Guideline for Prescribing Opioids for Pain

Centers for Disease Control and Prevention

Pain affects the lives of millions of Americans every day and improving pain care and the lives of patients with pain is a public health imperative. The Centers for Disease Control and Prevention (CDC) is releasing updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, will help clinicians work with their patients to ensure the safest and most effective pain care is provided. The publication updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain released in 2016.

“Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life,” said Christopher M. Jones, PharmD, DrPH, MPH, Acting Director of CDC’s National Center for Injury Prevention and Control.

The 2022 Clinical Practice Guideline addresses the following areas: 1) determining whether to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use.  The Clinical Practice Guideline supports the primary prevention pillar of the HHS Overdose Prevention Strategy – supporting the development and promotion of evidence-based treatments to effectively manage pain.

The guideline is a clinical tool to improve communication between clinicians and patients and empower them to make informed decisions about safe and effective pain care. The recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible, one-size-fits-all policy or law or applied as a rigid standard of care or to replace clinical judgement about personalized treatment.

CDC followed a rigorous scientific process using the best available evidence and expert consultation to develop the 2022 Clinical Practice Guideline. An independent federal advisory committee, four peer reviewers, and members of the public reviewed the draft updated guideline, and CDC revised it in response to this feedback to foster a collaborative and transparent process. CDC also engaged with patients with pain, caregivers, and clinicians to gain insights and gather feedback from people directly impacted by the guideline. The expanded guideline aims to ensure equitable access to effective, informed, individualized, and safe pain care.

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RAISE Act Council Offers National Caregiver Support Strategy 

A 102-page report marks the RAISE Act Family Caregiving Advisory Council’s September completion of the first-of-its-kind National Strategy to Support Family Caregivers. The product of extensive deliberation and analysis of expert contributions, the report includes substantial background information on the current landscape of family caregiving, as well as many proposed federal, state and local actions in support of caregivers. The proposals are organized under five major goals: 

• Improved awareness of and outreach to family caregivers; 
• Inclusion of family caregivers in the care team; 
• Services and supports for family caregivers; 
• Financial and employment protections; and 
• Data, research, and best practices.  

The ACL website provides access to the entire document and supporting materials. Comments from the public are encouraged through the deadline of November 30. 

Publication of the national strategy has been met by enthusiastic reactions across the caregiving spectrum, including the Family Caregiver Alliance (FCA). “We share the authors’ hope,” FCA stated, “that as the Strategy is implemented—and as the nation more fully comes to understand and respond to the challenges faced by family caregivers—society will embrace the cultural and policy shifts necessary to support them. As a result, over time, lawmakers likely will be called upon to propose legislative changes to better support family caregivers. This is a historic moment for family caregiving because, as the Strategy introduction states, ‘This is the first time that ideas from local and state agencies and nonprofit organizations are integrated with recommendations for the federal government in a combined initiative dedicated to family caregiving. The development of these lists also represents the first time that agencies across the federal government have formally worked together to coordinate family caregiver support planning.’”

President's Message

Posted: November 15, 2022

Recently, an APTA member brought to my attention that a large health system eliminated all of its home health rehab management staff, stating that “industry standard” dictated this change, and that they were “no longer qualified” to hold management positions. As President of APTA Home Health, I couldn’t disagree with this more! Our members, and physical therapists in general, are well qualified to lead in many practice arenas. I know of several Academy members who are successful agency owners and agency leaders! Furthermore, it is well within our scope of practice and education to lead others. In this reimbursement environment, I feel that it is key that rehabilitation professionals are led by other rehabilitation professionals who understand and have experience with the detailed clinical and documentation requirements of rehabilitation in home health. Quite simply, most nurse managers and business professionals don’t have a deep enough understanding of these requirements.

I challenge each of you, and your agencies and employers, to promote physical therapists as leaders and managers. It is vital to the success of our profession, and it is vital to the success of our employers!

Sincerely,

Phil Goldsmith
President
APTA Home Health

Dissecting the 2023 Home Health Final Rule: Several Articles to Help

The following articles help to bring additional perspective to the home health final rule and bring attention to things to look out for besides the pending rate cuts. Also see the downloadable resources included at the end of this section. 

NAHC President: CMS Was Tactical, Strategic In How Final Rule Was Announced
Home Health Care News | By Patrick Filbin

By walking back severe cuts initially proposed in the home health payment rule, the U.S. Centers for Medicare & Medicaid Services (CMS) was strategically trying to create positive feelings about the final rule in order to have an upper hand down the line.

That is the assessment made by William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), less than a week removed the final rule’s publishing.

“It’s important to understand some of the politics of what happened in this final rule,” Dombi said during a NAHC webinar Friday. “CMS went with a headline saying they were cutting over $800 million — in one year alone — from home health care spending to a headline that now says they’re increasing spending by $125 billion. That was a strategic, tactical move by CMS to put out a positive headline.”

That messaging, Dombi said, has helped CMS initially convince Congress that lawmakers may not have to make any additional changes.

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From HHVBP to LUPAs: Additional Takeaways From The 2023 Home Health Final Rule
Home Health Care News | By Patrick Filbin

Following the Centers for Medicare & Medicaid Services’ (CMS) release of the final payment rule, it is critical for each home health agency to figure out its own financial standing and strategic plan for 2023. 

In addition, agencies should be finding key areas for improvement and educating clinicians on the recalibrated case-mix weights and Low-Utilization Payment Adjustment (LUPA) thresholds.

Those suggestions came during a Thursday webinar with experts with the home health consulting firm SimiTree.

“Each agency is going to be different in terms of what the financial impacts are going to be,” Nick Seabrook, managing principal at SimiTree, said. “The LUPA threshold going down is going to be a pretty significant change to agencies and that could move the needle pretty significantly from a revenue standpoint as well. It’s important to know what the impact of this is for your agency.”

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What Home Health Providers May Change Due To Final Rule
Home Health Care News | By Andrew Donlan

Now that the final payment rule for the home health care industry is officially out, providers and advocates will take the long-awaited next step.

For advocates, that will mean continuing legislation efforts. Although the final rule includes a 0.7% aggregate payment bump for home health agencies, behavioral adjustment cuts are still being implemented. That’s a phased-in approach that the Centers for Medicare & Medicaid Services (CMS) would like to continue in coming years. 

“We now turn to Congress to correct what CMS has done and prevent the impending harm to the 3.2 million highly vulnerable home health patients that depend on this essential Medicare benefit annually,” National Association for Home Care & Hospice (NAHC) President William A. Dombi said in a statement shared with Home Health Care News Monday. “Even with the limited phase-in of the rate cut, with significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of rate cuts.”...

...There will still be margin pressures due to the final rule – and final rules for future years – if the Preserving Access to Home Health Act does not gain any more traction in Washington, D.C. That piece of legislation would curb any cuts to home health reimbursement until 2026.

And if the margins are not there, less investment in other service lines is almost a certainty. But what may actually tick up is investment in technology in order to increase efficiency in certain areas.

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RESOURCES

HH Final Rule 7.85% Rate Cut: Advocacy 1-Pager

HH Final Rule Federal Health Policy Strategies Analysis