The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018, while primarily intended to tackle the substance use disorder (SUD) crisis, included several pain management provisions. Perhaps the most significant provision from a pain standpoint is Section 6086, the Dr. Todd Graham Pain Management Study. 

The study memorializes Todd Graham, MD, a pain management doctor who was tragically murdered by a patient’s husband for refusing to provide opioids to his wife. The main purpose of the study is for the Department of Health and Human Services (HHS), working through the Centers for Medicare and Medicaid Services (CMS), to recommend revisions to Medicare provider payments and coverage of multidisciplinary, evidence-based, non-opioid treatments and technologies for acute and chronic pain management. It also asks for recommendations for individuals with pain and co-morbid mental health, SUD, or suicide risk.

On Feb. 2, Cindy Steinberg, Director of Policy and Advocacy, moderated a panel about the study as part of the Alliance for Balanced Pain Management’s (AfBPM) annual summit. The panel featured two speakers: Suchitra Iyer, PhD, of the Agency for Healthcare Research and Quality (AHRQ), which is conducting systematic reviews for CMS as part of the study, and Martin Schultz, of the Office of Congresswoman Jackie Walorski, which was integral in the inclusion of the Todd Graham study in the SUPPORT Act.

“The main purpose of the study is to gather evidence on alternative pain treatments and technologies, and use that evidence as a way to improve coverage and payment policies,” said Schultz.

In mid-September, CMS held two listening sessions – one for people with pain and one for providers – where they asked what treatments Medicare should cover for people with chronic pain that are not currently covered. Steinberg spoke at both sessions. 

“I recommended coverage for therapeutic massage and gentle exercise programs such as yoga, pilates and Tai Chi, all chiropractic treatments (Medicare only covers one technique for one condition – lower back pain), all licensed acupuncturists for all pain conditions (Medicare only covers acupuncture for chronic lower back pain provided by or supervised by a medical doctor), and ongoing support group programs with trained leaders that offer patient education.”  

Steinberg points out that private insurers usually follow Medicare’s lead in coverage decisions, so even for those not on Medicare, CMS’s decision to cover more treatments for pain management will likely have far-reaching effects and lead to similar decisions by private insurers.

AHRQ is currently conducting systematic reviews of studies showing efficacy for Integrated Pain Management Programs or Comprehensive Pain Management Programs. They define such programs as having three components: medication, psychological counseling, and physical rehabilitation. The second review is for effectiveness studies of interventional pain therapies that CMS does not now cover, such as peripheral and occipital nerve stimulation and stem cell treatments. By law, CMS must base national coverage determinations on scientific evidence in the population of patients served by Medicare, which includes those 65 and older and disabled Americans.

“A report is due to Congress from HHS recommending options for improving coverage of pain management therapies and we will be watching for it,” says Steinberg.

To watch the recording of the Feb. 2 Summit for Balanced Pain Management, visit the AfBPM’s website.