Becker's Clinical Quality & Infection Control

30 QUALITY IMPROVEMENT & MEASUREMENT Should Opioid Addiction Be Considered a Hospital- Acquired Condition? By Brian Zimmerman S ome medical experts and healthcare administrators are making the case that if an individual's addiction to opioids is directly rooted in hospital-based care, the hospital should be penalized, according to a recent report from NPR. Such a policy could result in post-surgical opioid addiction being placed on the same tier of adverse outcomes as certain hospital-ac- quired infections. Here are five things to know. 1. In a September Health Affairs blog post, Michael Schlosser, MD, CMO of Nashville, Tenn.-based Hospital Corporation of America, along with two other physician executives, argued hospitals should be on the hook for opioid addiction if the adverse outcome develops aer care for a high-cost, high-volume condition that could have been prevented by adhering to evidence-based practices. 2. While the authors of the blog post acknowledged it would be difficult for hospitals to monitor all patients prescribed opioids aer surgery, they said hospitals should attempt to do so. "Addressing long-term opioid use as a hospital-acquired condition will draw a clear line between appropriate and inappropriate use, and will empower hospitals to develop evidenced-based standards of care for managing post-operative pain adequately while also helping pro- tect the patient from future harm," Dr. Schlosser told NPR via email. 3. e implementation of such a policy could conflict with current reimbursement practices that link patient satisfaction surveys to payment. However, portions of surveys that address patient pain are moving away from questions that ask patients if their pain was adequately addressed, in favor of questions that ask if providers com- municated with the patient about their pain. 4. ere are no firm federal guidelines for prescribing opioids post-surgery. While the CDC released opioid prescribing guidelines for chronic pain in 2016, the recommendations contain few refer- ences to acute pain. However, there is some emerging evidence that could eventually be used to frame opioid prescribing best practic- es for acute pain. One such study published September in JAMA Surgery determined optimal post-surgical opioid prescriptions last between four and nine days. 5. Andrew Kolodny, MD, director of Physicians for Responsible Opioid Prescribing and co-director of the Opioid Policy Research Collaborative at Brandeis University's Heller School in Waltham, Mass., told NPR there are many physicians prescribing opioids without a firm grasp on what opioid withdrawal symptoms look like. Dr. Kolodny also said viewing post-surgical opioid addiction as a hospital-acquired condition is an idea worthy of consideration. "We're in the midst of a severe opioid epidemic, caused by the over-prescribing of opioids," Dr. Kolodny told NPR. "Putting hospi- tals on the hook for the consequences of aggressive opioid prescrib- ing makes sense to me." n Readmission Reduction Program Increases Mortality in Medicare Heart Failure Patients, Study Finds By Alia Paavola T he implementation of the Hospital Read- missions Reduction Program, created under the ACA, reduced the rate of readmissions, but also increased the mortality rate for Medicare patients with heart failure, according to a study published in JAMA. The team of researchers observed 115,245 fee- for-service Medicare patients hospitalized with heart failure at 416 hospitals across the U.S. be- tween 2006 and 2014 to understand the impact of the program, which was designed to reduce hos- pital readmissions. The observations were divided into time periods before and after HRRP penalties took effect. The ACA established the HRRP in 2010, which re- quired hospitals to publicly disclose their 30-day readmission rates for heart failure, heart attack and pneumonia and created penalties for hospi- tals with high readmission rates. Here are five things to know. 1. The researchers found 30-day readmission rates declined from 20 percent before to 18.4 percent after the implementation of the HRRP. 2. The 30-day risk-adjusted mortality rate in- creased from 7.2 percent before the program's implementation to 8.6 percent after the program was implemented. 3. The one-year risk-adjusted readmission rate declined from 57.2 percent prior to the program to 56.3 percent after. 4. The one-year risk adjusted mortality rate in- creased from 31.3 percent mortality before the HRRP implementation to 36.3 percent after the implementation. 5. The researchers concluded that among fee-for- service beneficiaries discharged after heart failure hospitalizations, the HRRP program was temporar- ily associated with a reduction in admissions but an increase in mortality. n

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