Full-Spectrum Prevention

SAFE Takes analyzes and assesses the federal recommendations and proposals made by the White House and National Governors Association.

SAFE Takes reflects our analysis and assessment of the progress made in each of the recommendations made by the President’s Commission (Commission) on Combatting Drug Addiction and the Opioid Crisis (November 2017) and the National Governors Association’s (NGA) Recommendations for Federal Action to End the Nation’s Opioid Crisis (January 2018). The following SAFE Takes focuses on government action pertaining to full-spectrum prevention efforts.

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RECOMMENDATIONS S.A.F.E. TAKE
NGA:  Continue to coordinate with existing prevention programs in schools and avoid increasing stigma and fear around punitive approaches for those who need access to treatment. Expand federal support for new and additional resources to support training officers in schools, community engagements, and other educational activities.

 

STATUS 
Limited Infrastructure
 
This recommendation will largely be helped by implementing universal screening programs for students, in addition to supportive environments and activities to keep students out of triggering situations for return to use. Funding without the infrastructure to support long-term prevention and support for those in recovery will reap few benefits. Our SAFE Campuses program will work to support and provide opportunities for those in recovery in higher education.
RECOMMENDATIONS S.A.F.E. TAKE

Commission #18: The Center for Medicare & Medicaid Services (CMS) should remove pain survey questions entirely on patient satisfaction surveys so that providers are never incentivized for offering opioids to raise their survey score. The Office of National Drug Control Policy (ONDCP) and Health & Human Services should establish a policy to prevent hospital administrators from using patient ratings from CMS surveys improperly.

STATUS 
Slow Progress
 

There is no agreement on what the right measures are for patient satisfaction and health outcomes, especially as they relate to propensity for opioid misuse.¹ ² Research in these areas is key; ensuring that patients have access to the right treatment, rather than the easiest and cheapest treatment, which matters to the long term wellness of the patient.

NGA has a long history of working with states to tackle complex issues, including opioids. Their leadership helps states develop public policy options, and helps identify what is working in other states. Analysis of which  states have policies that correspond to removing pain survey questions, as well as an analysis of what is working or not working would be helpful. The states then adopt their own state policy and regulations to align state systems with federal regulations.

The bureaucracy around changing state policy, internal systems, and effective implementation of those changes will slow down this recommendation.

RECOMMENDATIONS S.A.F.E. TAKE
Commission #19: CMS should review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.

 

STATUS 
Time and Labor Intensive
 
There are few provisions for alternative pain treatments across federal and private insurers. Some states are convening “Payors” councils to examine service definitions and establish payment mechanisms. CMS included in its 2018, Roadmap to Address the Opioid Crisis, a plan to “disseminate best practices for state Medicaid agencies and other payers on alternative pain management strategies and other tactics to address the opioid crisis.” Although, reimbursement rates for alternative treatments remain an under addressed barrier to reducing opioid dependence.
¹Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey
²Does Hospital Consumer Assessment of Healthcare Providers and Systems survey correlate with traditional metrics of patient satisfaction?