Michigan Gov. Gretchen Whitmer, D, has signed into law a bill that exempts hospices from opioid prescribing restrictions that the state enacted last year to combat the national addiction and overdose epidemic.
Prior to this legislation, the law mandated that prescribers have a “bona fide” prescriber-patient relationship, and that the prescriber obtain reports from the Michigan Automated Prescription System (MAPS) prior to prescribing or adjusting schedule 2-5 opioids to patients.
Because hospice care is delivered most often in patients’ residences, face-to-face visits with physicians or other prescribers are rare. Consequently, the prescriber restrictions have delayed patient access to necessary pain medications.
“We want to make sure that our hospices in Michigan have the ability to continue to care for and manage patients with dignity at end of life. This legislation will make sure they can do that,” said State Rep. Bronna Kahle, R-Adrian, who introduced the bill.
Hospices nationwide have encountered similar difficulties due to state laws or in some cases payer or pharmacy policies, many of whom require prescribers to comply with opioid guidelines from the U.S. Centers for Disease Control and Prevention (CDC) despite the fact that CDC has clarified that the recommendations do not apply to hospice or palliative care.
The CDC guidelines, issued in 2016, recommend non-opioid approaches including physical therapy as a preferred first-line treatment for some — but not al l— types of chronic pain, as well as dosage and pharmacy review requirements. Common misunderstandings about the guidelines relate to their recommendation to reduce opioid dosage to 90 morphine milligram equivalents (MME), as well as limits on how long a patient can receive opioid therapy, according to the CDC.
A 2014 study found patients and families view pain and symptom management as their top priority related to quality of hospice care. Deficiencies in pain management can affect a hospice’s publicly reported quality and patient and family satisfaction scores, which prospective referral partners and patients are using increasingly when choosing a hospice.
A version of the Michigan law failed to pass last year, but in the current session both the state’s Senate and House passed the bill unanimously and indicated that the law should go into effect immediately.
“Most of us have had some kind of experience with hospice care with our friends or with our family members or loved ones ,including me with my own father just two years ago and my father-in-law last year,” Kahle said. “And as I am talking to families who have been through this they know, and we know, how important it is for those individuals that are receiving that end-of-life treatment to be made as comfortable as possible.”