful trend in our country — as new statistics show 343,483 more people with disabilities joined the American workforce in 2016. This was four times the rate of the previous year. It’s a combination of fighting stigmas, supporting strong public policies and using best practices to lift up the talents of people with disabilities. (Jack Markell, 2/22)
Disentangling Health Care Billing
For many physicians, the term administration elicits a negative response. In fact, some administrative tasks and expenses, such as quality improvement personnel, cybersecurity, backup generators, and even parking, are necessary to enhance patient experience and care. Other expenses, most notably related to billing and insurance-related activities, seem less justifiable. In this issue of JAMA, Tseng and colleagues estimated the administrative costs associated with physician billing and insurance-related activities in one large academic medical center with a fully implemented electronic health record (EHR) system. (Vivian S. Lee and Bonnie B. Blanchfield, 2/20)
Principles For A Framework For Alternative Payment Models
The way physicians, hospitals, and other health care professionals are paid influences patient care because payment methods affect business models that clinicians and health care facilities use to prioritize investments, establish infrastructure, and design care processes. Fee-for-service medicine and its volume-based financial incentives can lead to overuse of low-value services and suboptimal care. A consensus is emerging among patients, health care professionals, payers, and purchasers that transitioning to alternative payment models (APMs) that better incentivize value for patients is essential for improving the quality and affordability of health care. (Sam Nussbaum, Mark McClellan, Grischa Metlay, 2/20)