Fix Physician Payment to Stem Opioid Epidemic, Says AAFP

Academy Tells Senate Committee Compensation, Regulatory Burdens Hinder Care

February 27, 2018 09:44 am News Staff

An important starting point for addressing the nation's opioid misuse epidemic is the creation of payment models that allow physicians to spend more time with patients and ensure they are appropriately compensated for services tied to substance abuse, the AAFP recently told a Senate committee.

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Earlier this month, the Senate Finance Committee asked medical organizations( for suggestions to address the epidemic, and the AAFP responded on Feb. 14 with a detailed letter(3 page PDF) that described how restrictive insurance policies and administrative burdens associated with nonpharmacologic treatment are hindering care for patients dealing with substance use disorders.

"It is unfortunate that the payment and regulatory framework for physician practices has reduced face-to-face time with patients, making it more difficult for physicians and patients alike," the AAFP wrote in the letter, which was signed by Board Chair John Meigs, M.D., of Centreville, Ala.

Exacerbating the problem are the restrictions payers place on mental health care that family physicians are trained to provide.  

"Unfortunately, payment for primary care office visits with a mental health diagnosis code has traditionally been discounted or proscribed by private insurance, Medicaid and Medicare," the letter stated. "Many managed care plans do not pay family physicians for the provision of mental and behavioral health care, even though family physicians are frequently in the position to diagnose, treat and provide the needed care."

The letter suggested that Medicaid and Medicare payment incentives could be used to reduce costs associated with opioid use disorder and other substance abuse treatment and to support appropriate coprescribing of naloxone.(207 KB PDF)  

The AAFP pointed out to the committee that although guidelines -- including one from the CDC( that the AAFP affirmed -- support nonpharmacologic treatment for low back pain, for example, such treatment faces barriers from public and private insurers.

"It is currently easier to write a prescription for opioids than to prescribe nonpharmacologic treatment," the letter stated.

In addition, more educational materials are needed to help patients who expect a prescription to accept nonpharmacologic treatment.

The letter also warned the committee against "one size fits all" approaches to educating physicians about opioids. Family physicians already are committed to "fine-tuning their ability to prescribe opioids appropriately and effectively," the AAFP said, noting that members completed more than 141,000 CME credits on this topic in 2016 alone.

"The AAFP continues to believe educating physicians is an important tool, but to be impactful, the education must be designed to address needs and gaps of the learners," the letter stated.

The committee also should consider ways to improve the interoperability of state prescription drug monitoring programs, and the AAFP noted its support for a national prescription database.

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