Modern Healthcare
By Steven Ross Johnson
November 1, 2017

While President Donald Trump’s opioid commission made several
recommendations Wednesday that highlighted the need for greater treatment
access, the final report didn’t address the insurance and cost issues that
affect recovery.

The Commission on Combating Drug Addiction and the Opioid Crisis
proposed 56 recommendations in its final report, many of which were designed to ease
federal regulations that critics say have hindered efforts to expand access
to treatment.

The group also got an assist from the CMS, which said it would approve
state demonstrations that waive federal Medicaid rules limiting coverage
for inpatient substance abuse treatment in facilities with more than 16
beds to 15 days.

“This new demonstration policy comes as a direct result of the president’s
commitment to address the opioid crisis and ensure states have immediate
relief and flexibility,” said CMS Administrator Seema Verma in a written
statement. “Previous policies ignored the growing urgency of the national
opioid epidemic and instead put onerous requirements on states that
ultimately prevented individuals from accessing these needed services. The
Trump administration’s approach reflects the pressing nature of the issues
states are facing on the ground.”

While the expansion of inpatient services for substance use disorder
treatment will be welcomed, the CMS announcement may have diverted focus
away from the lack of additional financial resources for outpatient
treatment, which would offer access to more people by comparison.

“It throws more money into a failed model,” said Dr. Indra Cidambi, medical
director at Center for Network Therapy, a Middlesex, New Jersey-based
treatment facility and vice president of the New Jersey Society of
Addiction Medicine. “Why not look at the outpatient, ambulatory detox
model, which will be more cost-effective and higher efficacy?”

The commission’s recommendations included a call to increase federal block
grants to states, which the panel said would simplify the process to apply
for funding for drug prevention, treatment and recovery initiatives. The
commission encouraged the White House’s Office of National Drug Control
Policy to work with other federal agencies to monitor how efficiently
states use federal funding.

The report also urged federal agencies to require providers to review their
state prescription drug monitoring programs and integrate PDMP data into
electronic health records so clinicians can review that information without
disrupting workflows.

“It is one of the most basic things, and I think many prescribers have not
understood the importance of checking the PDMP before even sitting down
with the patient,” said Dr. Michael Fiori, director of Addictions for Mount
Sinai Health System in New York.

Other recommendations included a proposal for HHS to develop a national
standard of care for opioid prescribers, incorporate quality measures that
address addiction screenings and treatment referrals, and remove
reimbursement barriers to treatment. Hospitals and health systems should
screen primary care patients for alcohol and drug use and provide treatment
directly or via referral within 24 to 48 hours.

But many felt the report, much like Trump’s address last week when he declared
the opioid crisis a public health emergency, provided solutions that would
have a marginal impact at best, and at worst, signaled an outdated strategy
that can’t combat the evolving nature of the current epidemic.

“It’s a complex problem and a complex proposed strategy,” said Dr. Omar
Manejwala, chief medical officer at Los Angeles-based firm, Catasys, which
provides analytics and behavioral health treatment solutions for health
insurance plans. “Most of us would view this as having some good stuff in
there, but overall will essentially not make a dent and really misguided.”

Manejwala felt the report represented a ‘missed opportunity’ to offer
effective solutions by failing to call for what many experts say would make
the biggest impact — more funding.

The report pointed out that the president’s budget request calls for $27.8
billion for drug control efforts, about a 1% increase over fiscal year 2017
funding levels. But the Trump’s budget would also reduce funding for drug
prevention programs by 11% over previous year’s figures.

“This is just puzzling that in the middle of a crisis we would reduce
prevention funding,” Manejwala said.

The commission also didn’t address the importance of patients maintaining
their healthcare coverage to access treatment and recovery services.
Congressional Republicans’ efforts to repeal and replace the Affordable
Care Act and convert Medicaid into a state block grant program would limit
coverage for millions, according to various estimates.

Failure to mention Medicaid coverage was a particular disappointment, said
Dr. Leana Wen, Baltimore public health commissioner, given that the program
is the single largest payer of substance use disorder treatment and cover
one in three patients who have a substance use disorder.

“No other disease is treated only through grants,” Wen said.

Steven Ross Johnson


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