Our seniors deserve the highest quality care for opioid dependency, but currently, Medicare does not provide the comprehensive care they need. That is wrong. I introduced H.R. 5605, the Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act, to give older Americans across our nation more access to comprehensive addiction treatment services through Medicare.
Seniors are frequently prescribed opioids to treat chronic illnesses with constant, lasting pain issues, such as arthritis and other issues related to the musculoskeletal system. The frequency and chronicity of this prescribing makes them acutely at risk of developing a dependence, which is even more dangerous for them. That’s because as you get older, your physiology changes, which makes seniors less able to deal with the side effects of opioids and more prone to respiratory depression, the leading cause of opioid-related death.
And so, when you consider that roughly one-third of Medicare beneficiaries received an opioid prescription in 2016, with over half a million receiving a high dose, it makes sense that the hospitalization rate related to opioid misuse in patients over 65 has increased by 500 percent in the past two decades.
Despite these heightened risk factors, many seniors still do not have access to comprehensive, evidence-based treatment under traditional Medicare. We cannot leave our seniors behind as we work to address this national crisis. Our seniors deserve access to the gold standard of care for treating opioid addiction. It’s that simple.
My bill does this by creating an Alternative Payment Model demonstration program through Medicare for comprehensive treatment and care programs for opioid misuse disorder — which will establish quality measures that reward comprehensive treatment programs that actually produce the best patient outcomes.
It works by giving providers and institutions that choose to participate a case management payment, which they would use to provide wraparound services for Medicare beneficiaries. Teams with an addiction specialist would also receive a higher incentive. Seniors participating in this program will receive Medication Assisted Treatment alongside psychosocial support, such as psychotherapy, treatment planning and appropriate social services.
This coordinated care approach is considered the gold standard of care, and if we want to successfully address this crisis, we need to ensure that individuals have access to treatments that will result in successful outcomes.
I have seen firsthand the importance of this with my own patients in the emergency department. Getting Medication Assisted Treatment is important, and the success of that treatment is enhanced if that patient is also participating in psychotherapy and receiving the appropriate social services. That’s why this demo is supported by the American Society of Addiction Medicine and the California Medical Association, among others.
Also included in this bill is H.R. 3528, the Every Prescription Conveyed Securely Act, introduced by Rep. Katherine Clark from Massachusetts. Her legislation will direct providers to use — by 2021 — electronic prescribing for controlled substances (EPCS) technology for Medicare Part D to cut down on opioid prescription fraud and illicit use of prescription opioids. Already, seven states have implemented this system to combat this crisis and keep illicit opioids off the streets. According to the Department of Justice, most fraudulent prescription opiates are obtained either through doctor shopping, forged prescriptions or theft, all of which can be addressed by an effective electronic prescribing for controlled substances system.
It is critical that all Americans — regardless of their age or how much money they make — have access to high-quality, comprehensive treatment. I am honored to have secured House passage of my bill, H.R. 5605, which will strengthen Medicare by giving older Americans access to gold-standard comprehensive care, including mental health counseling, addiction specialists, treatment planning and social services. Our seniors deserve no less. I will continue fighting to get this critical bill signed into law by the President.
• Rep. Raul Ruiz, M.D., California Democrat, serves on the House Energy and Commerce Committee.