As we see in the headlines nearly every day, the opioid crisis that has gripped our nation is still far from over. And, although we’ve made progress, we still have a long way to go.
Those of us in hospital administration have, since the beginning of the opioid epidemic, viewed it through a multi-faceted lens. Our view must take into account not only the impact to patients, but also the burden on our physicians and providers, on our clinics and hospitals, and the financial performance and viability of our practices and facilities. The opioid epidemic, specifically the overprescribing of opioids, jeopardizes both the well-being of individual patients, and the ability of hospitals, providers and practices to deliver the best possible care. As administrators, we are tasked with guarding against that threat.
Protection from the impacts of opioid overprescribing starts with understanding the consequences and ripple effect even one offender can cause:
Reputation Damage: With the increasingly tightened guidelines and oversight – wholly appropriate as they are – it is not uncommon for the Drug Enforcement Agency to one day show up looking for answers in the office or clinic of an overprescribing provider. There is nothing private or subtle about that event. Best case, there is an investigation, worse case, a provider may be arrested onsite. When these instances occur – as they are in more and more states – everyone associated suffers some reputation harm. Your image and brand are damaged from both employee and general public perspective. It is very difficult to recover from a reputation blow associated with provider wrongdoing.
Burden on Colleagues: In cases where an overprescribing provider has been let go – which is often warranted – the remaining professionals in a practice or department pay the price. Busy staff members now must pick up additional patient load, often comprised of difficult and time-consuming patients. In many cases, the patients of an overprescriber are used to obtaining pain medicines without question. They become upset, agitated, volatile and sometimes threatening when told no. Those left in a practice must now deal with those patients.
Toxic environment: When a provider overprescribes, it is rarely a secret to others in the office. This “open secret” inevitably causes friction and dissatisfaction, and sometimes even a sense that there would be no use reporting it. Eventually you lose quality employees or providers. This human resource impact is exceptionally costly in time and money.
Revenue loss: The consequences of overprescribing range from loss of prescribing privileges for the offender, to him or her being let go and in some cases, even arrested. When a physician loses the right to prescribe, someone else has to pick up that responsibility. And if a physician is let go, the practice or facility must now incur the expense of new physician recruitment, again a costly endeavor in time and money.
Against that backdrop, there are steps we can take to protect our providers, patients and organizations. Accomplishing that hinges on three factors: awareness, education & compliance and a willingness at all levels to change the way we look at historical metrics.
Awareness: In our organization, we decided to be proactive about raising the awareness level of all providers. In virtually every state, there are prescription drug monitoring programs (PDMPs) created to curb abuse. Providers should use tools such as the EMR to ensure every opioid prescription is appropriately documented. The regulations in Indiana where our physicians practice require every controlled substance obtained in a pharmacy to be logged. Our doctors are trained to look at their Inspect report, confirm the list looks appropriate in terms of patient receiving opioids and the quantity, and then compare to see if patients are getting other prescriptions filled elsewhere. Through this diligence, we found several patients getting multiple prescriptions around the state and were able to stop it. We also found patients who had fraudulently obtained medications using the physician’s information.
Education & Compliance: In terms of controlled substance abuse, education must be more than checking a box: We, as administrators, and our employees and providers should have at least a baseline understanding of the myriad of aspects of opioid prescribing – law and liability, recognizing the signs of abuse, prescribing limits, etc. As an example, we took the step of asking the DEA to conduct an in-service with our physicians that illuminated some surprising facts about the drug use and the mix of medicines being used by addicts. Our physicians expressed their appreciation for the in-service as it provided them with tangible tools and education. We heavily encourage providers in their critical thinking and patient assessment to be aware of abuse potential.
Willingness to Change: There was a point in the not-so-distance past when patient satisfaction became linked with the amount of pain – or lack thereof – they experienced. A pain-free patient was a happy patient – one willing to give a higher satisfaction score, which was one of the key measures of success. While no one would advocate any patient being in pain, that approach clearly went awry, contributing to the situation in which we find ourselves as an industry. Our system is beginning to look at managing pain differently with checks in place, especially for patients who seem to be on pain medications long-term, without an obvious reason. It is important that patients have an appropriate assessment with a physiatrist to verify the physical cause of the pain and whether pain medication is appropriate. If there is not a physical need for long-term pain medication, we refer for physical therapy, behavioral health, and other alternative methods to wean patients off of pain medications to return to a normal way of life.
Efforts in those three areas can help providers and those of us who support them all focus on what’s most important – delivering exceptional care to our patients.