Why I’m voting against marijuana legalization in Massachusetts

I’m not dead set against the eventual legalization of marijuana for recreational use. Still, I’m strongly opposed to Massachusetts ballot question 4: Legalization,  regulation and taxation of marijuana, and will be voting No.

Why? Because the arguments in favor of approval are not strong enough to make Massachusetts one of the first states to legalize. And some of the arguments against the ballot measure raise serious concerns. Instead I’d like to take five years or so to observe  how things go in early-legalization states like Colorado and Oregon and apply the lessons in Massachusetts.

I thought Massachusetts did the right thing by de-criminalizing marijuana. That kept police and the courts from wasting resources on possession of small amounts of marijuana and stopped lives from being ruined through unfair imprisonment and the stigma of  a criminal record.

Voters then went further and approved medical marijuana, which as I expected, became a precursor to the push for full legalization just a couple years later.

The innovative Citizens’ Initiative Review Project summarized the pros and cons of Question 4. The strongest pros were as follows (quoted verbatim):

• Legalized and regulated marijuana is safer than black market marijuana because the legalized product will be tested and clearly labeled according to state regulations.

• Question 4 will create a large number of regulatory, law enforcement, legal, and licensure jobs that are supported by taxes on the sale of marijuana.

• Question 4 would give patients and health providers ready access to marijuana without committing a crime. Legalization could help people avoid opiates, addiction and worse problems. 

The first point is accurate, however there is an implicit assumption that legalization will eliminate the black market. Colorado’s experience indicates that the black market may continue to thrive alongside the regulated, legal market, and that the official market is the province of middle and upper class white people, while the poor and minorities are priced out. So that’s not such a strong argument.

On the second point, it’s weird that one of the strongest arguments for a libertarian-oriented law would be to create large numbers of government jobs. That’s a terrible rationale as far as I’m concerned.

On the third point, there is already ready access to medical marijuana for patients and health care providers, thanks to the legalization of medical marijuana. There are some hints that people may be substituting marijuana for opiates. That’s probably a good thing and we should follow it closely.

The strongest “con” arguments from the Review Project include the views I expressed above about the black market and large number of new government jobs. The cons include two additional, compelling points:

• Although in development, at this time there is no definitive method of testing for impaired drivers.

• There is conflicting evidence of an increase in teen use or motor vehicle accidents in states that have legalized recreational use.

Beyond the Review Project’s findings, there are other good arguments against legalization. Marijuana is addictive for some people, it affects the developing brain in negative ways, and “edibles” are too easy for kids to get ahold of and to consume before or during school.

Please join me in rejecting Question 4 in Massachusetts in this election. If you do, I promise to be open minded about reviewing my stance in a few years, once evidence is in from other states.

Image courtesy of Paul at FreeDigitalPhotos.net

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By healthcare business consultant David E. Williams, president of Health Business Group.

 

from Health Business Blog https://healthbusinessblog.com/2016/10/24/why-im-voting-against-marijuana-legalization-in-massachusetts/
via A Health Business Blog

Health Wonk Review is up at Health System Ed

Health System Ed hosts the election edition of the Health Wonk Review, where healthcare bloggers do their very best to keep democracy alive. This edition leads off with a set of opportunities for bi-partisan cooperation in healthcare. Amen to that!

from Health Business Blog https://healthbusinessblog.com/2016/10/21/health-wonk-review-is-up-at-health-system-ed-5/
via A Health Business Blog

The case for healthcare cooperation with Cuba

I learned quite a bit from a brief Perspective in the New England Journal of Medicine (The United States and Cuba –Turning Enemies into Partners for Health).

A June Memorandum of Understanding (MoU) between the US Department of Health and Human Services and the Cuban Ministry of Public Health lays out a wide variety of areas for cooperation, including infection diseases like Zika, plus cancer and chronic conditions.

Thanks to the embargo, products developed in Cuba aren’t available in the US because they are not allowed into the FDA approval process. As a result, certain drugs like Heberprot-P, to reduce amputation risk for diabetic foot ulcers, aren’t available in the US even though they are on the market in many other countries.

We don’t need to copy the Cuban health system, but there are some lessons to be learned from Cuba’s experience with population health, community-based programs, disease control, and chronic care management.

It isn’t possible to fully implement the MoU now, because the embargo remains in place and only Congress can lift it. If Democrats take control of Congress, that could happen soon. If not, the author argues that the President has the authority to allow Cuban products into the US regulatory process just like products from any other country. He’d also like to see the President allow US students to attend medical school in Cuba, where some have been offered scholarships.

These all sound like good ideas to me and I hope they are implemented.

Image courtesy of taesmileland at FreeDigitalPhotos.net

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By healthcare business consultant David E. Williams, president of Health Business Group.

from Health Business Blog https://healthbusinessblog.com/2016/10/20/the-case-for-healthcare-cooperation-with-cuba/
via A Health Business Blog

Mass Health Quality Partners: 21 years young

Barbra Rabson, MHQP President and CEO

Health Business Group is a sponsor of the upcoming anniversary party for Massachusetts Health Quality Partners (MHQP). I asked MHQP’s President, Barbra Rabson to reflect on the first couple decades.

MHQP is about to celebrate its 21st anniversary. What are you celebrating?

We are celebrating the courage and vision it took 21 years ago to found MHQP, and the amazing two decades of progress we’ve made since our inception. Our 21^st anniversary is symbolic of our coming of age and reaching a level of maturity. MHQP has become an important part of the Massachusetts healthcare landscape over the decades thanks to the commitment and hard work of our diverse stakeholders – including patients, physicians, hospitals and payers.  More than 40 sponsors and over 300 people are gathering on November 2 to celebrate MHQP’s unwavering commitment to reliable healthcare measurement and transparency and our pioneering work in the Commonwealth and the nation to systematically capture the patient voice and integrate it into care improvements.

At our anniversary celebration we will be honoring the vision of MHQP’s Founding Circle –Blue Cross Blue Shield of MA, Fallon Health Plan, MA Business Roundtable, MA Hospital Association (MHA), MA Medical Society (MMS), Harvard Pilgrim Health Care (HPHC), Tufts Health Plan and the State (Governor Charlie Baker was a founding member of MHQP when he was Secretary of Administration and Finance).

We will also be awarding MHQP’s first award in honor of the late Richard Nesson, MD, a founding visionary of MHQP when he was the Chair of the MHA Board in 1995 when MHQP was established.  We are delighted that Susan Edgman-Levitan, the executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and the founding president of the Picker Institute will be the first recipient of MHQP’s H. Richard Nesson Award.

How has the environment changed in MA over the past 21 years? What role has MHQP played in that?

The healthcare environment is drastically different than it was when MHQP was founded in 1995.  When MHQP first started collecting and reporting comparative statewide performance information, we were the only game in town.  For example, MHQP’s first in the nation statewide patient experience survey of acute care hospitals and public release came a full decade before CMS developed the hospital H-CAHPs survey! Likewise, when MHQP began collecting and reporting statewide clinical and patient experiences measures for ambulatory care, MHQP’s data was the only reliable source for quality benchmarks for our provider organizations.  Before MHQP’s comparative quality reports, Massachusetts provider organizations only knew their own performance scores, they had no comparative benchmarks or best practices to drive performance improvements.  Physician leaders  (Barbara Spivak, Tom Lee and others) have told us MHQP’s performance reports were invaluable to them because our reports became the writing on the wall that they needed to make significant investments in their organization in the form of electronic health records and quality improvement infrastructure to advance their performance to the level they aspired to.

Another big change is that our reimbursement systems now provide millions of dollars of incentives for provider organizations to improve performance.  When MHQP first started the term ‘pay-for-performance’ had not yet been coined.  MHQP has always [encouraged] improvements through public reporting of reliable and trusted comparative performance information – relying on physicians’ intrinsic motivation to perform as well as they can. Now that provider compensation depends heavily on measurement we need to work harder to make sure we have accurate and fair measurements of quality care.

Finally, back in 1998 when MHQP first starting reporting on patient experiences of care, patient experience was not considered a core measure of quality.  MHQP’s statewide collection and reporting of patient experience helped draw national attention to the importance of listening to patients, and in 2001 the IOM introduced the concept of patient centered care as a key element of quality care in the Crossing the Quality Chasm Report.

Kindred organizations to MHQP have arisen around the country over the last couple decades. How do you relate to them?

MHQP was one of the first regional health improvement collaboratives (RHICs) to be founded in the country. Gordon Mosser (founding CEO of ICSI in Minnesota) and I organized the first meeting of regional collaboratives in 2004.  As a founding member and past Board chair of NRHI (the Network for Regional Healthcare Improvement), it has been very gratifying to see so many new RHICs being established.  There are now more than 40 across the country.  I have been told by many of the younger RHICs that MHQP was a role model for them when they were first starting out, and I take great pride in that.

What does the future hold?

Great question, and one I have been reflecting on as we have been looking back on our first 21 years. One of the biggest challenges (and one of our greatest failures as a health care system) has been that we have not done a good job engaging our patients as a resource to help us improve outcomes. In many cases we have actively refused to seek input from patients, and when given feedback we have ignored it.  We are now trying to make a 180 degree shift on this, to better engage patients in the co-production of solutions, and it is not easy because it requires a shift in mindset.  I believe that MHQP’s two decades of experience capturing the patient voice and integrating that voice into care improvements positions us extremely well to support our practices and healthcare systems as they embark on this journey.

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By healthcare business consultant David E. Williams, president of Health Business Group.

from Health Business Blog https://healthbusinessblog.com/2016/10/11/mass-health-quality-partners-21-years-young/
via A Health Business Blog

Is radiology doomed?

Which path to take?

The radiology profession is a famously paranoid lot, often worried about encroachment on imaging from non-radiologists, competition from teleradiology, reimbursement squeezes, and more. Auntminnie.com is a good place to go to observe how these worries play out.

The latest article, Will machine learning turn radiologists into losers? is a case in point. It reports on a New England Journal of Medicine article that asserts that machine learning will replace radiologists. Images will be sent straight to algorithms, bypassing radiologists completely, they say. There are differences of opinion on how soon this will happen, but an appreciation that once the electronic tools are good enough they will be preferred.

As a patient I’m all in favor of faster, more accurate, and cheaper interpretation of images and if that means there’s no future role for radiologists, so be it. But actually what I hope is that radiologists start to assert themselves as diagnostic quarterbacks, helping to organize and analyze information from pathology, genomics, lab tests and physical examinations. They can work with teams of clinicians in new ways, to speed diagnosis and treatment decisions.

I am aware that some enlightened radiology leaders are already thinking in these terms. I hope the fears spurred by the development of machine learning will accelerate the movement.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

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By healthcare business consultant David E. Williams, president of Health Business Group.

from Health Business Blog https://healthbusinessblog.com/2016/10/07/is-radiology-doomed/
via A Health Business Blog

Health Wonk Review is up at Managed Care Matters

Managed Care Matters hosts an alliterative edition of the Health Wonk Review (Pre-election pundit ponderings!) which you are bound to enjoy.

from Health Business Blog https://healthbusinessblog.com/2016/10/07/health-wonk-review-is-up-at-managed-care-matters-18/
via A Health Business Blog

Boston Children’s gets the go-ahead. I’m quoted

From the Boston Globe (Children’s gets green light for hospital expansion, with conditions)

Massachusetts health regulators said Friday that Boston Children’s Hospital should be allowed to go forward with a $1 billion expansion project, a recommendation that seeks to support one of the state’s premier hospitals without undermining efforts to control medical spending.

The staff at the Department of Public Health recommended approval of the plan to build an 11-story building in Longwood and an eight-story outpatient clinic in Brookline.

Here’s my quote:

“DPH seems to be trying to satisfy everyone here, including taxpayers, health insurers, [Children’s Hospital], and competing hospitals,” said David E. Williams, president of Health Business Group, a Boston consulting firm. “The conditions DPH lays out may help achieve these goals, but it is hard for a government agency to manage the hospital market so tightly.”

Children’s plan to use its expanded capacity to draw patients from out of state and overseas is consistent with the hospital’s overall strategy. DPH appears to accept Childrens’ explanation, but wants assurances that MassHealth patients will not be displaced and that Childrens will not attempt to lure well insured, healthier patients away from local competitors.

Ironically, DPH seems to be fighting the last war. After all it was Partners, not Children’s, that expanded widely within the local market. Meanwhile Children’s big recent acquisition was in New York, New Jersey and Connecticut not Massachusetts.

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By healthcare business consultant David E. Williams, president of Health Business Group.

from Health Business Blog https://healthbusinessblog.com/2016/10/02/boston-childrens-gets-the-go-ahead-im-quoted/
via A Health Business Blog