AAFP: Fix physician payment to stem opioid epidemic By AAFP News Staff
An important starting point for addressing the nation’s opioid misuse epidemic is the creation of payment models that allow physicians to spend more time with patients and ensure they are appropriately compensated for services tied to substance abuse, the AAFP recently told a Senate committee. In February 2018, the Senate Finance Committee asked medical organizations for suggestions to address the epidemic, and the AAFP responded on Feb. 14 with a detailed letter that described how restrictive insurance policies and administrative burdens associated with nonpharmacologic treatment are hindering care for patients dealing with substance use disorders. “It is unfortunate that the payment and regulatory framework for physician practices has reduced face-to-face time with patients, making it more difficult for physicians and patients alike,” the AAFP wrote in the letter, which was signed by Board Chair John Meigs, MD, of Centreville, Alabama. Exacerbating the problem are the restrictions payers place on mental health care that family physicians are trained to provide. “Unfortunately, payment for primary care office visits with a mental health diagnosis code has traditionally been discounted or proscribed by private insurance, Medicaid and Medicare,” the letter stated. “Many man-
[cont. from 21] The American Society of Addiction Medicine offers a waiver training course in multiple formats.
www.asam.org/education/live-online-cme/waiver-training The American Academy of Addiction Psychiatry also offers a course covering legislation, pharmacology, safety, patient assessment, and more.
www.aaap.org/education-training/mat-8-hour-waiver-training The Project Extension for Community Healthcare Outcomes, or Project ECHO, is a learning and guided-practice model in which expert teams use videoconferencing technology to teach physicians in remote areas. The project began and is still largely housed at the University of New Mexico School of Medicine. The first project focused on treatment of kidney disease but the model is now used to expand clinical expertise across a wide range of diseases, including opioid use disorder. For a few more months, Project ECHO is hosting a set of interactive learning opportunities funded by a grant from the Health Resources and Services Administration that results in a certificate of training completion from ECHO and the American Society of Addiction Medicine. The program ends on August 31, 2018.
https://echo.unm.edu/nm-teleecho-clinics/opioid/ 22
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aged care plans do not pay family physicians for the provision of mental and behavioral health care, even though family physicians are frequently in the position to diagnose, treat, and provide the needed care.” The letter suggested that Medicaid and Medicare payment incentives could be used to reduce costs associated with opioid use disorder and other substance abuse treatment and to support appropriate co-prescribing of naloxone. The AAFP pointed out to the committee that although guidelines — including one from the CDC that the AAFP affirmed — support nonpharmacologic treatment for low back pain, for example, such treatment faces barriers from public and private insurers. “It is currently easier to write a prescription for opioids than to prescribe nonpharmacologic treatment,” the letter stated. In addition, more educational materials are needed to help patients who expect a prescription to accept nonpharmacologic treatment. The letter also warned the committee against “one size fits all” approaches to educating physicians about opioids. Family physicians already are committed to “fine-tuning their ability to prescribe opioids appropriately and effectively,” the AAFP said, noting that members completed more than 141,000 CME credits on this topic in 2016 alone. “The AAFP continues to believe educating physicians is an important tool, but to be impactful, the education must be designed to address needs and gaps of the learners,” the letter stated. The committee also should consider ways to improve the interoperability of state prescription drug monitoring programs, and the AAFP noted its support for a national prescription database. Source: AAFP News, Feb. 27, 2018. © 2018 American Academy of Family Physicians.
AAFP CHRONIC PAIN MANAGEMENT TOOLKIT AAFP offers an extensive set of tools and resources for combating the opioid epidemic through its Chronic Pain Management Toolkit, available at www.aafp.org. According to AAFP, “The toolkit helps family physicians identify gaps in practice flow, standardize evaluation and treatment of chronic pain patients, and facilitate conversations on pain and treatment goals, as well as identify and mitigate risk.” It includes an action plan, pain inventory, work questionnaire, patientphysician medication agreement, opioid risk tool, and links to external resources, AAFP articles and issue briefs. There you can also find CME webcasts on opioid addiction treatment and the Academy’s position paper, “Chronic Pain Management and Opioid Misuse: A Public Health Concern.” And don’t forget about the trove of patient information you can mine at familydoctor.org. From the main toolkit page, you’ll find links to at least four articles for patients on chronic pain, opioid addiction, prescription drug abuse in the elderly, and the safe use, storage and disposal of opioids.
www.aafp.org/patient-care/public-health/pain-opioids.html Opioid addiction and the death and despair it brings seem an almost intractable problem, and ending this epidemic will take the combined and sustained actions of all facets of society. Family physicians on the front lines of care have an integral role to play in this effort. We hope these resources assist you as serve your community.