Subject: AANS and CNS Feedback on Committee Questions Concerning Policy
Recommendations to Address Opioid and Substance Use Disorders.
Dear Chairman Hatch and Ranking Member Wyden:
The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons
(CNS) appreciate the opportunity to provide feedback to the Senate Finance Committee regarding opioid
use disorder (OUD) and other substance use disorders (SUDs). Below are our thoughts related to six of
the questions you posed in your February 2, 2018 letter:
- How can Medicare and Medicaid payment incentives be used to promote evidence-based
care for beneficiaries with chronic pain that minimizes the risk of developing OUD or other
SUDs?
The incorporation of opioid contracts in the care of chronic pain patients may reduce the
incidence of substance abuse disorder (SUD) and opioid diversion during treatment. By
establishing a mutually agreed upon framework for continued opioid prescribing, these
agreements may include goals of therapy (including long-term weaning) and mechanisms for
nonjudgmental treatment in the case of misuse of opioids or other drugs of abuse. Keeping
patients in a therapeutic relationship is key to minimizing abuse. However, currently there is no
specific mechanism to account for the time, and effort physicians expend maintaining these
contracts, including the administrative burdens of checking state drug monitoring registries.
Perhaps, a new CPT code that allows a physician to be reimbursed for the time spent managing
this relationship would incentivize the use of these contracts. Furthermore, with the increasing
burdens being placed on pain management specialists to handle the non-procedural aspects of
pain control, many of these physicians are becoming increasingly reluctant to take on “medical”
pain patients who do not need interventional treatments. By providing a method for these
specialists to be compensated more fairly for treating these “medical” pain patients, improved
pain management care will be possible and even likely. A dedicated code may also improve
tracking of the use of these agreements in clinical practice.
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Read full letter here
