Physician Practice Roundup—Surgeon General says more people should carry naloxone; FDA head suggests mandatory opioid education for doctors

Doctors talking
The Surgeon General is urging more Americans to carry a lifesaving drug that can reverse an opioid overdose. (Getty/wmiami)

Surgeon General urges more people to carry naloxone to prevent opioid overdose

Surgeon General Jerome M. Adams, M.D., released a public health advisory today urging more Americans to carry naloxone, which can reverse the effects of an opioid overdose.

Adams is recommending that more people, including family, friends and those who are personally at risk for an overdose, keep the drug on hand.

In an emailed statement, the American Medical Association endorsed the Surgeon General’s call for expanded availability of naloxone and said its task force on opioids has encouraged physicians to co-prescribe naloxone for all patients at risk of overdose. (Surgeon General’s public health advisory)

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FDA commissioner suggests mandatory opioid education for physicians

The head of the Food and Drug Administration says the time may have come to require mandatory drug prescription and pain management training for physicians and others who prescribe opioids.

“Given the scale of the [country’s opioid] epidemic, it’s time to seriously consider mandatory education. Too many doctors from around my generation were trained in a manner that encouraged prescribing that was far too liberal,” FDA Commissioner Scott Gottlieb, M.D., said in prepared remarks he delivered at a national summit on the drug crisis Wednesday night.

Gottlieb said it might be most efficient to require mandatory training at the time of DEA registration and registration renewal that all prescribers must undergo. He envisions coupling training with education on the treatment of addiction, including prescribing buprenorphine, the drug used to treat addiction. The idea of mandatory training remains controversial and is opposed by the American Medical Association, which does not want to see the government impose a requirement on physicians.

Given the FDA’s evidence that there is a wide variation in the number of pills doctors prescribe for the same surgical procedure, the training could include information about the appropriate dose and duration of opioid analgesic use for the most common outpatient indications, Gottlieb said. (Copy of remarks by Scott Gottlieb)

CMS finalizes regulations to curb opioid misuse among Part D beneficiaries

Pharmacies and Part D beneficiaries will see new limits on opioid prescriptions starting next year.

As part of a Medicare Advantage final rule, the Medicare agency is also moving forward with policies to curb opioid misuse. And the agency seems to have taken some policy advice from Congress. 

The rule established a ceiling of 90-milligram morphine-equivalent units for opioid prescriptions under the Part D Medicare program starting in 2019. A prescription at or above 90 mg will require the pharmacist to speak with the prescribing doctor regarding the dosage and determine if an override is appropriate. 

The agency's initial proposal, which would have limited the prescription override to the insurer, received widespread backlash during the comment period.

“We received hundreds of letters from patients who have taken opioids for long periods of time and are afraid of being forced to abruptly reduce or discontinue their medication regimens with sometimes extremely adverse outcomes, including depression, loss of function, quality of life, and suicide,” the agency wrote in the rule. The “overall consensus was that a 90 MME-per-day hard edit threshold would have little clinical impact against opioid overuse.” (FierceHealthcare)

Walmart-Humana deal could be bad news for hospitals

Hospitals will be keeping a close eye on the potential merger between Walmart and Humana, as the deal could significantly hurt their bottom lines. 

Sources told The Wall Street Journal last week that Walmart, the nation's largest employer and retail giant, was in talks to purchase Humana. Walmart has dipped its toes into healthcare in the past, opening a series of primary care clinics in its stores. 

A merger with Humana would accelerate the corporation's entry into the healthcare space, a prospect that's worrying to providers, according to an article from the WSJ. The deal "should be a concern to everybody in healthcare," Randy Oostra, CEO of Ohio-based health system ProMedica, told the publication. (FierceHealthcare)

Atrium Health agrees to part ways with Mecklenburg Medical Group after physicians sue for independence

A medical group under Charlotte, North Carolina-based Atrium Health sued the system on Monday to be freed from their employment contracts and noncompete clauses. 

The nonprofit health system, which was until recently known as Carolinas HealthCare System, agreed to allow the Mecklenburg Medical Group to operate independently, according to a statement emailed to FierceHealthcare.  

The lawsuit (PDF), obtained by Charlotte Agenda, includes 92 of the 104 doctors that work for Mecklenburg. The physicians claim that Atrium's "self-serving monopolistic and anticompetitive actions" hinder their ability to provide high-quality care to their patients. (FierceHealthcare)

Doctors bring smiles, get recognition for aid work

Here’s some happy news about doctors. Two Mayo Clinic doctors, whose musical rendition went viral, landed on “The Ellen DeGeneres Show.”

The duo became an internet sensation, as Elvis Francois, M.D., sang Mike Yung’s hit song “Alright,” while fellow resident William Robinson, M.D., accompanied him on the piano. The song from the two orthopedic surgeons was an homage to patients and the stresses they encounter. The video of their performance attracted over 2 million views on Facebook.

And a group of 11 doctors from Florida Hospital were recognized for their aid work in Puerto Rico after Hurricane Maria devastated the island. In a declaration, the government of Puerto Rico labeled the doctors heroes. “It took us by surprise; we weren’t expecting it. No one did this because they wanted to be recognized,” said Katia Lugo, M.D., an emergency room doctor, who traveled to the island in late September. (Star Tribune, Orlando Sentinel)

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