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As the opioid addiction epidemic continues to dominate headlines, healthcare professionals are looking everywhere for potential solutions. Simultaneously, there’s a need to make significant adjustments to a multitude of internal structures as the healthcare field moves toward a value-based care model.

These can feel like drastically different challenges, but some see ways in which they potentially overlap, for the benefit of all involved.

To learn more, Surgical Products interviewed Scott Howell, MD, MPH&TM, CPE, chief medical officer at Tenet Diagnostics.

Surgeons have had many discussions about how emerging payment models might change the way healthcare is delivered, but you also see the evolving reimbursement structure as an opportunity to address the opioid addiction crisis. How so?  

The new payments, such as bundled payments, provide a single amount of payment that covers several disciplines in the current healthcare structure. Only one remuneration is provided, mostly for procedures, and any additional costs are incurred by the providers or the healthcare system. These payment models place healthcare providers with more fiduciary risk tied to outcomes. In theory this downstream risk should provide appropriate patient selection for procedures with improved care coordination. A corollary would be the early identification of a substance abuse disorder or prolonged pain syndromes.  

Do you see any efforts underway that are already making a difference in addressing the opioid epidemic?

Yes, several initiatives, such as limiting the number of days for acute pain prescriptions, state-specific practitioner databases, additional treatment options for opioid dependence. Just the fact that opioid dependence has taken on a national priority is a major step, and attracted new federal, state, and local funding.

The best models are integrated with pain management, addiction, neurology, psychiatry, counselors, and social workers. There is a change underway with a 'volume to value' paradigm from payers with results on outcomes, which benefits patients.

Addiction and chronic pain are co-morbid conditions affecting other underlying conditions whereby the total cost of care increases dramatically. Addressing addiction and/or chronic pain can improve outcomes in medication adherence, disease progression and clinical metrics of hospitalizations and emergency room visits.

This Feb. 19, 2013 file photo shows OxyContin pills arranged for a photo at a pharmacy in Montpelier, Vt. (Image credit: AP Photo/Toby Talbot, File)
Scott Howell, MD, MPH&TM, CPE
Chief Medical Officer at Tenet Diagnostics

How should surgeons and other healthcare professionals advocate for the sorts of changes that are needed to take the field forward in a way that effectively combats the opioid problem?  

There are a variety of ways to advocate for changes in the healthcare system. First, seek additional training in substance abuse and chronic pain disorders with an understanding of the pathophysiology, identification and treatment protocols even outside of their respective specialties. Second, support federal, state and local initiatives in opioid dependence and within their respective medical societies. Finally, on an individual practice level, prescribe opioids according to national CDC guidelines and referral to addiction medicine or pain management, appropriately.  

Prescriber education is obviously important. How does patient education factor in?  

Surgeons are usually in the acute pain space post procedure, and limiting the amount of opioids is necessary in the recovery process. I have received many patients where the origin of addiction was a dental or surgical procedure with long tails of prescription opioids. The transition into dependence can be complex to identify and awkward for healthcare professionals to engage.  

Even more difficult are patients with a chronic pain component. Provider education is the key for early identification and referral to the appropriate specialists to reduce the overall burden on the health system and improve outcomes.  

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