Dr. Steven J. Stack, President of the American Medical Association

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Mark Masselli: This is Conversations on Health Care I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret it's been nearly 35 years since the AIDS epidemic
emerged and finally we can say with some certainty that a tied has been turned in
battling this global health challenge.

Margaret Flinter: Well there is some really encouraging reports coming out of this year's
annual global HIV/AIDS conference in Vancouver. Researchers point to the news that
early int ervention with the antiretroviral treatment can delay HIV symptoms indefinitely
and new evidence that long term exposure to the treatment isn't as harmful to vital
organs health.

Mark Masselli: And they're really are looking at this as a treatable chronic condition in
many cases but of course it must be managed and as we know it's sometimes difficult to
get patients to comply with drug protocol.

Margaret Flinter: Indeed Mark there are an estimated 50,000 newly diagnosed people
infected with HIV in this co untry alone. Embedding HIV testing and routine preventive
care is a evidence based very effective way to help patients know their status early and
take those appropriate steps to avail themselves of treatment.

Mark Masselli: And UN Secretary General Ban Ki - moon announce that they were
tracking it Africa's 50 billion HIV positives patients on the antiretroviral treatment, that
would go a long way towards Caribbean this pandemic.

Margaret Flinter: Some scientist at the conference were predicting that HIV/A IDS as we
know it could be over by 2030, that's -- that would be remarkable but still much more
work to do.

Mark Masselli: Our guest today is a physician with plenty of work to do Dr. Steven J.
Stack is President of the American Medical Association the ch ief lobbying organization
representing physicians and medical students.

Margaret Flinter: Lori Robertson, Managing Editor of FactCheck.org will be stopping by,
she's always on the hunt for misstatements spoken about health policy in the public
domain.

Mar k Masselli: But no matter what the topic you can hear all of our shows by going to
CHCRadio.com and as always if you have comments you can email us at
[email protected] find us on Facebook or Twitter we'd love hear ing from you.

Margaret Flinter: Now we'll get to our interview with Dr. Steven J. Stack in just a
moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's Headline
News.

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Marianne O'Hare: I'm Marianne O'Hare with the se Health Care Headlines. Medicare
has hit a milestone 50 years in business providing access to health coverage for the
nation's seniors 65 and over. A quick snapshot of the popular program shows on
average seniors are healthier, living longer and spendi ng less time in the hospital than
their earlier counterparts. And according to a recent study conducted by Yale physician
Dr. Harlan Krumholz there has been a vast improvement in care interventions over
these past 15 years. Interventions he calls remarka ble and even jaw - dropping.

The researchers looked at the experience of 60 million older Americans covered by
Medicare between 1999 and 2013 and found mortality rates drop steadily during that
time and people were much less likely to end up in a hospital. Krumholz says if rates
had stayed the same in 2013 as they had been in 1999 we would have seen three and
a half million more hospitalizations. The study does note the biggest threat to Medicare
solvency is the dramatic increase in the cost of pharmaceutic al drugs.

And on that note we now have a cure for Hepatitis C roughly three million Americans
are living with Hep - C many can't afford the treatment because it's simply too expensive.
A recent analysis has shown a spike in Hep - C infections due to lack of a ccess to the
expensive cure, abut $80,000 per person. And Americans overall are feeling better in a
survey published in the Journal of the American Medical Association, half a million
Americans polled say they were feeling better in the age of Obama Care than prior to
the passage of the Affordable Care Act.

And having trouble achieving fitness success at the gym? Why not try tapping into your
natural hunter gatherer instincts. A fitness movement sweeping through Europe is
washing up on these shores with t he direct link to our Homo sapiens ancestry the Move -
Net movement suggest you skip the gym and go right to the hiking trail, climb over rocks
instead of using the stair master. Natural movement is at the heart of Move - Net an
international fitness system t hat reclaims hunter gatherer skills to achieve strength,
flexibility and power of course being chased by a saber tooth tiger will certainly get you
moving faster now, won't it? I'm Marianne O'Hare with these Health Care Headlines.

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th
Mark Masselli: W e're speaking today with Dr. Steven J. Stack the 170 President of the
American Medical Association. Dr. Stack is a board certified emergency physician
having served as medical director of multiple emergency departments in Kentucky and
Tennessee. He has also serve the American Medical Association's board of trustees in
several capacities including as its board chair and chair of the compensation committee.
Dr. Stack has a special focus on health information technology, having served on
several AMA advis ory committees to the office of the National Coordinator for Health
Information Technology. He earned his medical degree from Ohio State University, Dr.
Stack welcome to Conversations on Health Care.

Dr. Steven J. Stack: Thank you it's wonderful to be he re.

Mark Masselli: And, you know, the mission of the American Medical Association is to
promote the art and science of medicine for the betterment of public health and also to
advance the interest of physicians and their patients. And certainly one major activity
the American Medical Association is a lobbying organization for the nation's physicians
and there's been so much change and transformation going on out of Washington. And
can you tell our listeners what you see is the most pressing issue for phy sicians and
patients alike as you take on the mantle of the presidency of the American Medical
Association.

Dr. Steven J. Stack: Well I would say that the health system is in remarkable period of
flux and transformation. We undertook a journey a few year s ago to create a new
strategic vision for the work we do at the AMA and in that we have undertaken three
major projects. And we find that physicians face a regulatory Tsunami in which they
feel a challenged and unsupported all too often. And so the AMA is undertaking an
enormous body of work to enhance and improve physician's satisfaction and practice
sustainability. To that end we've undertaken multiple research projects and partnership
with the land corporation, you know, trying to better understand t hose things that
support physicians in the provision of high quality and affordable care for patients.

And then we have two other major areas taking on the most difficult that chronic health
conditions in the United States, pre - diabetes and hyper tension. There's over 70 million
people plus to nearly 90 million people with pre - diabetes. So those two conditions
alone cost over a half a trillion dollars a year to the US health system and if we can
make a dent in that in this period of incredible flux in the health care system it's
essential that the new physicians of tomorrow have the knowledge and skills necessary
to thrive and succeed in a way that helps them provide the best quality care for patients.
And to this end the AMA (inaudible 7:20 ) a consortium of 11 medical schools and have
funded 11 million dollars over a five year period for these 11 schools to create a
learning consortium to radically reform medical education and to create a medical
school of the future. Physicians with a enhance skill set that enables them to be

effective leaders and effective advocates, effective providers of health care for their
patients.

Margaret Flinter: Well Dr. Stack when I think about the regulatory Tsunami it strikes me
that each of those three are significantly impacted by the way practices are organized.
And I know that the AMA recently conducted a survey of the nation's medical providers
and found that a majority of physician still work in small practices. What does the data
show you about the typical configu ration of the work environments of the nation's
physicians and what shifts do you expect to see in the way practices are structured.

Dr. Steven J. Stack: So we found that the number of physicians in small practices
remain the majority at about 61%. On th e other side of its we found that the share of
physicians who work directly for a hospital or on practices that had at least some
hospital ownership increased modestly from 29% in 2012 to 33% in 2014. So clearly
there is a trend towards increasing physici an and pulling that by hospitals but it is not
the falling off the cliff experience. So just this past June where at least for all physicians
of United State is series of 16 modules called Steps Forward. And it's a free online
series of proven solutions that have been developed by physicians for physicians
covering a number of things, how to make your office practice more efficient, how to
select and then how to implement an electronic health record.

People submit ideas via that website for solutions to c hallenging clinical problems and
we hope to fund and grant five or more people to come up with novel solutions to help
us create some new modules to further help physicians. All of these takes place in the
context of us continuing our advocacy the incredi ble crush and burden of regulatory,
difficulties with ICD - 10 implementation, electronic health record meaningful issue
reference to at the beginning of my participation and moderation of a panel to try to give
voice from the grass roots to physician concer ns about the current state of electronic
health records and the federal governments meaningful use program.

Mark Masselli: And Dr. Stack certainly there must be a lot of consternation about the
way practices are compensated and we see the rise of a kind of a care organizations in
patient centered medical homes. And can you tell our listeners how these emerging
approaches are impacting the physician practices?

Dr. Steven J. Stack: In our study we found three key things, physicians had actually
seen some positive effects from the models. Doctors have said that they actually like
the concept when the model is fair and reasonable they like being paid to help keep
patients healthy. And they also found out that though they want to embrace these new
payment m odels they required an infrastructure and they require adequate lease
sources that's both financial and then human resources order to achieve these goals.
But that the current programs frequently do not provide those resources so and the final

thing I wou ld say is that a one physician sums it all up that it's like there's so much lack
of coordination across these that he said that it was like 50 people shouting their
priorities to you at the same time. So we need to streamline and harmonize quality
metric s, we need to make sure that there is timely accurate and actionable data. And
we need to make sure that these new payment delivery models provide physicians and
their practices the resources like I said both the financial and human in order to make
them successful.

Margaret Flinter: Now Dr. Stack now you conducted a recent town hall meeting called
Cutting the Red Tape where you certainly heard a number of concerns from providers
about this issue. I understand the AMA has asked HHS Health and Human Servi ces to
push back on meaningful use stage three, share this with our listeners what does this
mean in short?

Dr. Steven J. Stack: The government requirements related the EHR technology. If
interfered with face to face discussions with patients they've crea ted new cost that divert
resources away from patient care improvements. The much anticipated benefits being
able to share important patient health information electronically among and between
providers in different settings has gone utterly unfulfilled. In another landmark study
physicians found electronic health records to be the current most frustrating and
profound obstacle to providing quality patient care. And it's resulted in a lot of
physician, dissatisfaction, emotional fatigue having said that o ne of my other favorite
quotes is a referred physician digital omnivores.

We are some of the fastest and the most widespread doctors of new and early
technology such as smart phones and tablet computers. So we have ask the
administration to hold off on th e final stage of the meaningful use program because the
jump between stages one and two is already been so substantial. So many of those
physicians at the town hall in Atlanta commented that they had adopted one person -- I
think it was 1984 they had firs t adopted an electronic health record that is more than 20
years before the federal government created the meaningful use program. And yet
these people are struggling to work within the current construct of meaningful use in the
current world of EHRs.

One of those people even wrote their own personal electronic health record himself and
he's not reverted back to it and is taking a 1% (inaudible 13:11 ) from the government his
own software helped him to be far more efficient and effective for his patient. S o there's
always a risk of sounding overly negative, there is no doubt that we need to move
forward with effective and well - done health IT we have to take this massive one fifth of
the economy and organize it in a more effective way that enables us to bett er learn from
it and to better share it when it's appropriate between physicians and other clinicians
and our patients. And so one of the reasons we're doing town halls is to try to get the

grass root physician the opportunity to share just how constructi vely engage they have
been, the incredible amount of time, effort and money they have invested trying to make
this succeed and why it's so important for policy makers and others to hear their
concerns.

Mark Masselli: We're speaking today with Dr. Steven J . Stake President of the
American Medical Association. Dr. Stack is a board certified emergency physician. So,
you know, I do want to pull the threat a little more on this because you also said earlier
that you are trying to think about the next generati on of providers and have 11 medical
schools working on that and I wonder how much technology is going to loom in that sort
of new training.

Dr. Steven J. Stack: Right now there's more than 80% of physicians in United States
using electronic health records , kudos for that I mean so at this point now we think that
the federal government should focus on prioritizing all of its efforts to interoperability to
making these digital silos which we have sadly created actually interconnect and
communicate with each other. We also think that technological innovation will be
enhanced if the regulations from the federal government are reduced.

So the vendors for electronic health records and the physicians in the hospitals are now
empowered to work together to make tho se system (inaudible 15:08 ) them in the way
they need to. We want to make sure that patients are informed, we don’t think that
some of the rigidly mandated ways that we've been told we must structure those data
through patient portals and other things are either what some of our patients are asking
for or are being produced by vendors in a way that is useable and easy for patients and
physicians. So we really want to make those things better and we think allowing natural
innovation to occur would be a far better mechanism for that.

In our medical education work we do have some schools who are working very
specifically to use real patient data, to run simulated health care environments where
the students manage and treat our virtual patients if you will usi ng real data and learn
how to most effectively make use of electronic health record technology. Health IT is far
bigger than just electronic health records and that we all can confuse or conflict the two
so with wearables like Fitbits and smart phones and other devices that collect patient
generated data there is an enormous tidal wave of change ahead where we will have
this incredible influx of data, we're going to have to find ways to find among that
massive amount of data what helps patients and physici ans work together to provide
better care. But we have to be very careful, just within the last two weeks there is a
breach effecting maybe four and a half million patients whose health records are
compromise. The office of personal management for federal government had -- was it
22 million people?

Mark Masselli: Right.

Margaret Flinter: Right.

Dr. Steven J. Stack: Data was compromise and so for all of us who have to have 15
passwords the data's incredibly secure from those of us who need it but necessarily not
secured from those who shouldn’t have access to it. So we got to find a rational way to
make that safer.

Margaret Flinter: You know, shift just a little bit to so that I think the AMA is not shy
about budding heads with policy makers on i ssues that are of importance to your
members and to the organization. And a recent issue was the ongoing SGR formula
the Sustainable Growth issue which was finally resolved after more than a decade, so
congratulations for that. And then another such issu e is the switch to the ICD - 10 codes
for medical billing which we've been actively lobbying against for quite some time
successfully winning a delay last year for the plan start date, but this year I understand
the AMA has come to an agreement with the cent ers for Medicare and Medicaid
choosing to recommend compliance with this year's October 1 start date. Tell us a little
bit about the AMA reason both for the push back also the nature of the compromise that
you were able to achieve.

Dr. Steven J. Stack: I 've had a real privilege to work with physicians other participants
in the health care system and policy makers. They're committed civil servants trying to
do the best they can. Not that this is ever personal this is all about the issues and
differences of opinion and trying to get most effective way to outcome I think most of a
share. So ICD - 10 is a good example of this, the AMA has raise concerns that there is
an ordinate amount of detail and complexity that the code said explodes by over 400%.
And th ere are certain elements of the detail on there that make it a particularly
challenging paradigm shift for how we're going to have to document certain thing.

The collaboration we've had with CMS which I think is a wonderful example of how
policy makers and the professional can work together, acknowledges that there's this
complexity. And for a period of time for the first year of the implementation the
physicians will still be required to use the new code (inaudible 18:41 ) and to code in the
right family o f codes but enhance specificity where most people do acknowledge there's
a lot of complexity and uncertainty will not in and of itself be a reason to deny a client.
So if you see a physician -- you have a chest pain we still have the document, you have
ch est -- we have to code that correctly that you have chest pain. But we may not have
to put that you have acute chest pain secondary to chronic, hypertensions secondary to
water skiing after fell off a ladder or -- that's I've seen kind of examples that pe ople
come up when they came together bizarre circumstance. And so over the first 12
months of this we'll continue to partner and work with CMS and with the private fair

community to try to find what is a good and new reasonable study stake but not drown
o ut physician practices with economic distress because if denied claims which would
make it difficult for them to keep their doors open and care for patients. And so I think
it's a wonderful partnership we've had and we hope and we'll strive mightily to tr y to
st
make that transition this October 1 as smooth as possible for everybody involve.

Mark Masselli: We've been speaking with Dr. Steven J. Stack President of the
American Medical Association, you can follow their work by going to AMA - ASSN.org or
you ca n follow him on Twitter at Steven Stack MD. Dr. Stack thank you so much for
joining us on Conversations on Health Care today.

Dr. Steven J. Stack: Thank you it's been a great privilege and pleasure.

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Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about health care reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org a nonpartisan,
nonprofit consumer advocate for voters that aim t o reduce the level of deception in US
politics, Lori what have you got for us this week?

Lori Robertson: On the subject of medicinal marijuana republican presidential
candidate Carly Fiorina said that "we don’t understand how it interacts with other drug,
but there is information about marijuana's interactions with other medication".
Prescribing information for approved versions of medicinal marijuana does include drug
interaction details. However there is less information available on medicinal marijuan a
compared with other medications because it's legal status more difficult to study in
clinical trials.

The prescribing information for one pill form of medicinal marijuana includes warnings
about potential interactions such as depressive effects when used with any central
nervous system depressant. Another pill form warns that it should be used with caution
by those also using sedative hypnotics or psychoactive drugs (inaudible 21:29 ) have
looked at the effect of medicinal marijuana specifically on patien ts undergoing cancer
treatment that was the context of Fiorina's remarks she was diagnosed with breast
cancer in 2009.

One study published in 2007 found that (inaudible 21:45 ) of medicinal marijuana doesn’t
significantly influence how certain cancer drugs function. Other study from 2011 found
that medicinal marijuana combined with a drug use to treat brain tumors produce a
strong anti - tumor effects and for HIV/AIDS patients a 2003 study found no adverse
effects on patients from medicinal marijuana. And th at's my fact check for this week, I'm
Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at th e
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health C are.

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Mark Masselli: Each week conversations highlights a bright idea about how to make
wellness a part of our communities and to everyday lives. Depression is extremely
common among adolescents in this country but it's often hard to differentiate between
typically teen angst and a clinical condition that requires more immediate intervention.
Suicide is the third leading cause of death among 10 to 24 year olds a population that
almost ubiquitously uses texting as a form of communication. Nancy Lublin is founder
and CEO of Cr isis Text Line an instant texting service design to encourage teens in
crisis to reach out for help which they receive instantly. All they have to do is text the
numbers 741741.

Nancy Lublin: So if you're someone who is in pain you text us and then the c ounselor
on the other side is not working from a phone they're on a screen that almost looks kind
of like Facebook or Gmail. When messages come in with certain keywords in them they
automatically get tagged as high risk. So we don’t take them chronologic ally, if you're at
risk for suicide you're automatically bumped up in the queue and you're like a code red,
you got flagged on our system. And the supervisor would determine whether or not this
person with the eminent harm.

Mark Masselli: Since she found ed Crisis Text the word had spread like wild fire. They
receive an average of 15,000 text per day from kids experiencing everything from
typical teen dilemmas such as a fight a boyfriend, to kids contemplating suicide, those in
most danger are encouraged to take action through a serious of channels. Crisis text
line an instant age appropriate intervention available free of charge and 24/7 to give
kids in crisis a lifeline, and leave them the help they need, now that's a bright idea.

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Margaret Flinter: This is Conversations on Health C are, I'm Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and health.

Conversations on Health C are, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brou ght to you by the Community
Health Center.