Ethics guidance is regularly added or amended in the AMA Code to reflect changes in medical science and societal expectations. As with any “living” document that is authored by different individuals over many decades, the AMA Code became fragmented and unwieldy.
To address these issues, the AMA embarked on a multi-year “modernization” project to comprehensively review and update the AMA Code. After much deliberation and debate, the AMA House of Delegates adopted the modernized AMA Code last June.
“The modernization project ensures that the Code of Medical Ethics will remain a useful and effective resource that physicians can continue to rely on, while remaining faithful to the virtues of fidelity, humanity, loyalty, tenderness, confidentiality and integrity enshrined in the original Code,” AMA Immediate Past President, Steven J. Stack, MD, said.
A commemorative, leather-bound edition of the modernized AMA Code is available.
Published in Population Health Management, the study demonstrates how preventing the onset of type 2 diabetes can reduce annual health care costs by thousands of dollars per patient and generate large positive returns on investment (ROI) for health systems, insurers and employers.
Researchers in the study used individual-level claims data from more than 8,000 commercially insured adults to estimate medical expenditures among individuals with prediabetes. Data on expenditures were combined with findings from previous studies to estimate net savings and ROI if they were to participate in a Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention program (DPP).
Based on an analysis of the data, researchers found that:
• Patients who develop diabetes are very costly. Expenditures during the one-to-three-year period following HbA1c screening are one-third higher for those who develop diabetes. That amounts to an annual average of $2,671 per patient.
• Preventing diabetes is more than a vital public health solution—it’s an effective financial strategy. Because the annual cost differential for patients who develop diabetes is significant, “The three-year ROI for a National DPP is estimated to be as high as 42 percent,” wrote the study’s authors, Tamkeen Khan, Ph.D., Stavros Tsipas and Gregory Wozniak, Ph.D., all of the American Medical Association (AMA).
• Diabetes prevention programs are still one of the best solutions for improving health outcomes and reducing burdensome medical expenditures. In fact, patient participation in a CDC-recognized DPP in a community-based or primary care setting costs between $400 and $500 per person—far less than the average annual medical care expenditure savings. Not to mention previous research confirms that the impact of these programs extends beyond dollar signs: People who complete DPPs are one-third less likely to develop type 2 diabetes after 10 years.
Using results from this analysis and findings in previous studies, the study authors estimated just 14 percent of patients who complete a DPP will be diagnosed with diabetes within three years, compared with 29 percent of those who do not participate.
DPPs in California: The California Medical Association's plan to prevent diabetes
These recent findings underscore precisely why AMA and the California Medical Association (CMA) have partnered to advance patient participation in DPPs throughout our state and galvanize support for community-based interventions.
More than 86 million Americans are living with prediabetes, but most of them are unaware. In California alone, an estimated 13 million adults have the condition, putting them at high risk of developing type 2 diabetes without intervention.
"The diabetes epidemic is out of control and getting worse. In California, diabetes rates have increased by 35 percent since 2001," says CMA President Ruth Haskins, M.D. "In partnership with AMA we are working hands-on with California's physicians to implement meaningful diabetes prevention efforts to improve the health of Californian's and ultimately improve the health of people across the country.”
The partnership is part of Prevent Diabetes STAT, a strategic effort launched by AMA in collaboration with the CDC in 2015 to engage more Americans with prediabetes and slow the progression of type 2 diabetes.
"The goal of this partnership is to get patients with prediabetes into proven lifestyle change programs that have been shown to cut the risk in half of progressing to type 2 diabetes," said AMA President Andrew W. Gurman, M.D. "By working with a variety of practices and health systems within California, we are learning the best ways to implement processes for screening, testing and referring across different clinical settings. We will use these models in the future to support other states as they adopt a similar process—helping even more Americans stave off or delay type 2 diabetes to improve health outcomes."
Calculate DPP savings for your patient population
An online tool from AMA helps employers, insurers, health systems and others to calculate net savings and ROI for their sample populations. Play with this calculator to see how upping the share of your patients who enroll in a DPP can have a sizeable effect on the number who develop diabetes and how much money can be saved through prevention.
To find a CDC-recognized program near you or online, visit https://nccd.cdc.gov/DDT_DPRP/Programs.aspx.
For more diabetes prevention resources from AMA and CMA, visit http://www.cmanet.org/issues-and-advocacy/cmas-top-issues/public-health/diabetes-prevention/
• CHOC implemented an EHR-enabled Pediatric Early Warning System (PEWS) to trigger a rapid response team for deteriorating patients. As result, approximately 369 children have avoided resuscitation, with potentially as many lives saved.
• CHOC implemented centralized breast milk preparation including barcoding to effectively eliminate feedings of the wrong breast milk. Efficiencies associated with the centralized processes for breast milk preparation resulted in significant annual savings.
“CHOC demonstrates an enterprise-wide approach to collaboratively identifying clinical challenges, selecting IT interventions and developing workflows to address those challenges,” said Jonathan French, senior director of quality and patient safety and Davies program director with HIMSS. “Through using information technology to standardize care and continually look to improve care delivery and outcomes, CHOC has significantly improved the quality and patient safety outcomes for their patients. HIMSS is proud to recognize CHOC as a 2016 Davies Enterprise Award winner.”
Named one of the best children’s hospitals by U.S. News & World Report (2016-17) and a 2016 Leapfrog Top Hospital for safe, quality care, CHOC has achieved recognition as a HIMSS Stage 7 EMR (electronic medical record) adoption hospital. CHOC is also a leader in the adoption of population health technologies, and is a recipient of a $17.7 million grant from the Centers for Medicare & Medicaid to help Southern California pediatricians expand their quality improvement capacity, learn from one another and achieve common goals of improved care.
“These examples of our institutional quality and safety initiatives are an important part of our mission to nurture, advance and protect the health and well-being of children. As we now reach out to the larger community with our population health efforts, our focus extends to keeping well children well, in addition to keeping those who are ill as well as they are able to be,” explains Dr. William Feaster, chief medical information officer, CHOC.
CHOC will be recognized as a HIMSS Davies Award recipient at the 2017 HIMSS Conference & Exhibition, Feb. 19-23, in Orlando, Fla. For more information on the awards program, visit the HIMSS Davies Award website.
“Being acknowledged as a Top Hospital is an incredible feat achieved by less than three percent of hospitals nationwide,” said Leah Binder, president and CEO of The Leapfrog Group. “With this honor, CHOC has established its commitment to safer and higher quality care. Providing this level of care to patients requires motivation and drive from every team member. I congratulate CHOC’s board, staff and clinicians, whose efforts made this honor possible.”
To see the full list of institutions honored as 2016 Top Hospitals, please visit www.leapfroggroup.org/tophospitals.
Contact: CMA Member Help Center (800) 786-4262 or firstname.lastname@example.org.
*The California Medical Association/Institute for Medical Quality (CMA/IMQ) is accredited by the Accreditation Council on Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The California Medical Association/Institute for Medical Quality (CMA/IMQ) designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Provider approved by the California Board of Registered Nursing, Provider Number CEP370, for 1 contact hours.
On-demand webinars are not available for CEU or CME credits.
By: Darla S. Holland, M.D., President, OCMA
The OCMA Board of Directors met on Thursday, November 10. The following highlights the major discussions and actions that took place at that meeting: