Category: Opioids Addiction

Open Payments Expansion Will Capture APRNs’ 2021 Transactions

  

As a result of effective advocacy by nurses, federal policymakers are gradually moving the needle to expand access to advanced practice registered nurses (APRNs). As so often is the case, added opportunities for APRNs can some with more oversight or potentially greater scrutiny. A case in point is Open Payments, which will shed sunlight on APRN relationships with drug and device manufacturers, due to upcoming implementation of a provision in the federal opioid response.

It has been two years since passage of the landmark legislation, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or the SUPPORT Act. The SUPPORT Act unequivocally recognized APRNs as a key part of the nation’s response to the opioid epidemic. Specifically, Congress permanently enabled nurse practitioners (NPs) to obtain the necessary waiver to prescribe buprenorphine as treatment for opioid use disorders (OUDs). For certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists, this same authority is provided with a five-year sunset, ending in 2023. ANA is not done working with Congress to get permanent authority of all APRNs to prescribe Medication-Assisted Treatment (MAT).

Congress first expanded APRN authority to treat OUDs, on a temporary basis, in the Comprehensive Addiction and Recovery Act of 2016 (CARA). Elevating APRNs in the opioid crisis response has given patients with OUDs increased access to MAT. Medication-Assisted Therapy is a widely endorsed, evidence-based approach combining buprenorphine use with counseling and behavioral therapy. Allowing APRNs to prescribe buprenorphine has been especially beneficial in areas of the country experiencing shortages of healthcare providers. According to one analysis of CARA, the number of NPs prescribing buprenorphine increased by 79 percent, and rural counties had a higher proportion of advanced practice prescribers, including NPs, compared to urban counties.

At the same time, the SUPPORT Act included a provision that expands Open Payments to include information about drug industry payments to APRNs. That provision is set to be implemented over the next two years.

The Open Payments program is not new. Open Payments comes under the Physician Payment Sunshine Act, which Congress enacted as part of the Affordable Care Act in 2010. Open Payments allows anyone on the internet to look up their physicians (or teaching hospital), and soon other qualified health care providers, and find out about money or gifts their providers have received from sources such as drug companies, device manufacturers, and research sponsors. Open Payments was created out of the desire for transparency in certain health industry transactions, and out of concern that patient care decisions might be influenced by money from outside interests.

The Open Payments searchable database is maintained by the Centers for Medicare and Medicaid Services (CMS). As shown in the screenshot below, members of the public can visit the site and search providers by name and other information such as zip code.

A search reveals how much money a provider received in a given year, who made the payments, the types and nature of payment, and how receiving these payments compares to activity of other providers. The nature and types of payment include general payments, research-related payments, and food and beverage.

In addition to keeping and displaying the data, CMS conducts the process of collecting and vetting Open Payments information. Here’s how the process works, step by step:

  1. For each calendar year, manufacturers and other reporting entities transmit data on individual transactions (valued at around $11 or more) to CMS during an open reporting period in the following year, no later than March 31.
  2. After manufacturers and other entities report for the previous year, CMS prepares the data for disclosure to recipients identified by reporters.
  3. Recipients then have a window of time each Spring to review and verify information about them and ask for corrections if appropriate.
  4. Information for the previous year goes live on the Open Payments website each June.

For APRNs, step 3 will be important in 2022 and beyond, to ensure that reports of payments in the previous year are accurate. However, there are key steps that can be taken in 2021 to prepare. First, visit OpenPayments. Get to know the database and learn more about how to participate in the program. On the Open Payments site, there is a section titled Program Expansion and Newly Covered Recipients. Providers can also sign up for information and notifications.

To summarize, payments in 2021 from manufacturers to APRNs will be subject to reporting. In early 2022, the information will be entered in Open Payments. Affected providers will have a limited opportunity to review what is reported about them. The database will be updated with 2021 data in June 2022. This sequence will recur annually.

ANA works to ensure nurses are equipped to treat their patients’ pain effectively

  

As the largest healthcare provider group in the country, nurses are no strangers to treating pain, including chronic, acute, and emotional pain. Nurses are also subject to their own personal pain, and they are not alone. Today, there are approximately 50 million adults in the US living with chronic pain and over a third of those adults’ pain interferes with their daily activities. ANA is monitoring and advocating along with our nursing partners, around the Department of Health and Human Services Pain Management report due to be finalized later this year, that promises to help providers use evidence based treatments to manage their patients’ pain while considering the nationwide opioid epidemic.

In 2011, the Institute of Medicine recommended that pain and relieving pain should be a national priority. The report goes on to say that pain is a chief driver for visits to physicians and other healthcare providers, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. We have all experienced pain and for many, if not all nurses, we have had to decide how and to what degree to treat that pain.

The Code of Ethics for Nurses with Interpretative Statements (the Code) mandates that nurses have an ethical obligation to treat their patients’ pain without bias. To minimize biases, the nurse must identify the influences and intentionally set them aside. However, the Code does not say how they must treat pain. For many what first comes to mind is treatment that involves opioids. For some diagnoses, opioids are part of the best clinical practices for treatment; for others, it may be a combination of pharmacological, restorative, and alternative therapies. Patient adherence, access, coverage, and social determinants may all affect the best option for the individual.

More recently, there has been a renewed interest in the role of pain with regards to the opioid epidemic. Pain is a separate disease from the addiction and dependence that can come from opioid use, a fact which has been recognized by the Department of Health and Human Services Pain Management Best Practices Inter-Agency task force. Encouraging to nurses, the task force recommends an individualized and multidisciplinary approach to chronic pain that also includes increased insurance coverage for Complex Management Situations. It also calls for safer opioid stewardship through a risk assessment based on the patients’ medical, social, and family history.

Nurses are also positioned to provide care coordination activities for improved patient outcomes to patients and their families suffering from chronic pain conditions and associated co-morbidities. ANA commented on the draft pain management report and will continue to advocate the role of nursing in treating chronic pain to the task force and agency. The task force will meet on May 9th and 10th to vote on final recommendations.

Recognizing pain as not just a symptom, but rather a disease for some patients, may help shape the patient-provider relationship and higher quality outcomes of care. Pain can have devastating personal, financial and social consequences. Reshaping how nurses talk about pain with their patients and taking the time to learn about and advocate for alternative therapies available in the community, can help in the immediate care of a patient and the long-term ability to complete activities of daily living.

Opioid Bill Contains Victories for Medicaid – as the Administration Undermines Medicaid Access

  

This week the Senate passed a landmark piece of legislation, the SUPPORT for Patients and Communities Act, that aims to curb the nation’s ongoing opioid-use disorder crisis. The legislation includes a critical provision that enables nurse practitioners and physician assistants to prescribe buprenorphine permanently – once they obtain a waiver required by any provider to prescribe medication-assisted treatment (MAT) – and expands MAT prescribing authority for five years to other advanced practice registered nurse (APRN) specialties: certified nurse-midwives, clinical nurse specialists and certified registered nurse anesthetists.

Medicaid Provisions in the SUPPORT for Patients and Communities Act

The bill also includes several critical Medicaid provisions aimed at treating individuals who suffer from an opioid-use disorder and preventing others from developing an opioid-use disorder. Taken together, these provisions will significantly increase access to opioid-use disorder treatment and counseling services for some of the nation’s most vulnerable populations and will decrease the rate of new opioid-use disorders.

These provisions include:

  • A temporary suspension (from Fiscal Year 2020 through FY 2023) of the Medicaid institution for mental disease (IMD) exclusion for short-term stays (less than 30 days per year) and the codification of regulations that allow managed care organizations to receive federal funding for patients who are in an IMD for 15 days or less per month (current law does not allow federal payment for patient stays in IMD facilities with greater than 16 beds);
  • A requirement for states to cover MAT, including methadone and counseling services, for opioid-use disorders from FY 2021 through FY 2025;
  • A provision that allows states to cover care for infants with neonatal abstinence syndrome at a residential pediatric recovery center and an extension of enhanced federal match provided under Medicaid for health home services to treat individuals with substance use disorders;
  • A requirement for state Medicaid programs to not terminate coverage for juvenile inmates under the age of 21 while they are incarcerated and an extension of Medicaid coverage for former foster youths ages 18 to 26 who move states, and;
  • A requirement for states to comply with drug review and use requirements as a condition of receiving federal Medicaid funding and a provision that allows state Medicaid programs access to state prescription drug monitoring programs.

Trump Administration Approval of Medicaid Work Requirements

It is ironic, then, that as the SUPPORT for Patients and Communities Act heads to President Trump’s desk, his administration is actively taking steps that will create barriers for Medicaid beneficiaries to remain covered under the program. CMS Administrator Seema Verma recently defended the administration’s policy of approving Medicaid waivers for demonstration projects that impose work requirements on certain Medicaid populations (i.e., the Medicaid expansion population of low-income, childless adults).

CMS recently faced criticism after 4,300 Arkansans lost Medicaid coverage in September as a result of not meeting the state’s new work requirements; this is the first time in the Medicaid program’s 53-year history that beneficiaries have lost coverage for not meeting work requirements. The administration has approved work requirements for Indiana and New Hampshire, and waivers to impose work requirements are pending in South Dakota, Kansas, Mississippi, Ohio, Maine, Utah and Arizona. Kentucky’s work requirements waiver was struck down in federal court in July, though the administration is currently working with Kentucky to revise implement those requirements nonetheless.

Studies show that work requirements for Medicaid beneficiaries have little to no impact on employment and, as demonstrated in Arkansas, result in coverage losses. According to a December 2017 Kaiser Family Foundation issue brief, roughly 6 in 10 of the 22 million non-disabled adults receiving Medicaid benefits are employed either full- or part-time, while 8 in 10 of these adults live in a working family. Most of these individuals work either for small firms or in low-paying industries which do not offer healthcare coverage and thus rely on Medicaid for such. Further, among those adults who are not working, most report a major barrier to employment such as illness, disability, or care-giving duties. According to the same Kaiser issue brief, Medicaid expansion has not negatively impacted labor market participation; in fact, some research demonstrates that Medicaid coverage supports work.

ANA Commends Congress and Urges Its Members to Vote in the Midterms

ANA applauds Congress for its hard work and dedication in passing the SUPPORT for Patients and Communities Act and for recognizing the role that RNs and APRNs play in patient care for those with an opioid-use disorder.

However, ANA firmly believes in universal access to comprehensive and affordable healthcare services for all Americans. The recent moves by both the Trump administration and state governments fly directly in the face of that goal and represent major steps backward in the effort to ensure that all Americans – especially vulnerable populations such as low-income women and those with pre-existing conditions – have access to all necessary healthcare services. These moves also undermine the progress made in Congress with the SUPPORT for Patients and Communities Act.

Healthcare stands to be a major issue in the upcoming 2018 midterm elections – 22 percent of respondents to a June 2018 NBC News/Wall Street Journal poll named healthcare as the most important factor in deciding their vote. These elections are right around the corner and are an incredibly important opportunity for ANA’s members to make their voices heard when it comes to determining the future of healthcare in this country. When nurses vote, lawmakers in Washington, DC, and in statehouses across the country listen. Visit ANA’s #NursesVote Action Center today and help us make this the most meaningful election for nurses yet.