Limiting Opioid Overprescription after Prostatectomy: How Payer-Provider Collaboration Can Lead to Improved Patient Safety and Reimbursement
NEJM Catalyst Innovations in Care Delivery
Blue Cross Blue Shield of Michigan (BCBSM) has a history of working with health care providers to improve quality of care and value through its Collaborative Quality Initiatives program. The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a consortium of 44 urology practices and more than 250 urologists, both academic and private, which maintains a prospective registry of validated clinical data in partnership with BCBSM. Through this collaboration, a multidisciplinary pain-control optimization pathway was created and implemented, resulting in a significant decrease in the number of opioid tablets prescribed after robotic prostatectomy while increasing reimbursement of professional fees for the procedure by 35% though the use of a modifier code.
Shah PK, Linsell S, Qi J, Hafron J, Sarle R, Lane B, Peabody J, Miller DC, Ghani KR, Dupree JM. Limiting opioid overprescription after prostatectomy: how payer-provider collaboration can lead to improved patient safety and reimbursement. NEJM Catalyst Innovations in Care Delivery. 2020 Apr 15;1(3).