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13 Articles in Volume 18, Issue #3
Anger Expression & Chronic Pain
Ask the Expert: Should reliance on gabapentin/pregabalin be limited?
Chronic Pain in Children
Considering Comorbidities When Selecting Medications for Chronic Pain Management (Part 1)
Dousing the Physician Burnout Epidemic: An AMA Perspective
Harnessing the Power of Words
Inside ASRA with David Provenzano, MD
Management of Intrathecal Therapies by Interprofessional Teams
Nurse Burnout in Pediatric Pain Management: A Model and Pilot Intervention
Physician Burnout: An Oldtimer’s View
Reporting Metrics, Media Coverage...Letters from the Minds of Peers and Patients
The Case for Slow-Release Anesthetics
The Impact of Pain Practice

Reporting Metrics, Media Coverage...Letters from the Minds of Peers and Patients

April/May 2018 PPM Letters to the Editor from practitioner peers and patients


Be Wary of CMS Data Capture & Reporting Metrics 

Dear PPM Peers,

I am a nurse practitioner in northern California practicing in a comprehensive pain management setting. Recently, I received a letter from a company called eGlobalTech, which conducts research on behalf of the Centers for Medicaid and Medicare Services.

The purpose of the letter was to inform me of my opioid prescribing practices compared to others in my specialty and the nation as a whole. This information was reportedly gathered based on my NPI taxonomy selection, and broken down by five metrics gathered between July 1, 2016 and June 30, 2017:

  • a summary of my opioid prescriptions per Medicare beneficiary
  • percentage of beneficiaries prescribed opioids above 90 MED for 3 months
  • average number of days prescribed per beneficiary
  • average charges per beneficiary
  • percentage of beneficiaries prescribed opioids by four or more providers.

Historically, nurse practitioners were allowed to choose one taxonomy: Nurse Practitioner, which included geriatric, pediatric, acute, emergency, family, and unaffiliated. As could be predicted, my data was well above average for my specialty (pain management).

I contacted eGlobalTech and was referred to their website to compare my data to those from other specialties. Predictably, when compared to others in pain management, including anesthesia, physical medicine and rehabilitation, and pain management, my numbers were in line, and actually a bit lower. While looking at the other specialties, however, I found several items that called the validity of the collected data into question.

For instance, according to the data listed, 22% of beneficiaries seen by acupuncturists are prescribed opioids by that provider. Dental Assistants, similarly, prescribe opioids to 22% of their patients, according to the website data. There were numerous other similarly questionable data points presented. The complete data collection can be found on the eGlobalTech website at www.cbrinfo.net/cbr201801-statistical-debriefing.

I share this experience because, like myself, I am sure there are a number of providers who received this information and were, and may continue to be, distressed by the suggestion that they are over-prescribing opioids. While I do have a general concern about opioid prescribing, data like this serves only to invoke anxiety for providers, and the public, and increase the burden for legitimate pain management practitioners.

–JD Frazer, NP-C

Media Misses Target Population

Dear PPM Peers,

It can be a difficult time for physicians treating pain with all the media buzz and changing regulation. I don’t believe I have read any published material of late that has focused specifically on us as pain specialists who treat chronic intractable pain day in and day out. Most articles seem related to family practice, ignoring the unfortunate individuals whose lives are shattered by chronic intractable pain.

The media seems to infer that any physician treating one of these unfortunate conditions is breaking some kind of code or, worse, law. As a pain physician who cares deeply for his patients, I have taken the CDC opioid prescribing guidelines to heart and lowered opioid dosages for all of my chronic pain patients, and yet, some of them now are reporting decreased quality of life and decreased function as a result.

That said, my patients have adapted fairly well because of their absolute trust in my prescribing ability. We are using 200 MME as the target and applying due diligence to monitor any changes.

I wonder how many physicians who strictly treat chronic, long-standing pain are prescribing higher doses and doing so in a proper manner? It is too bad that such little upfront attention has been paid to this type of practice or to the patients, including all the stress placed on their treating physicians, now under the threat of “standard of care limits” and fear of malpractice or other sanctions due to the CDC guidelines on opioid prescribing.

–DT Rubino, MD, Devon, PA

Last updated on: October 2, 2018
Continue Reading:
Challenging the Chronic Pain Personality Profile
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