AAOS February 6, 2018
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Opioid Hearing Focuses on CMS Actions

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Opioid Hearing Focuses on CMS Actions

On January 17, the House Ways and Means Committee held a hearing titled “The Opioid Crisis: The Current Landscape and CMS Actions to Prevent Opioid Misuse.” The hearing focused on efforts by the Centers for Medicare and Medicaid Services (CMS) to utilize data to identify individuals in the Medicare Part D program who are at risk to abuse opioids. It also examined the agency’s tools to support those efforts and any areas in need of improvement.

“The opioid crisis in this country is devastating entire communities,” stated House Ways and Means Chairman Kevin Brady (R-TX). “While many Medicare patients need certain opioid medication as part of their treatment, there are a growing number of reports of opioid abuse within the Medicare program. As one of the biggest payers of prescription drugs, CMS has a responsibility to ensure that prescription drugs are not abused, particularly those that are highly addictive such as opioids. During this hearing, Members will learn from experts about Medicare and opioids and whether CMS facilitates opioid use that may not be medically necessary and could be harming the very community Medicare is intended to help.”

As was expressed at the hearing, opioid abuse and misuse is a significant national problem that has grown substantially over the past couple of years. In 2015, opioid-related deaths exceeded 33,000 people with more than 60 percent of drug overdose deaths attributed to opioids. The hearing also emphasized that there is an additional problem within the Medicare program, where more than one-third of Medicare’s 44 million beneficiaries are prescribed an opioid at some point during the year. In 2016, the Medicare program spent $4.1 billion on opioids, an increase of 165 percent from 2006. Furthermore, the HHS OIG found more than 500,000 beneficiaries who received high amounts of opioids in 2016. As one of the nation’s largest payers of prescription drugs, it was noted that CMS can play an important role in identifying and preventing opioid abuse.

Witnesses included Gary L. Cantrell, Deputy Inspector General for Investigations at HHS, Elizabeth H. Curda, Director, Health Care, Government Accountability Office (GAO), and Kimberly Brandt, Principal Deputy Administrator for Operations at CMS.

“Combating the opioid epidemic is a top priority for the Department of Health and Human Services and the Administration as a whole,” stated Brandt. “In April 2017, HHS component agencies developed targeted initiatives to respond to this crisis with a multi-pronged approach identified to improve prevention, access to treatment and recovery services. HHS outlined its five-point Opioid Strategy, which provides the overarching framework to leverage the expertise and resources of HHS agencies in a strategic and coordinated manner.”

The Opioid Strategy mentioned by Brandt aims to:

  1. Improve access to prevention, treatment, and recovery support services to prevent the health, social, and economic consequences associated with opioid addiction and to enable individuals to achieve long-term recovery;
  2. Target the availability and distribution of overdose-reversing drugs to ensure the broad provision of these drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations;
  3. Strengthen public health data reporting and collection to improve the timeliness and specificity of data and to inform a real-time public health response as the epidemic evolves;
  4. Support cutting-edge research that advances our understanding of pain and addiction, leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms; and
  5. Advance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.

AAOS continues to engage with Congress and CMS to address this issue, and to help prepare our members for conversations with their patients, AAOS recently launched a new pain relief tool kit. The online resource includes pre- and postoperative discussion talking points on pain relief, common pain relief solutions, orthopaedic and emergency department opioid strategies, a questionnaire for determining patient opioid addiction risk, and safe use storage and disposal strategies/resources.

The committee has another hearing, titled “Removing Barriers to Prevent and Treat Opioid Abuse and Dependence in Medicare,” scheduled for Feb. 6.