Physicians in New Hampshire and around the country report feeling pressure to overprescribe opioids because patient pain surveys are tied to their hospital’s Medicare reimbursements.
Breaking the link between federal reimbursements and pain management surveys was one of the initiatives to combat the national opioid crisis released by the United States Department of Health and Human Services on Wednesday.
The change was inspired by a bill co-sponsored by New Hampshire U.S. Rep. Annie Kuster and West Virginia Rep. Alex Mooney.
“To me, it’s at the heart of why people are being prescribed too many opiates,” Kuster said in an interview on Thursday.
Kuster first heard of physicians being reimbursed by Medicare last year during roundtables discussing the heroin and opiate crisis.
“This was a thing that kept coming up in our conversations,” she said. “Often, the physicians and hospital administrators acted as though their hands were tied.”
Kuster said she was shocked to hear there was any sort of financial influence when it came to how doctors were prescribing opioids for pain.
“There shouldn’t be any incentive in that way,” Kuster said.
New Hampshire Medical Society President James Potter said the new rule will allow doctors to better use their clinical judgment with each patient.
“It’s one of those factors that creates another challenge for physicians and hospitals,” he said. “(It’s) is a very good thing and a step in the right direction to take this away.”
Potter said there are multiple studies showing that patients reporting more pain on their surveys corresponds with doctors prescribing more opioids to relieve it.
Potter added he’s glad to see the medical community in the state address the issue head-on and also work closely with law enforcement.
“We’re all trying to actively work on a number of fronts on this,” he said. “Overall, we’re really gaining.”
Though the new measure applies to Medicare reimbursements, Kuster said she is hopeful Medicaid and private insurance companies follow suit.
“It’s a significant development of national consequence,” she said. “These issues are urgent.”
Earlier this year, the Centers for Disease Control and Prevention and the New Hampshire Board of Pharmacy changed their guidelines for prescribing this kind of medication, admitting that opioids can be addictive when used improperly.
Kuster and Mooney’s bill, called the “Promoting Responsible Opioid Prescribing” or PROP Act, is still making its way through the U.S. Congress, but she said she was happy to see these national recommendations come through faster than the legislation could.
“It’s precisely what we wanted in our legislation,” she said. “This certainly is faster than Congress.”
Other initiatives released Wednesday include increasing the number of patients buprenorphine providers can treat from 100 to 250, boosting education around prescribing, and prioritizing addiction research.
Buprenorphine is a maitenance drug that reduces the euphoric effects for heroin and other opioids while keeping withdrawal symptoms at bay.
Currently, buprenorphine providers are capped at 100 patients. The new measure would more than double that number and will go into effect on August 5.
Manchester mayor and Republican gubernatorial candidate Ted Gatsas applauded the change in the rules in a statement Thursday.
“Based on current waiting lists in New Hampshire there is a real need for this increase and I fully support it,” Gatsas said. “While this is not a cure-all solution it is a much needed step in the right direction to reduce opiate addiction in the Granite State and I applaud it.”