Earlier this year, the Centers for Disease Control (CDC) released guidance on opioid prescribing, partly in response to the nation’s opioid epidemic, which resulted in some 19,000 deaths in 2014. The guidelines cautioned against using painkillers as the first course of treatment for patients with chronic pain, and gave strong recommendations about restricting the dosage and duration of treatment with opioids.
The guidelines were not well received by those in the chronic pain management community, who felt the guidelines were biased against appropriate drug therapies for patients with chronic pain. The CDC guidelines were in no way binding, however, and did not address other what might be called structural issues in the chronic pain management framework, such as interdisciplinary cooperation, and fair and transparent reimbursement policies.
Now, however, the Department of Health and Human Services has issued its own National Pain Strategy (NPS), as mandated by the Affordable Care Act. Unlike the CDC document, this 83-page policy paper makes no recommendations about opioid use. In fact, it doesn’t address opioid efficacy at all, or take a position on treatment with opioids.
Instead, the HHS document is designed to give individuals suffering from chronic pain management issues access to a more interdisciplinary, team-based approach to their medical care. In addition, HHS hopes to increase awareness about issues related to chronic pain management both in the health care environment and among the population at large.
Specifically, the strategy aims to help people “recognize chronic pain as a complex disease and a threat to public health,” and calls on the health care community to take “active measures to prevent the progression of acute to chronic pain.” It also calls for resources to provide more education for patients with chronic pain to help them participate in self-management of their condition, as well as understand the pros and cons of various treatment options in order to empower them to partner effectively in their care.
Where the HHS strategy document differs drastically from the CDC guidelines, however, is the well received section on overhauling the payment framework that is at the center of much of the chronic pain management debate. The document states, “Insurance policies have been shown to affect consumer choices of treatments and their adherence to treatment regimens. Payment policies also can affect the clinical strategies adopted by health care providers.” It goes on to conclude that payment models “exert powerful effects on how pain is managed.”
The solution, according to the NPS, is payment reform with guidelines to “foster coordinated interdisciplinary care, and greater support for primary care clinicians to deliver the most effective, safe, and timely care, including more opportunities for consultations with pain specialists.” This multi-modal approach to pain management is designed to dismantle reimbursement barriers that affect treatment options for patients who suffer from chronic pain.
While there is currently no specific timeframe for enacting the recommendations in the NPS, the paper does include a framework for deliverables. In the short term (the first 12 months), the NPS committee will identify and invest in “new models of care that deliver high-value pain care that both maximizes patient benefit and minimizes risk and costs,” and facilitate reimbursement models that increase payment for higher quality pain management. Within two to four years, HHS will issue guidelines on based on pilot studies that explore emerging models of care and payment structures that lead to high quality, low cost pain management care.
As a medical billing team that specializes in pain management clients, M-Scribe understands the coding, documentation, and reimbursement challenges affecting these providers. Contact us today if you have questions about reimbursement guidelines for chronic pain management.