by Jared Staheli
February 27th, 2018
The opioid epidemic continues to ravage communities nationwide. Since 1999, opioid deaths have quadrupled. 91 Americans die every day from opioid overdoses, and these numbers show no signs of declining. To address an epidemic of this magnitude, unprecedented cooperation between all involved parties needs to occur. In January 2017, CMS released a white paper aimed at disseminating strategies among payers for reducing the impact of opioid use disorder in the United States. The white paper is directed at instituting changes across all types of payers (e.g., public, private, employer-based, etc.), so providers need to be aware of the types of changes that they may be expected to understand and comply with.
The Healthcare Fraud Prevention Partnership (HFPP) outlines five priority actions they strongly advise payers consider adopting:
- Train providers on the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain
- Promote access to and usage of Medication-Assisted Treatment (MAT)
- Promote the availability of naloxone
- Encourage the use of data to identify fraudulent, wasteful, or abusive practices associated with opioids in order to target corrective actions
- Identify and disseminate effective practices across the healthcare sector
This is not an exhaustive list of actions that payers may take, and each payer may choose different actions, so it may be beneficial for organizations to contact their payers and find out what actions they are taking and what they expect from providers. Some payers may not require anything from the provider's end, while others may ask that providers participate in some kind of training or continuing education program. It is also important to find out what approaches payers are taking because it may mean opportunities for your practice to expand its offerings. For example, your organization may consider expanding access to Medication-Assisted Treatment or telehealth services. Providers also need to be aware that many payers will be analyzing claims and looking for outliers in opioid prescribing rates.