As a practicing physician I found myself angry about the opioid crisis in our country. I was completely taken aback and defensive as the media blamed physicians for the crisis. I countered this narrative with personal stories and reflections on how The Joint Commission imposed pain scores as an additional vital sign for my hospitalized patients, who in turned rated my care on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results. I also noted the conflicts that physicians encounter between the requests of their patients and the external pressure placed on us by the Centers for Medicare & Medicaid Services (CMS) to prescribe certain amounts and types of medications. How can society really blame me when I had no choice but to succumb to the pressures brought upon me by these external forces that affected my reputation and compensation?
Then my 21-year-old son came to me distraught because one of his friends, who I’ve known since he was a child, almost died from a heroin overdose. His friend became addicted to prescription opioids after he was given a 30-day supply following an ankle fracture. When he could no longer use his friends and family to gain access to pills, his addiction led him to heroin as a cheaper and easier alternative. This story personalized the crisis, which led me to a major realization: lives are being destroyed and people are dying. The simple fact is that in 2016, 11 million Americans abused prescription opioids with 175 people dying on a daily basis. This struck me to the core as a physician and caregiver.
The story also led me to realize that this issue is an emergency. Under emergency conditions, who is to blame doesn’t matter. I’m a physician; I made an oath to care and prevent harm. If I’m not part of the solution, then I’m part of the problem.
For the last three years, Vizient has been a key part of the Transforming Clinical Practice Initiative (TCPi), a CMS cooperative agreement awarded to Vizient to help provider groups prepare for the Quality Payment Program. As part of this initiative, CMS has challenged our program to be part of the solution for the opioid crisis.
From our work on TCPi, we have learned that we can make a major impact in the reduction of prescribing oral opioids by just taking a few steps.
- Do not prescribe greater than three to five days of medication for nonmetastatic pain. Studies show that most patients are at a higher risk for opioid addition if given greater than seven days of medication.
- Remove all narcotics from order sets.
- Implement shared decision-making into your daily care of patients. More information about shared decision-making can be found on the Choosing Wisely website, an initiative created by the American Board of Internal Medicine Foundation.
A Vizient member once told me, “As physicians we worry about a 3-percent risk of allergy in writing a cephalosporin prescription for a penicillin-allergic patient. Why are we not concerned about prescribing a medication that has a 10-percent chance of causing an addiction?” That comment resonated with me.
Despite all the political rhetoric and additional state- and federal-mandated pressure this crisis will bestow on us, the heart of the matter is a simple truth: we as health care providers can prevent future addictions from happening. By concentrating on the reason that leads most of us to choose to enter the health care profession (to make a difference in our patients’ lives), we can take direct actions that prevent injury while allowing patients to participate in their care.
About the author. In his role at Vizient, Dr. Villanueva serves as the clinical and operational lead for the Vizient Transforming Clinical Practice Initiative team and the Vizient Practice Transformation Network. Prior to his current position, he served as chief of primary care for the Baptist Health Medical Group, part of Baptist Health South Florida, where he was responsible for the redesign and transformation of primary care practices toward value-based payments, risk sharing and population health. He has more than 18 years of physician leadership experience, first as a hospitalist, where he created several different programs and as a member of the inaugural class of Senior Fellows for the Society of Hospital Medicine. A Fellow of the American College of Physician Executives, Villanueva is double boarded in Internal and Palliative Care Medicine.