A Q&A with Dr. Corey Waller of Health Management Associates
Dr. Corey Waller has traveled the country to assess hospitals’ and health care systems’ effectiveness at treating chronic pain with opioids. Waller says his findings show a lack of understanding on the part of physicians and hospital administrators to tackle the opioid epidemic head-on.
Waller, a nationally recognized addiction specialist, is a principal at Health Management Associates Inc. in Lansing. He previously was senior medical director for education and policy at the National Center for Complex Health and Social Needs. With West Michigan roots, Waller began as an emergency medicine doctor at Spectrum Health in 2006, where he would later become medical director, and also worked with The Grand Rapids Red Project when it was first funded to distribute overdose-reversing Naloxone kits.
Waller spoke with MiBiz about his observations on the U.S. health care system’s inadequate response to the opioid crisis. (The interview was edited and condensed for length.)
How did you get involved in this field and specifically opioid addiction?
I recognized pretty quickly that the subset of patients I was seeing in the emergency department with chronic pain focused on wanting and feeling like they needed opioids. We didn’t get a lot of training in pain and addiction in residency. I continued to work in the space until I became board-certified in addiction, then opened a clinic for patients in ER at high frequencies. That’s where I had dug in. Every time I really opened the lid on something, I recognized 50 other things we didn’t have an answer to and didn’t understand.
What have been the biggest changes over the past decade you’ve seen with health systems responding to the opioid epidemic?
The biggest focus would be on obstinance: They clearly have no desire to do this rapidly. Despite hospitals and ER departments being the most equipped to intervene early, they have ubiquitously as a core large group made a decision to not lean in. They’re failing — that’s the easiest way to say it. They’re biting around the edges a little bit now, but even that’s new. There’s no predictability, no large-scale implementation efforts. Because of that, we continually lose lives because when (patients) do reach out for help, they reach out to an emergency department. There is no large-scale effort to build an ecosystem of care within.
Why are hospitals and health systems not making stronger moves to address the crisis?
It’s two-fold: I have visited a few hundred health care systems around the country. One of the biggest ones is that they’re fearful that if they start a program, everyone is going to show up. To me, this is interesting and lays bare the stigma of this disease. We’d never make that statement about fractured ankles or heart attacks. They don’t want to be seen as the hospital that treats ‘those people.’ The stigma is front and center.
Close behind is really a lack of understanding of the disease at the level of practicing clinicians and the administration. It’s a lack of understanding of how to identify and treat it on the side of clinicians, and from the C-suites, a lack of understanding of how to bill for it. They don’t know how to do this. If you dig into hospital administration master’s degrees around the country, it’s not something they learn. They’re flying just as blind as we were coming out of residency. There needs to be rock-solid national efforts to really teach administrators how to bill these systems.
How do we build a health system that is consistent and predictable in treating opioid addiction?
Be honest about what you have. (Figure out) how many (systems) have appropriately licensed personnel and also allow for medication, then rapidly whittle that down to a small group of people. If you’re not willing to offer evidence-based treatment, then we as taxpayers aren’t going to pay you. We have to decrease some of the regulatory barriers so people can get access to medication immediately if they’re at risk.
At that point, look at the system and identify gaps, then bring in small business associations for loans or grants through the federal or state government to go toward building out gaps in care. This is easy. It’s easy to build it; the problem is all of the infighting that goes on. Even with current budgets and the flow of everything, this isn’t a massive amount of new money coming in.
Do you find some areas in the state and country effectively keep quiet their use of evidence-based treatment with medication or distributing Naloxone?
Sure, especially with opioid treatment programs or methadone clinics. A huge amount of NIMBY comes into this. The stigma is interesting, and very different from HIV. HIV stigma was really built on fear of getting an unknown virus that we don’t have a treatment for. With addiction, it’s different. The vast majority of people either know a first-degree relative or have a close friend struggle with addiction. We carry that frustration, and when we come in contact with the same disease, all of that buried frustration and anger comes out.