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WASHINGTON – MedPAC advisors think it might be time to address opioid abuse as a quality of care issue.
Commission member Herb Kuhn, president and CEO of the Missouri Hospital Association, suggested the Centers for Medicare & Medicaid Services develop coding that tracks how opioids are used and what conditions they are treating and see of those treatments line up with standards of care.
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“You could begin to look at some of the protocols from some of the medical societies in terms of proper prescription or activities here and begin to look at this more as a quality initiative so that, ultimately, that comes into play in terms of payment,” Mr. Kuhn, a former deputy director at CMS, said at the Oct 9 meeting of the Medicare Payment Advisory Commission.
Commissioner Scott Armstrong, president and CEO of Seattle’s Group Health Cooperative, agreed.
“To me, this is much more a quality of care issue,” Mr. Armstrong said. Currently “what’s so difficult here is that all of our interventions are retrospective.”
He noted that within his organization, once opioid prescribing became an issue, every patient prescribed an opioid was identified.
“We began to monitor what percentage of those patients had a proactive care management plan,” he said. “Every patients’ needs are going to be different, but it was really about are we paying attention to the evidence and the kind of use of opioids that should be appropriate given to every individual patient.”
Commissioner Kathy Buto, former vice president of global health policy at Johnson & Johnson and senior health advisor at the Congressional Budget Office, called on CMS to better understand how Medicare can incentivize better pain management efforts.
One challenge that will need to be overcome in Medicare is that in Part D stand alone plans, there is no direct connection between the drug benefit and the rest of the health care services provided, something that also will need to be resolved as the country shifts to an accountable care model.
MedPAC advises Congress on issues affecting Medicare and makes recommendations on payment and quality issues affecting the program. No recommendations were made at this meeting as commissioners still sought seeking further information on how to address opioid abuse.
Commissioners also suggested CMS find incentives to promote the use of tools such as prescription drug monitoring programs more regularly.
