Testifying Feb. 24 before a Senate Special Committee hearing on opioid use among seniors, Steven Diaz, M.D., MaineGeneral Health’s senior vice president and chief medical officer in Augusta, spoke about the alarming increase in opioid misuse among the elderly and the need for a multidisciplinary approach to treating chronic pain. Among other issues, he raised concerns over how the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) pain questions may contribute to the opioid epidemic.

 The problem stems from the fact that the HCAHPS query is both publicly reported and part of value-based purchasing, Diaz noted. “This compulsion to do well on rankings for pain queries, coupled with pain toolkits proposing that medications for pain can be used ubiquitously and safely has created an untenable conflict,” he told the committee.

 “The result is that we now give more opiates and more opiate addiction, diversion and overdoses,” he testified. “This is increasingly a problem for the elderly.”

 Diaz’s comments sparked the interest of committee Chairman Susan Collins, R-Maine, who queried witness Sean Cavanaugh, director of the Center for Medicare & Medicaid Services’ Center for Medicare, about the matter. Cavanaugh agreed to consider revising the HCAHPS questions. 

 Diaz said his hospital’s emergency department saw 10 opiate overdoses in patients age 65 or older last year, more than double the past average.

 “The treatment of patients with chronic pain is a significant contributor to the epidemic,” he said, adding that “opiates for non-terminal chronic pain, especially in the elderly, should not be first-line treatment.”

 While primary care physicians and specialists in psychiatry “are key for work in the treatment of pain,” he said national shortages of each are amplified in rural areas such as Maine.

 “Ideally, when a patient presents to the medical system for chronic pain or opioid addiction, whether through their primary care physician, specialist, therapist, emergency department visit or through an interaction with law enforcement, the pathway for intervention and expert clinical support should be readily available,” he said.

 Also testifying at the hearing were representatives from the Department of Health and Human Services’ Office of Inspector General, Indiana State Department of Health and Stanford University School of Medicine.