Prescription for Change

Your post-operative pain medications could be costing you

by Julie Riley

Over the last few months, we’ve increasingly heard the question, “Is IV acetaminophen worth it?” In fact, earlier this year in a Corporate Strategy poll, 20% of pharmacists told us they have been conducting analyses on IV acetaminophen to inform formulary decisions and clinical pathways.

Why the surge in interest? Both the cost and use of IV acetaminophen have approximately doubled over the last year, and with the increased expense comes increased scrutiny. Digging into the data, we quickly realized the real question is: What is the impact of moving towards multi-modal pain management approaches? Do they meaningfully reduce length of stay and complications?

Many organizations are trying to answer this question on their own, but face challenges. Opioid-related complications are rare events, so it’s difficult to analyze outcomes within a single facility due to limited sample size. And already published, randomized clinical trials often compare results in narrow populations that don’t represent the “real world” patients the average acute care facility serves.

Our colleagues in Research & Development were able to conduct a comprehensive analysis of two years’ worth of data from more than 400 Crimson Continuum of Care hospitals to answer this question. In a sample of more than two million cases, opioid-related complications are no longer rare events.

What their analysis found might surprise you: many institutions have the opportunity to reduce charges by millions. The secret? Reducing opioids used to manage post-operative pain.

Here’s just one insight from that analysis: Clinical leaders can prioritize where they reduce opioids to maximize their benefit. We found that the impact of a multi-modal approach depends on the DRG, and the biggest benefits are in reducing opioid use for major small and large bowel procedures.

In fact, the average 250-bed facility has the opportunity to reduce largely unreimbursed charges by just over $1 million dollars a year if they reduce opioid use in these surgeries.

As we’ve shared with you in our 2014-15 national meeting series, when clinical leaders step back and use charge data to analyze care variation in their organization, they can also find opportunities to reduce costs and improve quality. This new analysis of different approaches to post-operative pain management protocols is just one more example.

See the rest of our insights

Check out our research briefing to learn more about our pain management analyses and the key observations we made about IV acetaminophen and multi-modal pain regimens.


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