Doctors, pills, and a heroin crisis compared to Vietnam

CLEVELAND - As the nation's drug overdose crisis now kills people in numbers more resembling a war than an epidemic, the FOX 8 I-Team has discovered a government policy that may actually be making the situation worse.

That policy reduces how much the federal government pays hospitals for the care of Medicare patients, based on how patients answer survey questions about how doctors controlled their pain.

If patients don't answer "always" to both pain control questions, indicating the doctors did everything they could for their pain, the amount of money the government pays the hospitals goes down.

And, ultimately, that can reduce the doctors' paychecks.

Experts say the problem is that such a system encourages doctors to prescribe more opiates for pain, and that can indirectly lead to more people getting addicted.

According to the Drug Enforcement Administration, four out of five new heroin addicts started on prescriptions written by doctors.

Just in Cuyahoga County, 370 people died of overdoses last year - a number that is expected to nearly double this year.

Nationwide, the number is expected to be about 47,000

"We lost 58,000 people in Vietnam," Drug Court Judge David Matia says, "and we're almost losing that many people now. And how many years are we into this?"

It has been almost five years since the I-Team first traveled to southern Ohio to report on what was then an an emerging crisis: more and more people overdosing and dying on heron, and its legal cousins - painkillers such as Oxycodone and Oxycontin.

"There are hot spots all over the country," says Chuck Rosenberg, the Acting Administrator of the DEA, "(and) Ohio has been hard hit - no question about it."

In a sit-down interview with the I-Team, Rosenberg said the 47,000 deaths is "in some ways...a significant under-count."

"We have many, many, many more people who overdose, but don't die," he says.

"This isn't a public health crisis," Judge Matia says, "it's a plague."

Though there have been heroic efforts by many officials to stem the number of deaths, given how those numbers continue to explode, there are now questions about whether the efforts are large enough, and whether long-standing policies need to be reexamined.

One of those policies involves that federal survey of Medicare patients.

Doctors say it puts more pressure on them to prescribe opiates in the middle of a heroin and opiate epidemic.

None of Cleveland's three major hospital systems (MetroHealth, University Hospitals, and the Cleveland Clinic) reduce their doctors' individual pay based on the federal survey scores.

"The messaging (to doctors) is always the same," says Dr. Joan Zoltanski, Chief Experience Officer at UH, "and that is 'practice good medicine.'"

But "several hospitals across the country do structure their payments that way (where doctors' pay does go down based on the Medicare survey scores)," says Dr. Joan Papp, an ER doctor at Metro.

A survey of 1,100 doctors in Ohio, conducted by the Cleveland Clinic and the Ohio State Medical Association, found 74 percent of doctors felt increased pressure to prescribe opiates because of how the government reimburses for pain management.

"It's unrealistic to believe that they are not going to cave into that pressure in some cases," Dr. Papp says.

Dr. Jason Jerry, a nationally-honored addiction specialist at the Cleveland Clinic, says people come to him when they want to get off pills, not on them.

Still, he says, other doctors tell him "the pressure is intense (to prescribe more opiates), and often these patients have been on these medications for years."

Dr. Jerry adds that, while opiates have been proven to be effective in fighting acute pain (such as post-operative pain, or end-stage cancer pain), there is no scientific evidence that they are effective in the long run against chronic pain.

There is some evidence now that the number of opiates being prescribed is going down - but it still incredibly high compared to historical levels (note: some of the difference may be because of new opiates that have been introduced in recent years).

In Ohio, the number of opiates prescribed "per capita" was 60 in 2015 (that is, there were enough opiates prescribed last year to give every single person in the state 60 pills - a total of over 701 million pills prescribed in just one year).

That compares to 68 pills per capita back in 2012.

But in 1997, that number was just 7 pills per capita, according to the Ohio Pharmacy Board.
The Center for Medicaid and Medicare Services, the government agency in charge of the Medicare pain surveys, declined an on-camera interview.

But, in written statements and press releases, it indicated that there is a proposal to change reimbursement practices so that patients' answers to the pain questions would not effect how much the hospitals are paid.

CMS acknowledged that doctors were reporting feeling pressure, although it added there was no empirical evidence on a national scale to support that position.
If adopted, the proposal will take effect in Fiscal year 2018.

Judge Matia says changing the reimbursement rules only makes sense, because the way it's done now, "is the exact opposite of what the medical profession should be doing."

There are now calls for the federal government to put more money into drug treatment programs to try and help more people fight what is an incredibly hard addiction to beat.

The White House wants Congress to act on a proposal to pump $2 billion dollars into treatment - a proposal that, if approved, would bring $45 million to Ohio over the next two years.

Meantime, people continue to die in record numbers. More people now die from overdoses in Ohio then die from car accidents.

And, Judge Matia has a very sobering way of looking at the number of Americans nationally who die from overdoses - which will approach 50,000 in 2016.

"It's like Vietnam," he says, "every year."

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