Insurers pushed back against an HHS task force's finding that they are not covering non-opioid pain management therapies such as acupuncture, while proponents of such treatment see a chance to argue for Medicare reimbursement.
A congressionally mandated report from the Pain Management Best Practices Inter-Agency Task Force on gaps in treatment concluded that payers often don't pay for non-opioid therapies that are more expensive than opioids. But America's Health Insurance Plans, the top insurance lobbying group, said in comments to the report that it isn't that simple.
"There are many approaches to therapeutic modalities (e.g., acupuncture, yoga, tai chi)," AHIP's comments said. "These pose unique challenges to building a network of providers due to the lack of standardized licensing." AHIP added that there are limitations with existing evidence for some of the emerging therapies and "conflicting and difficult-to-follow treatment guidelines."
For instance, AHIP said, there is some evidence acupuncture could help patients suffering from lower back pain but there isn't enough evidence to show it helps alleviate shoulder pain.
UnitedHealthcare said in comments that the task force must not recommend just "broader reimbursement for pain treatment and management."
UnitedHealth said that any reimbursement for pain treatment and management be integrated wherever possible into the reimbursement for the underlying condition.
"For example, where there is a bundled reimbursement mechanism for a knee replacement, the knee replacement and the corresponding bundled reimbursement must include components which address the associated pain treatment and management," UnitedHealthcare said.
But some hospitals were happy with the recommendation for more reimbursement.
Houston-based Memorial Hermann Hospital System said that in addition to greater coverage, insurers should also reimburse for not only the cost of a treatment but also the time spent counseling and educating patients.
The system gave an example in its comments of "pre-surgical education classes for patients undergoing major surgical procedures that can be successful in setting pain management expectations prior to the patient's exposure to post-op pain."
Meanwhile, acupuncture proponents see an opportunity to expand coverage. Currently the CMS does not cover acupuncture.
"Improving reimbursement will also help reduce the perverse incentives currently present in Medicare and other payment programs, which encourage the prescription of cheap opioids over more involved treatments tailored to individual patients," said the National Certification Commission for Acupuncture and Oriental Medicine.