Intentional Structured Opioid Monitoring Protocol: Responsible and Viable Opioid Deprescribing

Abstract

INTRODUCTION Primary care providers are increasingly called to address the problem of treatment of non-malignant chronic pain with opioids, particularly in low resource areas. An Intentional Structured Opioid Management Protocol (ISOMP) is a primary care-based program shown to significantly decrease opioid burden. The development of sustainable programs that improve opioid-related outcomes is especially important in these low resource areas. METHODS A retrospective electronic health record review was conducted for financial data and billing practices for a cohort engaged in the ISOMP between 2011 and 2014. Data was analyzed for sustainability within macroscopic practice-wide and microscopic daily scopes. Further analysis was conducted on the implications of patients maintained on (Group A) and weaned from (Group B) opioids. Data was analyzed with STATA software. RESULTS ISOMP demonstrated decreased patient encounters numbers (-7.38%), increased total work relative value unit (RVU) (+7.73%), reduced no-show visits (-12.14%), and increased total reimbursement (+13.06%). Group A had fewer encounters (-6.41%) and increased work RVU (+42.95%). Group B had fewer encounters (-24.04%) but decreased work RVU (-17.56%). Significant decreases in encounters (-44.99%) and work RVUs (-47.39%) were seen after discontinuation of opioids. CONCLUSIONS Besides its previously documented opioid discontinuation rate, the ISOMP model was associated with fewer visits and better visit compli-ance. Sustainability was proven as neither global practice nor daily productivity was negatively impacted. Time-based coding for Group A offset losses seen in Group B productivity with savings directly related to speed of opioid wean