Pain management physicians are currently facing a major challenge – the misuse or abuse of legal prescription drugs by patients. Even as they deal with the complexities of pain management billing and coding, transition to ICD-10, and reimbursement issues, these specialists now find that they have to be extremely cautious when prescribing opioids, even for patients who really need them. The American College of Preventive Medicine (ACPM) says that the confluence of pain control versus risk of abuse of prescription medications is the “perfect storm” as far as the physician is concerned.
In a survey conducted by WedMD and Medscape more than half of the physician respondents (52%) said they believed that opioids prescriptions were misused. In fact, the gravity of the problem has prompted President Obama to allocate $1 billion to fight the drug abuse epidemic in his proposed budget for 2017. However, according to a new poll conducted by Kaiser Family Foundation, most Americans felt that providers, the government, and drug users themselves are not doing enough to fight the drug abuse epidemic. The survey also found another major problem – those with substance abuse issues lack access to care.
Focus on Best Practices to Prevent Opioid Abuse
If unchecked, acute pain can progress to chronic pain, leading to medical, physiological, psychological, family, and social consequences and decreased quality of life. Proper pain treatment is a crucial part of patient care, especially in cancer treatment. Adherence to best practices in patient assessment and treatment can promote the goals of pain management – pain relief, enhanced function, and safety of the patient, prescriber, and community, according to an expert speaking at the 21st Annual Conference of the National Comprehensive Cancer Network (NCCN) which took place in April 2016. The key points highlighted were:
- Pain assessment: This should cover the physical aspects of the pain, but also the effect of the pain on the patient’s quality of life, other medications the patient takes, previous treatments and outcomes, co-morbid conditions, financial conditions, risk for misuse, and the patient’s goals for pain care
- Focus on the risks of overtreatment and undertreatment
- Responsible assessment: differential diagnosis of non-compliance and aberrant drug taking behavior
- Proper opioid prescribing and patient counseling
A multidisciplinary approach to care is recommended to ensure that patients with drug abuse disorders would be treated for any underlying any psychosocial conditions as well as for their pain.
Revenue Cycle Management in the Face of Increasing Patient Responsibility
In the face of increasing patient responsibility and other challenges such as the Affordable Care Act, ICD-10 coding, and the rise of value-based reimbursement, pain management practices need to pay special attention to their revenue cycle. Competency can be ensured by partnering with a reliable medical coding and billing company.
A professional company would provide a comprehensive suite of services covering everything from patient enrollment, and insurance verifications and authorizations to pain management billing and coding and accounts receivable management. Their team of certified coders would be experts in using codes, modifiers, and NCCI edits and claim submission processes. The support of a reliable service provider would ensure that pain management specialists can focus on providing proper while handling the critical problem of painkiller abuse among patients.