Another Committee Setting New Rules for Opioids

Little Known Committee Setting New Rules for Opioids – March 07, 2017/ Pat Anson

Like the CDC, FDA, DEA and CMS, the National Committee for Quality Assurance (NCQA) is targeting high doses of opioid pain medication, as well as patients who see multiple prescribers and use multiple pharmacies.

NCQA is a little known non-profit organization that plays a big role in determining the standard of care expected of healthcare providers. It manages accreditation programs for physicians, medical groups and health insurance plans by measuring and ranking their performance against a set of standards known as the Healthcare Effectiveness Data and Information Set (HEDIS).  

To post a comment – please! – click here
(a detailed registration is required).
Comments will be accepted until March 22.

In other words, NCQA decides who is doing a good job and who is not, based on guidelines that it sets for the healthcare industry. That makes it a very powerful and influential organization

In a proposed new HEDIS standard for opioid prescribing, NCQA will set a daily ceiling on opioid medication at 120 milligrams morphine equivalent dose (MED) when prescribed for 90 consecutive days or longer. The number of prescribers would also be limited to no more than four, as would the number of pharmacies.

Any insurer or provider in violation of these standards would be red flagged, and if too many violations are found they risk losing their accreditation, a heavy price to pay for anyone in the healthcare industry.

In a statement explaining the proposal, NCQA said opioids may be prescribed for acute conditions such as post-surgical pain and for chronic pain conditions “such as sickle cell disease or late stage cancer.”

The fact that they can only come up with two terminal diseases to illustrate “chronic pain” shows how completely out of touch these guys are.

And then follows the full propaganda we see everywhere these days: opioids are bad!

“The appropriate use of opioids can be vital to pain management, but there is limited evidence for the long-term beneficial effects of opioid use for chronic pain management for nonterminal conditions. In addition, long-term daily use of opioids can lead to increased tolerance (higher doses are needed to feel the effects).

Taking excessive amounts of opioids can result in overdose, which may lead to death. Long term opioid use can lead to addiction or dependence; therefore, patients prescribed opioids should receive regular, rigorous monitoring and screening.”

Critics says the proposal makes no allowance for patients who are currently stable on high doses of opioids above 120 MED, who may be involuntarily tapered to a lower dose under the new HEDIS standard.

“What seems desirable at the system level (overall lower opioid prescribing) may put patient-centered care at risk. Most importantly, the impact of this proposed quality metric might be to push providers to engage in involuntary opioid discontinuation on currently stable patients, a course of action that the CDC Guideline did not recommend.”

NCQA is seeking public comment on its opioid proposal, not only from physicians, but patients as well.

To post a comment, click here
(a detailed registration is required).
Comments will be accepted until March 22.

Here are the instructions from the site:

Public Comments


  1. Select a product.
  2. Click the Instructions link to view public comment materials, including instructions, proposed specifications and measures.
  3. When submitting your final comment, click the Submit and Logout button to receive an e-mail summary of the comments you made.

Note: You will receive an e-mail confirmation after you submit your comment by clicking Submit and Logout.

If you do not receive an e-mail or if you have an issue with the public comment process, submit a question to under My Questions and select the “Support” category.

Below are the selections you must make to comment on the opioid limits:

Notice your comment is limited to 2500 characters!

The average length of a word in most documents is just over 5 characters, so this limits you to just under 500 words.

Also: CMS Public Comments End

“These changes pose serious risks to some patients who currently receive opioids,” said Kertesz in a letter to CMS signed by 82 other physicians, including some who helped draft the CDC guidelines.

“While some small studies do report favorable outcomes from voluntary opioid tapers carried out by experts, there exist no data to justify involuntary dose tapering carried out by clinicians lacking expertise. And worse, there are a rising number of reports of patient harms, including suicide and death,” the letter states. “CMS mandates will cause previously stable patients to suffer acute withdrawal with or without medical complications, including death.”

To see a full copy of the letter, click here.

As PNN has reported, the insurance industry appears to have played a major role in drafting the CMS plan, which closely follows a 62-page “white paper” prepared by the Healthcare Fraud Prevention Partnership, a coalition of private insurers, law enforcement agencies, and federal and state regulators formed in 2013 to combat healthcare fraud.

The white paper goes far beyond fraud prevention, however, by recommending policies that will determine how a patient is treated by their doctor, including what medications should be prescribed.  

The white paper was drafted largely by insurance companies, including Aetna, Anthem, Blue Cross Blue Shield, Cigna, Highmark, Humana, Kaiser Permanente and the Centene Corporation.

CMS only accepted public comment on its opioid proposals that were emailed, instead of using the Federal Register, where all comments become official public record and are easily available for public inspection. The agency routinely uses the Federal Register for other rule and policy changes.

Asked by PNN why the Federal Register was not used this time, a CMS spokesman said the agency would have no comment.

Why are so many new restrictions on opioids being pushed through so secretly?

It seems an odd coincidence that only standards relating to opioids are handled using such non-standard tactics.

The agency plans to publish its final rules on April 3.

Another date to dread – I can hardly keep up.

Posting the rules in the Federal Register and asking for public comment would have delayed their implementation.

So we can be pretty sure that the comments won’t be taken into consideration when there’s such a rush. All opioid restrictions are being fast-tracked because their sponsors believe these rules will decrease heroin/fentanyl overdoses.

If doctors actually prescribed heroin/fentanyl this might be effective, but since doctors are NOT prescribing heroin, these rules have no effect on overdoses.

This insanity is happening only because Kolodny and PROP managed to lump illegal opioids together with prescribed opioid medication. If those two were separated, it would become crystal clear that there is no cause/effect relationship between prescriptions for pain and heroin overdoses anymore – prescriptions have been declining since 2010, but heroin overdoses are skyrocketing.


7 thoughts on “Another Committee Setting New Rules for Opioids

  1. Kathy C

    People! This is not about the “Government” it is about the Insurance Industry, and the use these Quality or Accrediting Groups or Committees, to mislead and manipulate the Medical Industry, to avoid risk and increase Profitability. The Pharmaceutical Industry has likely already made sure their Interests were covered here too.
    The NCQA is one more Committee, that is using their appearance of credibility, to influence Healthcare Policy. The deficiencies in their Data have been noted. For discreet issues, like tracking Asthma Medications and Compliance, they may be adequate. The Collection of this Data, is fairly straightforward, and in a lot of cases would not reflect badly on the HMO, Hospital or Physician. These Committees get a lot of input from the Industries, just like CMS. The Data collection has been truncated, They clearly use this data to benefit the Insurers, in their calculation of “Risk”, It is Inferred that this would help Patients, or “Consumers” as they are referred to now. The Mythical “Choice and Comparison,” that is perpetuated to maintain the For Profit Healthcare System.
    For the last couple of decades we were promised a “Data Revolution” we got the Internet, we have “Instant Access to Information.” The Industry could not have that, they had to not only influence the Data that was collected, they had to obscure their place in the Public Perception. The Corporate Media was happy to oblige. They only reported on Healthcare on approved story lines.
    An occasional “Finding”; by a Public Health Agency, could be Spun, with a Counter Article, or explained away. The Shocking finding that Infant Mortality Rates are climbing, was downplayed, it was “those people.” It was Poor People, or “Minorities” anyway, it won’t affect me or mine. Those are the same people the Insurance Industry blamed for my Premiums being so high. Corporate Media continued to point the blame for the Cost of “Healthcare” at the Medicaid recipients, and even Immigrants. They manipulated an angry Mob, a group of people who were looking for a scapegoat or an explanation.
    This same “Mob” was directed at people on Pain Medication. There were the people who did not like the idea that money was being spent on Pain Medications, or anything that might benefit the “undeserving”. The Corporate Media sensationalized the “Overdose Deaths” and ran the “Drugs are bad” story line. These story-lines showed a distorted view of serious Health and Social Issues. They also found that the Psychological Industry and Big Pharma were perpetuating this story line. Some of the “Conclusions” on some Cherry Picked “Studies” were injected into the Media, and Social Media. The ones that reaffirmed their pre existing Biases, went Viral. They used “Soft Science” or pseudo Science to back up their claims. This was about perception not Facts or Hard Data. They just avoided the Facts.
    They pointed to the “Lack of Data,” to prove their Point. The Lack of data was by design. The Industry found it was easier to obfuscate Facts, in the Data Collection, than to explain after the fact. Physicians were told that collecting some data could be “Government Overreach or might lead to liability issues. Each and every bit of data collected by Healthcare Providers had to be approved, and had to avoid any possible Liability or accountability issues. They ran every possible permutation. In some cases it made sense. Hospitals in lower income areas had a sicker population so they had to adjust for the increased death rate. They also kept the Reporting Requirements voluntary. The HMOs and their employees still had some discretion. A decision like Cause of death was still up for Interpretation. A dead patient could be attributed to “Natural Causes” rather than a Medication Mistake. They made sure that capturing the mistakes was kept vague. So this data was up to interpretation. The reporting of the data was up to interpretation.. Even Medicare, the Countries largest Insurer was only allowed certain data. The “Government” was not allowed to collect any data the Industry might find uncomfortable.
    Only certain Public Health issues were tracked. Infant Mortality is one important one. They mention Schizophrenia Medication and heart problems. There are more people with “Back Pain” than Schizophrenics, or other targeted issues. Yet there is little or no Research. CMS has a Back Surgery they compare across providers. The Provider participation is voluntary, and there is enough fluidity to avoid or explain certain negative outcomes. The most important conclusion from that data should be “why this one Procedure? If a Patient were researching their chances at a particular Hospital this is very limited information to base a life changing surgery on.
    There is no Agency acting on our behalf. CMS should be, the impression is that these Government Agencies have unlimited access to data. There is an awful big amount of data, but how much is useful, or what is allowed to be used, is another matter. We have all been deceived. The Industry is Gas Lighting us all. Even the “Big Government” Myth, is an Industry Construct, A theme in so much “Media” is the “Big Bad Government” Our Government was supposed to protect us from these Industries, instead the Government has been infiltrated by Industry insiders. There used to be an assumption, or an ideal that the Government, without financial ties, and an interest that should be in serving the public would protect us from these Industries. Instead we have unlimited Industry, they have been chipping away at any regulations they don’t like, while demonizing the Government.


    1. Zyp Czyk Post author

      I have to admit, I think you’re right.

      In my mind, there’s so little distinction between Business and Government that I assume Government is just another Business fighting for it’s continued existence. Whether with votes or sales, there’s money to made and for financial sharks, that’s like blood in the water.


      1. Kathy C

        Hi Zyp!
        There used to be some kind of distinction. There were supposed to be Laws to protect us. Government was supposed to have Regulations on Monopolies, unfair Trade Practices, and even Consumer Protection. There used to be at least the impression that Government was to protect us from unregulated businesses. There is not much anymore. I have been trolling around on Facebook, looking at Local “News.” 20 years ago there were Articles about Local Healthcare. The only “News” anymore are PR Pieces about a New Cancer Wing. They repeat PR Pieces from the CEO’s. When Pro Publica did a Piece on U.S Healthcare, they were the only one. Sure there are lots of Industry perspective pieces, but not much critical. There seems to be a “News Blackout” on certain Subjects.

        Here is an Article about the conflagration of Psychology and Science.

        There are some good Links on here.

        I really need to stay offline, especially now that Spring is here. Next week we are going to Truth Or Consequences New Mexico. It is a really funky eccentric place, where there are old Bathhouse Motels. I am going to soak in some Hot Mineral Water, and I can’t wait. I hope that your winter was not too dreary.


        Liked by 1 person

        1. Zyp Czyk Post author

          Hi Mary/Kathy,

          Yes, things really have changed, haven’t they? We’re the first generation having to deal with America’s decline, having it harder than our parents instead of easily surpassing their incomes.

          Pure unrestrained capitalism has become like a religion that the state is demanding we join. The full force of vast funds will be determining our lives, not humane efforts, and certainly not compassion!

          We had an astounding amount of rain here in northern California – so many roads through the hills between my cabin and Silicon Valley were washed out that a trip to town took 2 hrs instead of one. We’re just having a week-long interlude of above average temperatures, and then we’re supposed to go back to a rain pattern next week.

          Oh well, it makes sunshine even more precious :-)


      2. Kathy C

        “Media manipulation in the U.S. today is more efficient than it was in Nazi Germany, because here we have the pretense that we are getting all the information we want. That misconception prevents people from even looking for the truth.” – Mark Crispin Miller


  2. Pingback: Compelling Comments on Opioid Restrictions | EDS and Chronic Pain News & Info

  3. Pingback: Opioid Quality Metric Based on Dose Alone | EDS and Chronic Pain News & Info

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