CMS sent a new State Medicaid Director letter (read it here) in early June to help agencies understand options to use federal funding to fight opioid addiction with tech. There is particular emphasis on using the dollars to integrate the systems docs use to identify doctor-shopping for pills (Prescription Drug Monitoring Programs, or PDMPs) into other EHR-systems. The idea is to reduce the steps a doctor has to take to check for abuse if they suspect the patient is an addict and attempting to get opioids illegally.
Here’s a good writeup at Health Data Management
Here’s another good writeup, with more discussion of CMS’s goal of using telehealth to address Neonatal Abstinence Syndrome (NAS) over at mHealth
The article below originally appeared in the Baltimore Sun. Reprinted with kind permission from the author Dr. Dan Morhaim (whom I had the good fortune of working with years ago in Maryland – Clay F)
– Dan K. Morhaim
On March 27, in a House Judiciary Committee hearing, I asked Baltimore County State’s Attorney Scott Shellenberger what percentage of crime in Baltimore County was due to drugs. His answer: “Upwards of 85 percent.” I then asked Baltimore City Police Major Byron Conaway the same question, and his answer was “90 percent.”
As an E.R. doctor, I ask my patients who are substance abusers where they get the $50 a day needed to sustain their habit. Many get others hooked because then those new users become paying customers. There’s also petty crime, prostitution and the major crimes that plague our streets and neighborhoods.
If we are to be serious about reducing crime, then the focus must be on preventing and treating substance abuse. New multi-faceted policies are needed, both in the criminal justice system and in health care.
There is no point in saddling people arrested with small amounts of drugs with a misdemeanor conviction. Instead, users should be provided treatment instead of a criminal record that will haunt them for the rest of their lives. (The small number of people convicted of repeat violent crime felonies, however — especially with firearms — need to be vigorously prosecuted and incarcerated for extended periods.)
Substance abuse treatment ought to be immediately available, 24/7/365, and one of the best places to initiate this is in hospital emergency rooms. Persons with substance abuse disorders already show up in E.R.s for a wide variety of health issues, so why not routinely include drug treatment as part of the care? Treatment plans should be individualized, just as is done for all other medical conditions. Some patients may need long term care, others medicated assistance treatment (e.g. methadone, buprenorphine) and others faith-based approach. One size does not fit all.
Supervised consumption facilities also have been shown to work, reducing deaths, addiction, discarded needles and crime. It may seem to some that this idea condones substance abuse, but the data showing success cannot be denied. It is shortsighted to dismiss this option without seriously considering it first.
Among other efforts we should make: find ways to dispose of all medications safely, especially opioids; make naloxone more available to at least avoid some overdose deaths; allow people go to fire or police stations when they need help without fear of penalty; use methods other than narcotics to treat pain unless absolutely necessary; continue public education regarding substance use, especially in schools.
How can we afford to do this? The real question is how can we afford not to? There are about 30,000 daily drug users in the Baltimore metro area. At an average cost of $50 per day to sustain a habit, that means that $1.5 million per day — or $547 million per year — is spent solely to buy drugs. Statewide, Marylanders spend about $800 million per year on illegal drugs. Then there all the other costs in health care; the criminal justice system; and harm to families, victims, businesses and neighborhoods.
Where does all that money go? Ultimately, it goes to dangerous and violent overseas drug cartels and terrorist organizations, like ISIS and al-Qaida. We’ve been on a policy trajectory that is destroying our society from the inside while shipping vast sums of money to those who would destroy us from the outside.
The economics of the drug war now define the economic activity of many communities. Re-directing “drug money” to legitimate businesses and education would bring jobs, income and safety.
Imagine if only 10 percent or 20 percent of daily users got into treatment today, an achievable goal. Overnight the health care and criminal justice system would be decompressed because those now in treatment would tomorrow not be seeking money for drugs.
Of course, there’s a deeper question that must be confronted: Why do so many of us turn to drugs? Perhaps our focus on material wealth, our endless distractions via media, the daily stress most people endure, hurtful behaviors spanning generations and the emphasis on the individual over community leave too many of us feeling isolated, angry and unfulfilled. As author Johann Hari observed: “The opposite of addiction isn’t just sobriety; it is connection.”
But we’ve got to start somewhere.
Dan K. Morhaim is a physician and Democrat representing Baltimore County in the Maryland House of Delegates. His email is email@example.com.
Copyright © 2018, The Baltimore Sun, a Baltimore Sun Media Group publication | Place an Ad
1. Which segment of the industry are you currently involved?
A: I lead a Cleveland based “think tank” called the Center for Community Solutions. Community Solutions among other things works to support cost effective Medicaid policy through non-partisan research, analysis and advocacy.
2. How many years have you been in the Medicaid industry?
I’ve worked in this space for nearly two decades, first as a researcher and policy advocate and then as President of Community Solutions, as an Ohio Medicaid Director, and as the Medicaid and governmental policy Vice President for Ohio’s largest public hospital – the MetroHealth System.
3. What is your focus/passion? (Industry related or not)
My work passion is getting more people and organizations engaged in policy advocacy. My personal passions focus on my Cleveland neighborhood and the great Cleveland food and cultural scene.
4. What is the top item on your “bucket list?”
Visit Cape Town, South Africa
5. What do you enjoy doing most with your personal time?
Spending time with my partner, friends, and family.
6. Who is your favorite historical figure and why?
Martin Luther King because of he showed how one person could change a country and because he led the fight for justice and racial equality. He was a brilliant and inspiring orator who continues to inspire new generations even 50 years after his assassination. Finally his courage and commitment to non-violence even in the face of physical attack and threats.
7. What is your favorite junk food?
8. Of what accomplishment are you most proud?
Working with the State of Ohio, CMS, Cuyahoga County, and the MetroHealth System to get an 1115 waiver approved that expanded Medicaid in Cuyahoga County a year early and provided health care coverage to over 30,000 uninsured adults.
9. For what one thing do you wish you could get a mulligan?
While I was Medicaid Director, during the Great Recession, we focused most of our attention on expansion proposals for different categories of individuals which impacted relatively small numbers. Looking back it would have been much better to have focused on simplification measures that would have affected many more people and kept more people covered longer. I also wish I could have focused more on ways to leverage Medicaid to address social determinants of health.
10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
November general election results, in many cases (including Ohio), will determine future of state Medicaid expansions. If CMS changes in Medicaid eligibility (e.g. work requirements, et al) are allowed to proceed we will need to pay careful attention to how they are implemented. Expect to see some states pursue a “Medicaid for all” option via a 1332 waiver.
Helping you consider differing viewpoints. Before it’s illegal.
The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment, KFF, Julia Zur, April 11, 2018
Clay’s summary: A good primer on the demographics and coverage patterns for those hit hardest by the Opioid epidemic. Some of the findings may surprise you – almost 2M Americans are addicted to opioids.
Key Passage from the Article
Medicaid covers a disproportionate share of nonelderly adults with opioid addiction, and an even greater share of those with low incomes. In 2016, nearly 4 in 10 (38%) were covered by Medicaid and a similar share (37%) had private insurance. Approximately 1 in 6 (17%) was uninsured (Figure 3). Low-income nonelderly adults with opioid addiction are typically less likely than adults with higher incomes to have jobs that offer health insurance.8 In 2016, over half (55%) were covered by Medicaid, while only 13% had private insurance. Nearly 1 in 4 (24%) were uninsured (Figure 3), although if they lived in states that expanded Medicaid, they would likely be eligible for coverage.
When it comes to the opioid crisis, Medicaid is part of the solution, Eric Blevins, Richmond Times Dispatch, April 26, 2018
Clay’s summary: Good perspective from a recovering Opioid addict.
Key Passage from the Article
As Virginia legislators consider Medicaid expansion, we need to keep in mind the important role it plays in addressing the opioid epidemic. I live in Southwest Virginia, and I’ve been dealing with addiction since I was 12 years old. It didn’t start out with opioids, but by my 20s I was a heavy opioid user, taking high doses daily just to avoid withdrawal.
Recovery from opioid addiction is never an easy road, especially when you live in a small, rural town like mine. Where I live, there are only two choices for mental health treatment. Neither one specializes in treatment for substance use disorders.
GOP panel proposes lifting Medicaid limits on opioid care, Peter Sullivan, April 5, 2018
Clay’s summary: Dems want to look good supporting the fix to the opioid crisis – but don’t want to pay for it with cuts to other programs.
Key Passage from the Article
Republicans on the House Energy and Commerce Committee on Wednesday night unveiled a proposal to lift limits on Medicaid paying for opioid treatment.
The proposal could be one of the more significant and costly steps that Congress takes to fight the opioid epidemic, but there are concerns about how to pay for it. Members of both parties have called for lifting these limits on Medicaid paying for treatment at facilities with more than 16 beds, saying they are a major barrier to care as lawmakers work on a package of opioid bills that could reach the House floor by Memorial Day.
Congressional Hearings Examine Medicare, Medicaid Opioid Crisis Roles, Patrick Connole, Provider Magazine, April 13, 2018
Clay’s summary: A lot of new regulations on physician prescribing behavior will be out soon. Why were they not there before?
Key Passage from the Article
The key witness to appear before the panel was Kimberly Brandt, principal deputy administrator for operations, Centers for Medicare & Medicaid Services (CMS), who told lawmakers that the number of Americans struggling with an opioid use disorder (OUD) is staggering.
“In 2016 alone, nearly 64,000 Americans died from drug overdoses, the majority (over 42,000) of them involved opioids,” she said.
Brandt said CMS recently finalized a series of changes for 2019 to further the goal of preventing OUDs. To reduce the potential for chronic opioid use or misuse, beginning in 2019, the agency expects all Part D sponsors to limit initial opioid prescription fills for the treatment of acute pain to no more than a seven days’ supply.
“This policy change is consistent with the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain that states that opioids prescribed for acute pain in most cases should be limited to three days or fewer, and that more than a seven-day supply is rarely necessary,” she said.