By Pat Anson, Editor
A group of 80 doctors, pharmacists, academics and health researchers have signed a joint letter opposing “perverse” new guidelines being proposed to limit high doses of opioid pain medication.
The National Committee for Quality Assurance (NCQA) is a little known non-profit organization that accredits healthcare organizations and ranks their performance against a set of standards known as the Healthcare Effectiveness Data and Information Set (HEDIS).
In a proposed new HEDIS standard for opioid prescribing, NCQA would set a daily ceiling at a 120 milligram morphine equivalent dose (MME) when opioids are prescribed for 90 consecutive days or longer. Any insurer or provider in violation of that standard would be red flagged, and if too many violations are found they risk losing their accreditation.
The proposed standard “will pose a serious risk to some patients currently receiving opioids,” according to the letter drafted by Stefan Kertesz, MD, a primary care physician and Associate Professor at the University of Alabama at Birmingham School of Medicine.
The letter was signed by a diverse group of healthcare providers, including some who helped develop the CDC’s opioid prescribing guidelines. Those guidelines are voluntary and intended only for primary care physicians, but are being widely adopted and made mandatory throughout the U.S. healthcare system.
Ironically, the NCQA's limit of 120 MMEs is actually higher than the CDC's recommended limit of 90 MMEs.
“We must distinguish between the language of the CDC Guideline itself, and the perverse care decisions that the NCQA ‘Opioid High Dosage’ binary measure will incentivize,” the letter states.
Kertesz and his colleagues say the proposed standard would force many doctors to taper patients off high opioid doses “despite the lack of any evidence to assess its impact on risk to patients, and the reality that the CDC Guideline did not endorse this approach.”
“Put simply, the ‘Opioid High Dosage’ measure will accelerate a reconfiguration of care that has never been tested in prospective trials and that could actually increase risk to individual patients, as illustrated by scholarly and popular reports of acute withdrawal (with death), protracted abstinence syndrome, and suicide associated with incautious unilateral opioid discontinuation or unrelenting pain,” they wrote.
The letter concludes by urging the NCQA to abandon its high opioid standard until evidence is available to assess the potential harm to patients.
In a statement explaining its proposal, NCQA said “there is limited evidence for the long-term beneficial effects of opioid use” and suggested opioids were only appropriate for acute pain and chronic pain conditions “such as sickle cell disease or late stage cancer.”
The NCQA just ended a public comment period on its opioid proposal. Several PNN readers have complained they were unable to post comments on the NCQA website.