Sarah Wakeman: Treating Patients With Substance Use Disorders & the Opioid Crisis

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Today we are joined by Sarah Wakeman to talk about substance use disorders, one of the most pressing public health issues of our time. Sarah is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative. She designs systems of care that draw on the strengths of communities to care for patients and residents with addictions. Sarah also practices in the Adult Medicine Department of the MGH Charlestown HealthCare Center.

We talk about the importance of language and discourse on the care for patients with substance use disorders (4:00), how an approach of compassion has proven more effective than the popularized tough love style (7:30) and how rewarding it can be to witness a patient have a Lazarus moment (10:00) in a journey to recovery. We also talk about the very real challenges of caring for this patient population (13:00), the complexities and power dynamics of monitoring (16:15), and what needs to be done to turn around the epidemic (20:45).

You can find the landmark report on the opioid epidemic from our Surgeon General Vivek Murthy here, which is full of helpful information on this topic.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Natalie Spicyn: Unionizing Clinicians

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This week we are joined by Natalie Spicyn, an internist and pediatrician at Chase Brexton, a Federally Qualified Community Health Center in Baltimore. Like all FQHCs, Medicaid patients are a large portion of the Chase Brexton payor mix, but the clinic also provides specialized care for a large and active LGBT and HIV positive community in the city.  Last year, caregivers and administrators faced conflict regarding proposed workflow, volume, and compensation restructuring. Several employees were terminated during early efforts at unionization; ultimately, clinicians voted to unionize and attempt collective bargaining.  Natalie published an op-ed in the Baltimore Sun during this tumultuous period, and joins us to talk about her experiences with unionizing, fair compensation practices in primary care, and how all of this affects patient care.

Photo: Rally outside Chase Brexton Health Care in Baltimore, Maryland, on Aug. 19, 2016. Photo: Jay Mallin, jay@jaymallinphotos.com, Courtesy of 1199 SEIU

Matt Broaddus: What are Medicaid Block Grants?

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This week we are joined by Matt Broaddus to talk about block granting Medicaid, which is a major health policy change that the Trump administration plans to pursue in the coming months. Matt is a Research Analyst in the Health Division at The Center on Budget and Policy Priorities, a non-partisan research and policy institute in Washington DC. His policy, research, and analytical work is conducted in the areas of Medicaid and the State Child Health Insurance Programs.

We start with an overview of the Medicaid program, the largest insurance program in the US. We touch on the possible benefits of block granting (19:00), and how it may affect other industry stakeholders such as health systems, hospitals, community health centers, and insurers that offer Medicaid managed care products (23:20). Lastly we discuss another block granted program, CHIP and why many see it as a successful block grant program (29:00), and one other suggestion that has been made for Medicaid reform, per-capita funding (32:45).

You can find the article we mentioned by Sara Rosenbaum here, as well as some additional resources on block grants from Kaiser Health News and The Commonwealth Fund.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Photo: President Lyndon B Johnson surrounded by supporters and advisors signing Medicare into law.

Journal Club: Powers et al – Non-Emergency Medical Transportation; Delivering Care in the Era of Uber and Lyft

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This week we’re excited to bring you a journal club episode, highlighting a study published in the September 2016 issue of JAMA by Brian Powers and colleagues Scott Rhinefort and Sachin Jain from Caremore Health, entitled NonEmergency Medical transportation, Delivering care in the Era of Lyft and Uber. Powers and colleagues report on their pilot study of Caremore Health patients utilizing Uber and Lyft for non-emergency medical transportation to and from appointments.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Jessie Gaeta: SPOT – Supportive Place for Observation and Treatment

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Today our guest is Jessie Gaeta, the Chief Medical Officer of Boston Health Care for the Homeless Program. She is a leading advocate for supportive housing for chronically homeless individuals, and has led BHCHPs efforts in responding to the opiate use disorder and overdose crisis, which is what we discussed.

Dr. Gaeta and her colleagues found themselves confronting the reality of opiate overdose as the leading cause of death among Boston’s homeless individuals day after day on their campus. In reaction to this, Gaeta and her colleagues opened SPOT, or Supportive Place for Observation and Treatment – a space within their building where individuals can come after using to ride out a high while being monitored by a nurse for overdose, and for opiate reversal if necessary.

Photo: Jessie Gaeta, MD

Andrew Morris-Singer: Organizing & Advocacy

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We are joined this week by Andrew Morris-Singer, a general internist and founder of Primary Care Progress. Primary Care Progress is a national non-profit organization dedicated to building a stronger primary care system. Working with current and future healthcare professionals from across disciplines and career stages – from students and faculty to providers and health systems leaders – PCP offers leadership development and support that emphasizes relational skills, individual resiliency, and advocacy. Andrew has a unique background as a community organizer with more than 15 years of experience. He is a lecturer in Global Health and Social Medicine at Harvard Medical School, an Assistant Professor in the Dept of Family Medicine at OHSU and an Adjunct Professor in the Department of Family and Preventive Medicine at the University of Utah. He currently sees patients in Portland, Oregon. On the show, we talk about relational leadership,  advocacy and activism in primary care.

Photo: Andrew Morris-Singer MD

Emma Sandoe: Affordable Care Act Repeal Update

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Emma Sandoe, a PhD student in Health Policy Political Analysis at Harvard University, joins us for a discussion of the Affordable Care Act. Prior to starting her PhD program, Emma spent six years in Washington, DC working on the passage and implementation of the ACA. She served as the spokesperson for Medicaid and HealthCare.gov at the Centers for Medicare & Medicaid Services and worked on ACA coordination at the HHS Budget Office.

We start with an overview of the ACA and then review key players in the repeal and replace efforts thus far (5:25); the recent CBO report and the possibility of an insurance premium death spiral (15:00); the likelihood of Trump’s ability to keep his promise to retain the popular provisions of the ACA and what a replacement law might look like (18:00); the ACA’s flaws and some historic context for them (24:12); and give some well-hedged predictions for the coming weeks (32:05).

We discuss a report released last week by the Congressional Budget Office projecting what might happen if the ACA is repealed without a replacement, and two articles from healthcare reporter Sarah Kliff looking at potential ACA replacement plans and a story about discontent with the ACA among beneficiaries. Here is a helpful article from New York Times reporter Margot Sanger-Katz looking at what President Trump’s executive order against the ACA might mean. You can find the resources for getting involved Emma mentioned here.

Follow us and tweet us your thoughts @RoSpodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email us at contact@rospod.org. We’d love to hear from you. And thanks for listening.

Journal Club: Sinsky et al, Allocation of Physician Time in Ambulatory Practice

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David Rosenthal, Thomas Kim, and Audrey Provenzano discuss the recent manuscript published in Annals of Internal Medicine by Sinsky and colleagues, Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

Have you ever wondered how much time you spend each month fighting with technology or filling out VNA forms? Well, Christine Sinsky and her colleagues studied this and have some answers for us…all of which raise more fascinating questions about how we practice medicine.

Tweet us your thoughts @rospodcast, and send us feedback at contact@rospod.org!

David Levine: Home Hospital Research

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On our premier show, Dr. David Levine, a general internist and research fellow in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital and Harvard Medical School talks about his research looking at home hospitalization. Instead of admitting patients to the floors from the ED, he admits them back home. He also reflects on some of his other research and interests in the quality of outpatient care, digital health technology, and novel methods of care delivery.

Check out an article about David’s research in the Boston Globe, a video about his home hospital work, and one of his other publications that we talk about in the show, comparing doctors to symptom checking software.

We also reference Bruce Leff, a leader of the home hospital movement in the US; Community Servings, an organization in the Boston area dedicated to bringing wholesome food to the chronically ill; and Iora Health, an innovative healthcare delivery organization.

Welcome to Review of Systems – Your Primary Care Podcast

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Welcome to Review of Systems, your podcast for discussion of primary care innovation, payment reform, health care policy, and more. Our mission is to produce a weekly show that will engage clinicians, administrators, policy makers and public health officials in a conversation about how we can make primary care better for our patients.

The show is produced and hosted by Audrey Provenzano, an internist in the Boston area, with co-hosts Thomas Kim, a family practice physician in Houston, and David Rosenthal, an internist in Connecticut.

Our first show is coming next week! Stay tuned!