Dear NES Providers,
I hope you all are doing well. I wanted to thank you all again for the hard work. I am watching our RVUs increase month by month and it’s all because of your dedication. You all are getting credit for all the hard work and long hours you put in.
August’s edition of Lost in TranslatYIN is all about Medication Assisted Treatment (MAT) for Opioid Use. Truth be told, there’s always been a stigma about prescribing Suboxone (Buprenorphine/Naloxone) for opioid dependent patients. In our minds, maybe we think to ourselves, I really don’t want to replace one addiction for another. Or maybe the thought is, what is to stop the patient from abusing Suboxone in addition to opiates? I myself am guilty of these thoughts.
The truth is this. 15% of the US population deals with chronic pain and addiction. During a 12-month period from March 2022 to April 2023, there were 111,355 overdose deaths. This was a record high. 70% of the deaths were males. In a randomized trial of Emergency Department interventions for patients with opioid use disorder, the patient group that was started on Suboxone had fewer self-reported days of illicit opioid use than patients who just received referrals and were enrolled in intervention groups.
We all signed up to be Physicians, PAs, and NPs to help of people. MAT is helping people. By initiating MAT in the Emergency Department, we are giving mothers back their sons. Children return to their fathers. No parent should ever have to bury their child.
Previously, in order to prescribe Suboxone, you needed to take a special course to get a certificate called an X waiver. Providers no longer need to get an X waiver to initiate Suboxone treatment. CMS wants us to initiate MAT in the Emergency Department if it’s appropriate. That’s why they got rid of the X waiver. Addiction is a disease that can treated. Now that providers don’t need an X waiver to prescribe Suboxone, if we correctly document and initiate MAT in the ED, MAT adds an additional 1.89 RVU per chart. This is a gracious amount for something so simple. Think also about this. Soon MAT will be the standard in Emergency Departments. How much longer till we have a similar program for alcohol? Or for benzos? It’s only a matter of time.
Thus, in order to correctly document and get credit for MAT you need 3 components. 1) Administer a dose of Suboxone (Buprenorphine8mg/Naloxone2mg) in the Emergency Department. 2) Copy and paste this phrase into your MDM “I initiated medication-assisted treatment for the patient in the Emergency Department. I gave the patient a dose of suboxone for the treatment of the patient’s opioid use disorder. I provided counseling and positive reinforcement to help encourage the patient’s success and gave the patient a 3-day supply of suboxone. The patient will be referred to an outpatient medication-assisted treatment center to provide continuing care and support. The patient agrees to follow up for further care and treatment.” 3) Diagnose the patient with “Opioid Dependence or Opioid Abuse.”
Some Emergency Departments will have a medication called Subutex (Buprenorphine) instead of Suboxone (Buprenorphine/Naloxone). The reason why Suboxone is preferred over Subutex is because there is Naloxone (Narcan) included in Suboxone. Thus, it’s way harder to abuse Suboxone (as opposed to Subutex) as it has Narcan included in the drug. When we discharge these patients, please give them a 3-day supply of Suboxone just in case they can’t follow up the next day to continue their therapy. The dosage of Suboxone for the 3-day prescription is Suboxone (8mg/2mg) BID for 3 days.
Please let me know if any of you have any questions. Thank you all for listening and thank you for making a difference in patient’s lives.
David Yin
