If you’ve watched or read the news during the last year, you’re probably aware of the ongoing opioid epidemic in the United States. As drugs like fentanyl have spread across the nation, fatality rates have exploded, with around 59,000 deaths from opioid abuse reported in 2016. Even higher numbers are expected once data is compiled for 2017 and beyond, and despite a public outcry to halt the epidemic, government officials and health care administrators alike have so far been unable to contain or even slow the spread of these dangerous drugs across the country. And the problem isn’t limited to overdoses - studies have suggested that opioid use can shorten average life expectancy by 2.5 months.
It’s a problem of staggering proportions, one that we’re only just now beginning to understand. Luckily, as the data have demonstrated the severity of the problem, steps are being taken to address how opioids are administered as a part of pain management and overall medical treatment plans.
DORN is excited to share the latest blog from our guest blogger Mark Pew about the opioid crisis in the United States.
The Joint Commission’s Game-Changer
The Joint Commission announced their new standards for pain assessment and management on August 29, 2017, via their R³ Report (Requirement, Rationale, Reference). These new standards will be effective January 1, 2018, for all accredited hospitals around the United States. This is a game-changer for the opioid epidemic.
Why is this a game-changer? First,The Joint Commission “certifies nearly 21,000 health care organizations and programs in the United States,” so their influence is massive. Secondly, the new standards are dramatically different from the existing standards they defended in April 2016 against accusations of “fostering dangerous prescribing practices by physicians that contributed to the country's opioid crisis.” The Joint Commission’s press release about the new standards affirmed the problem by referencing a statistic from the U.S. Department of Health & Human Services that 91 Americans die from an opioid overdose every day. Within one year, the clinician’s role in the epidemic could no longer be ignored and the only path forward requires their involvement. In this case, mandatory involvement.
The R³ Report is exhaustive in its coverage. The expectation is that these revised standards will “improve the quality and safety of care” by requiring hospitals to:
• Identify pain assessment and pain management, including safe opioid prescribing, as an organizational priority (LD.04.03.13)
• Actively involve the organized medical staff in leadership roles in organization performance improvement activities to improve quality of care, treatment, and services and patient safety (MD.05.01.01)
• Assess and manage the patient’s pain and minimize the risks associated with treatment (PC.01.02.07)
• Collect data to monitor performance (PI.01.01.01)
• Compile and analyze data (PI.02.01.01)
For each intended goal, there is a list of requirements: LD.04.03.13 has seven, MD.05.01.01 has one, PC.01.02.07 has eight, PI.01.01.01 has one, and PI.02.01.01 has two. Each requirement has a rationale (a narrative description of why it needs to be done) and references (citations of studies that explain how they came about deciding on this particular requirement). But don’t be fooled by the relatively small quantity of requirements - they are substantive. Those that resonated most with me include:
• The hospital has a leader or leadership team that is responsible for pain management and safe opioid prescribing and develops and monitors performance improvement activities. (LD.04.03.13, EP1)
• The hospital provides non-pharmacologic pain treatment modalities and promotes non-pharmacologic strategies, either by providing these themselves or post-discharge. These strategies include, but are not limited to physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy. (LD.04.03.13, EP2)
• The hospital identifies opioid treatment (addiction) programs that can be used for patient referrals. (LD.04.03.13, EP5)
• The hospital facilitates practitioner and pharmacist access to the Prescription Drug Monitoring Program databases. (LD.04.03.13, EP6)
• The medical staff is actively involved in the establishment of protocols and quality metrics and in reviewing performance improvement data. (MD.05.01.01, EP18)
• The hospital has defined criteria to screen, assess, and reassess pain that are consistent with the patient’s age, condition, and ability to understand. (PC.01.02.07, EP1)
• The hospital develops a pain treatment plan based on evidence-based practices and the patient’s clinical condition, past medical history, and pain management goals. (PC.01.02.07, EP4)
• The hospital involves patients in the pain management treatment planning process. (PC.01.02.07, EP5)
• The hospital collects data on pain assessment and pain management including types of interventions and effectiveness. (PI.01.01.01, EP56)
• The hospital monitors the use of opioids to determine if they are being used safely. (PI.02.01.01, EP19)
As you read the 3,536 words - which I strongly suggest you do - it’s obvious that many of the conclusions The Joint Commission has reached on what should be the standard of care by clinicians to patients are not new, especially if you’ve heard me speak or read any of my written musings. The impact of newly expected behavior in hospitals cannot be underestimated, as maintaining accreditation by The Joint Commission is of primary concern to every hospital administrator. The requirements for compilation and analysis of compliance performance will ultimately provide transparency that will help patients and payers identify the best treatment options. I’m sure organizations like the Leapfrog Group will very quickly incorporate these metrics into their hospital rating system.
There are likely many hospitals that already comply with most, if not all, of these requirements. However, there are many hospitals that likely comply with few or none of these requirements. All will need to be in compliance in just a few weeks, which should make for a very busy last four months of the year.
As I have said repeatedly since 2012, fixing the opioid epidemic will require an “all of the above” approach. The good news is, for those of us battling for better patient care by the appropriate use of opioids, non-opioid, and non-pharmacologic treatment, we have a new ally. There’s a new sheriff in town - the name is The Joint Commission. And that is a real game-changer. #CleanUpTheMess
About Mark Pew
Mark Pew, Senior Vice President of PRIUM and The RxProfessor, is a passionate educator and agitator. He has been focused since 2003 on the intersection of chronic pain and appropriate treatment. That ranges from the clinical and financial costs of opioids and benzodiazepines to the corresponding epidemic of heroin use and the evolution in medical cannabis. Recipient of the 2016 Magna Comp Laude award and named one of the “Best Blogs” of 2016 and 2017, he is relevant and respected. Contact Mark at mpew@prium.net, on his LinkedIn blog at linkedin.com/in/markpew, or on Twitter @RxProfessor.
About PRIUM
PRIUM, a division of Genex Services LLC, sets the industry standard for workers' compensation medical interventions through a collaborative physician engagement process encompassing evidence-based medicine, clinical oversight, and jurisdictional guidelines to ensure optimal financial and clinical outcomes. PRIUM’s ability to secure higher agreement rates with physicians to modify treatment plans and ensure compliance is unmatched. The hallmark of the medical intervention company's success is to eliminate unnecessary treatment through a comprehensive approach that includes complex medical interventions, utilization reviews, and independent medical exams. Based in Duluth, Ga., PRIUM can be reached at www.prium.com or 888-588-4964.
