Opioids Bill Means Sweeping Changes to Pain Management

On October 3, the U.S. Senate passed by an overwhelming vote of 98-1 the bipartisan-supported House omnibus opioids bill, H.R.6, the “ SUPPORT for Patients and Communities Act,” which made its way through Congress for most of the year as dozens of separate bills. The House passed this final version September 28.

Much of the bill concerns opioid abuse treatment. However, it also seeks to make sweeping changes in surgeons’ approaches to pain management. Key provisions are:

• The Department of Health and Human Services (HHS) is being told to start collecting data, a year after the bill is signed, on opioid prescriptions for common surgeries, including prescribing patterns, opioid use before and after surgery, average dosages at the hospital, quantity and duration of opioid prescription at discharge, and quantity consumed and number of refills. HHS is directed to issue publicly an action plan to implement pain management protocols to limit opioids both perioperative and upon discharge.
• For Medicare patients, the already-covered Initial Preventive Physical Examination for new members will include review of the patient’s current opioids and risk factors for opioid abuse, and information on alternatives.
• All Medicare prescriptions for Schedules II through V drugs must be conveyed electronically, unless exempted by HHS.
• HHS is to create a technical panel, including representatives from medical and surgical specialty societies, to recommend how to reduce opioid use in inpatient and outpatient surgical settings and best practices for pain management, including:
  • ow to limit perioperative patient use of opioids and how to identify patients at risk of opioid use disorder pre-operation.
  • Shared decision making with patients and families on pain management.
  • Education on safe use, storage, and disposal of opioids.
  • Prevention of opioid misuse and abuse after discharge.
  • Development of a clinical algorithm to identify and treat at-risk, opiate-tolerant patients and reduce reliance on opioids for acute pain during the perioperative period.

• Medicare Advantage plans and part D prescription drug plans will be required to inform enrollees about risks associated with opioids and about coverage, if any, of nonpharmacological therapies and nonopioid medications or devices used to treat pain.
• HHS will be required to hide patient information on pain from the public:
  • After January 1, 2020, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) “may not include questions about communication by hospital staff with an individual about such individual’s pain unless such questions take into account, as applicable, whether an individual experiencing pain was informed about risks associated with the use of opioids and about non-opioid alternatives.”
  • HHS will no longer be allowed after January 1, 2020 to include pain management question results as a quality indicator in the “Hospital Compare” website.
  • Patient pain management questions and answers will no longer be considered in reimbursements to hospitals for quality under the “hospital value-based purchasing program” for 2018 and 2019.

The Centers for Medicare and Medicaid Services (CMS) proposed a more extreme approach to hiding pain survey data from patients.

• The Food and Drug Administration (FDA) is instructed to issue evidence-based guidelines for prescribing opioids—which the FDA said it’s already undertaking on its own (FDA’s Draconian Opioid Plan Rebukes CDC,” Orthopedics This Week, Wednesday, September 9, 2018.).
• For Medicare patients, the Initial Preventive Physical Examination for new members will include review of the patient’s current opioids and risk factors for opioid abuse.