Surgeons from three Central New York hospitals are among 18 across Upstate who are collaborating with Excellus BlueCross BlueShield to reduce the number of unnecessary opioid pills prescribed after certain surgeries. The idea is to reduce the risk of opioid misuse that could turn into an addiction.
Dr. Renato M
andanas is Chief Medical Officer of Oswego Health. He says they’ve already been explaining to surgeons that many pain medications go unused by patients. Mandanas says doctors have had a habit of prescribing large numbers of pills.
"Say, 30 pills or 60 pills in some instances, with refills to boot. It varies from individual physician to individual surgeon. Our experience has been that all of our surgeons have adopted the recommendations of a reduced prescription of opioid medications."
Mandanas says most patients haven’t complained, and they, too, have been educated about opioid addiction and the need to use simple pain medications. Manager for performance improvement at St. Joseph’s Hospital Stephanie Johnson says doctors there have been very receptive to finding new ways to address pain that don’t have unintended consequences.
"How can we do better. How can we provide the best care for the patient and get them place where they've had a successful surgery, they're healing, and can move on without inadvertendly setting them up for an addiction."
But the reducing the number of prescription opioid pills doesn’t mean patients can’t simply ask for more. Dr. Mandanas says that’s when surgeons will have a conversation about the risks…
"When you say you need more, why do you need more? The doc will ask how much more. Is it proportionate to the surgery? Proportionate to the pain?"
Stephanie Johnson at St. Joes says there alre almost always alternative therapies that can be considered.
"Everybody responds differently. Alarm bells should be going off when you feel like you 'need' the medication to be able to get through your day as opposed to 'I'm going to see how long I can go without it.'"
Johnson says they’ll be collecting data and reporting back to the collaborative throughout the year to monitor progress and make adjustments as needed. Upstate University Hospital is also participating. Excellus and the doctors settled on 21 surgeries for the opioid reduction program, ranging from total knee and hip replacements to incision-less bladder tumor surgery.
Participating hospitals with surgeon champions in the program include:
Utica/Rome/North Country Region
• Bassett Medical Center
• Samaritan Medical Center
• A.O. Fox Hospital
• St. Elizabeth Medical Center
Central New York Region
• Oswego Health
• St. Joseph’s Health
• Upstate University Hospital (2 sites)
Western New York Region
• Kaleida Health (2 sites)
• Erie County Medical Center (ECMC)
• United Memorial Medical Center (Batavia)
Finger Lakes Region
• Clifton Springs Hospital
• Highland Hospital
• Newark-Wayne Community Hospital
• Rochester General Hospital
• Strong Memorial Hospital
• Unity Hospital
Southern Tier Region
• Our Lady of Lourdes Memorial Hospital
• United Health Services Hospitals (1 site)
Surgeries that are part of the program include:
• Total knee replacement
• Lumbar laminectomy
• Total hip replacement
• Cervical arthroplasty/discectomy/fusion
• Lumbar microdiscectomy
• Rotator cuff repair
• Total abdominal hysterectomy
• Breast reduction
• Laparoscopic cholecystectomy
• Laparoscopic vaginal hysterectomy
• Inguinal hernia repair
• Laparoscopic nephrectomy
• Laparoscopic gastric bypass
• Laparoscopic gastric sleeve
• Carotid endarterectomy
• Mitral valve replacement
• VNUS closure (varicose vein treatment)
• Transurethral resection of the bladder tumor
• Endoscopic sinus surgery
- Coronary artery bypass grafting