Value-Based Reimbursement and Pain Management in Today’s Opioid Crisis

Updated: Jul 4

Originally Published by Be Unique on Medium

Photo by Pretty Drugthings on Unsplash

Opioid addiction has reached a crisis level in America. But the addiction and crisis are two different things. Today’s opioid crisis is a symptom of larger problems in our healthcare system, for example, poor drug control policies at the expense of independent physicians’ practices.

The majority of prescription opioids that have been illegally exported to the public move through pain clinics. One of the solutions by the government is to have quality training for physicians to dispense opioids or prescribe them. But many of these clinics are not even managed by pain experts.

We cannot generalize this problem. We must be specific about real issues. Although regulations are needed, unnecessary regulatory mandates that do not provide the physician with the necessary tools to comply will make the counterproductive effort.

How did this happen? Who pays for prescription drugs?

The opioid problem has always been around, and it will not go away. But the scale of this epidemic and its similarity to heroin is a flashpoint for controversy.

If you look closely, you will see these crises have some connection to independent physician practices. Independent practices are under the radar and raided by the DEA, the FDA, or other agencies.

The Cause-and-Effect Problem

Government solutions are not getting to the root of the problem in healthcare. They treat the symptom, not the disease. Enforcement of value-based reimbursement on physicians and making them a target at the same time is counterproductive.

It will cause physicians to avoid prescribing opioids to those who really need them unintentionally.

Patients will evaluate physicians based on what they expect, and opioid is not a tool that will work in their benefit today. Let’s not forget physicians spend all of their lives becoming what they are; they will never jeopardize their careers, at least not intentionally.

Unfortunately, some may be forced to take shortcuts under significant pressure. After all, they are trying to stay alive. We all know that treating pain requires its own clinical skills that consider clinical, physical, emotional, behavioral, socioeconomic, and mental-health factors. At some point, the physician needs to draw the line in prescribing opioids because there can be a thin line between helping and doing harm.

Physicians prescribe opioids based on personalized medicine and professional evaluation. The public needs to learn that those who prescribe inappropriately are not physicians but criminals. But we cannot punish those who practice true medicine because of a few bad apples.

Punishing physicians and providers based on population-based protocols, especially in pain management, is wrong and will only lead to chaos. Any action that leads to under-prescribing opioids is just as bad as any action that leads to over-prescribing.

Prescription opioids sold on the streets are not necessarily coming from physicians. An increase in prescribing pain medicine doesn’t necessarily reflect over-prescribing.