- A concerted, industry-wide effort to curb the impacts of opioid abuse on millions of Americans must start with taking a hard look at prescribing practices and focusing more intently on personalized patient-centered care, CMS said in a blog post this week.
With more than 33,000 deaths attributed to opioid misuse in 2015, providers should reexamine their pain management strategies if they wish to address the “staggering” toll of painkillers on patients from all walks of life.
The precipitous rise in the misuse of opioids has sent shockwaves through the healthcare industry, producing negative downstream effects for healthcare providers as well as patients, write Shantanu Agrawal, MD, Director, Center for Program Integrity and Kate Goodrich, MD, MHS, Director, Center for Clinical Standards and Quality.
While opioids do play a critical role in managing acute and chronic pain, and can be used appropriately to significantly improve quality of life for many patients, non-medical opioid use invites higher risks of future heroin use, which may also increase the risk of exposure to HIV/AIDS and Hepatitis C through injection drugs.
The number of adult patients ending up in the hospital due to opioid-related conditions has doubled between 2000 and 2012, a recent report from AHRQ shows, while emergency department visits saw a cumulative increase of 99.4 percent between 2005 and 2014.
“The Medicare population has among the highest and fastest-growing rates of opioid use disorder, currently at more than 6 of every 1,000 beneficiaries,” Agrawal and Goodrich added.
“For Medicaid beneficiaries, the prevalence of diagnosed opioid use disorder is even higher, at 8.7 per 1,000, a figure which is estimated to be over 10 times higher than in populations who have private insurance coverage.”
In conjunction with a 200 percent rise in opioid-related deaths from 2000 to 2014, and a quadrupling of opioid prescriptions over the past two decades without a commensurate rise in reported pain, the wide-ranging impacts of painkiller misuse must be addressed, CMS says.
Tackling this massive public issue will require a coordinated culture change across the industry, involving outreach to patients, collaboration with state public health entities and payers, policy changes, and the implementation of more patient-centered care strategies.
“CMS wants beneficiaries, their families, and caregivers to know what opioids are, the risk associated with their use and the role opioids may play in pain management,” Agrawal and Goodrich said.
“Our primary aim is to ensure that patients, their families, and caregivers have a better understanding of how to work with providers to identify treatment goals and successfully manage pain using current, safe, effective, and accessible treatments; for many patients this may not include an opioid.”
Physicians and other clinicians have a primary responsibility to identify the signs of opioid misuse, suggest alternative treatment pathways, and prescribe opioids more judiciously to prevent negative long-term consequences.
Doing so will require providers to invest in population health management strategies, including individual monitoring and more intensive follow-up for high-risk patients, personalized patient and caregiver education, the use of evidence-based guidelines for opioid prescribing, and the ability to connect high-risk patients to complementary services like substance abuse treatment.
In addition to promoting new CDC guidelines for prescribing opioids for chronic pain and releasing a best practices guide for Medicaid organizations, CMS has recently adjusted its HCAHPS survey criteria to better reflect current views on opioid use.
The agency hopes that removing the pain management dimension of the patient satisfaction framework for participants in the Hospital Value-Based Purchasing program will “eliminate any perceived financial pressure that clinicians might feel to overprescribe opioids.”
“We are continuing to research this issue and develop alternative survey questions, which will focus on provider communication about pain,” Goodrich and Agrawal said.
Other collaborative approaches to addressing the issue include requiring all Medicare Part D and Marketplace plan formularies to include naloxone as a covered medication, developing new policies that will prevent approval for Part D plans that hinder access to medication-assisted opioid treatment, and helping health plans monitor high-risk Part D beneficiaries through the Overutilization Monitoring System.
“CMS is committed to high quality care, including appropriate pain management,” the post concludes. “In order to best fulfill that commitment, we need to modify trends in opioid prescribing, use, misuse, and overdose, and increase support services to help individuals recover from opioid use disorder, as well as provide the full spectrum of evidence-based practices for acute and chronic pain management.”
“We will continue our strong collaboration with community stakeholders, HHS agencies, and across government. We are focused on making a real, positive impact in the lives of our beneficiaries.”
In conjunction with the blog post, CMS has released an updated roadmap of its opioid misuse strategy, which is available here.