Opioid-Free Anesthesia

Summary: 

Given all the changes taking place in medicine, the specialty of anesthesia is often on the cutting edge with new approaches and strategies. Today's crisis is opioids. The response of a growing number of those in the anesthesia specialty is opioid-free anesthesia. It is a very worthy objective, but the question is whether it has more than clinical value.

At a recent documentation in-service session for one of our clients, the question was asked if there was a modifier for opioid-free anesthesia. The short answer to the question is no; there is no billing modifier that would enhance the payment opportunity for a case that did not involve the administration of opioids, nor would we expect there to be. In American medicine, providers get payment for services they provide, not for services they do not provide—regardless of the social value of a given clinical strategy in the eyes of many. Some contracts have a quality metric based on the minimization of opioid use, but this should not be confused with payment opportunities.

The Causal Crisis

This fact notwithstanding, it was an interesting question from a number of perspectives. One might ask why it would be worth creating a financial incentive to minimize the use of opioids in anesthesia. Clearly, we are experiencing a national opioid crisis. Every day in the United States, at least 128 people die from opioid overdose. The misuse of opioids includes a variety of pain relievers, heroin and synthetic opioids, such as fentanyl, which is commonly used in anesthesia. While it is clear that anesthesia providers are not responsible for this crisis, they see themselves as well placed to help mitigate the causes, especially in the domain of chronic pain management. The parameters of the current crisis can be summarized as follows:

• *It has been estimated that 21 to 29 percent of patients who have had opioid prescribed misuse them.
• *Between 8 and 12 percent of patients who receive opioids develop an opioid use disorder.
• *It has been estimated that 4 to 6 percent of patients who misuse opioids transition to heroin.
• *About 80 percent of people who use heroin now first misused prescription opioids.

The financial impact of this crisis cannot be under-estimated. The broader implications include significant increases in the cost of treating addicted patients, increased rates of HIV infection, and lost productivity.

Synthetic opioids were first promoted as a safe source of relief for chronic pain. The drug companies argued there was minimal concern for addiction. This, obviously, turned out not to be true, which is why the drug companies are the focus of such ire and legal actions. Whatever the genesis of the crisis, the reality is that it is now out of control and, like the Covid-19 pandemic, it will take a dramatic and coordinated effort to get it under control.

Searching for A Solution

Clearly, any strategy that minimizes the impact of opioid abuse would have significant financial value to the country as a whole. The U.S. Department of Health and Human Services (HHS) and the National Institutes of Health (NIH) are working to address the problem by focusing on five areas:

• *By improving access to treatment and recovery services;
• *By promoting the use of overdose-reversing drugs;
• *By enhancing our understanding of the magnitude of the crisis;
• *By providing support for cutting-edge research into pain and addiction; and
• *By advancing other strategies and practices for the management of chronic pain.

The American Society of Anesthesiologists (ASA) has made this a major focus. The following summarizes the specialty position: As the universally acknowledged experts in pain management, physician anesthesiologists have been at the forefront of implementing best practices to reduce opioid utilization and consumption for patients. To this end, the ASA has become a major advocate of political action and recognition of the important role anesthesia providers can and do play in addressing the crisis. Thus far, however, none of the discussions have included any revision of CMS payment policy.

The morbidity and mortality metrics of American anesthesia are so good that we tend to take quality anesthesia care for granted. As a result, the specialty is always striving to make the public aware of its value proposition. Playing a key role in addressing the opioid crisis could prove to be just such an opportunity.

If you have questions about this topic, please reach out to your account executive or contact us at info@anesthesiallc.com.