Voluntary outcome reporting is rare because nothing pays for the measuring: no payer asks for the number, no registry exists to compare it against, and an unflattering figure carries concentrated risk. That is why one St. Louis pain practice publishing its own opioid outcome data stands out.
This is an argument about incentives, written by an organization that is not a medical provider and makes no clinical claims. Read it as economics.
An unusual thing happened in August
A private interventional pain practice in St. Louis published its own opioid outcome data. Not a case series submitted to a journal, not a quality measure it was required to report — a set of numbers about its own patients, released voluntarily, on the record, on International Overdose Awareness Day.
The figures themselves are that practice’s to defend, and this foundation does not evaluate them. They were carried by AP News and are published in full here. What interests us is not the content. It is that almost nobody does this, and the reason almost nobody does it is the same reason this foundation exists.
Why is publishing outcome data so rare?
Our opioid safety page makes one claim: the gap in long-term opioid therapy is not knowledge, it is funding. Nobody disputes that a person on long-term opioids should be assessed on a schedule. What has never been settled is who absorbs the cost of doing it, because a structured assessment is time and time is not a billable procedure.
Publishing outcomes sits one step further down the same road. To report that a defined share of your patients reached a defined endpoint at 90 days and at one year, you must first have decided what to measure, measured it the same way each time, kept it in a form that can be counted, and then accepted whatever the count says. Every one of those steps costs something. None of them is reimbursed. And the practice that does the work carries a risk the practice that skips it does not: numbers can look bad.
That is a textbook description of an activity a market will underproduce. Our second test asks exactly this — whether the work would happen anyway if we did not fund it.
Are practices that don’t publish outcomes hiding something?
It is worth being fair to clinicians here. A practice that publishes nothing is not necessarily hiding anything. It is responding accurately to the incentives in front of it:
- No payer asks for the number, so producing it earns nothing.
- No registry exists to compare it against, so a published figure is uninterpretable in isolation and invites bad-faith reading.
- Measurement infrastructure — consistent instruments, reliable follow-up, a way to reach patients who stopped coming — is a capital cost carried by the practice alone.
- The legal and reputational downside of an unflattering number is concentrated; the upside is diffuse.
Add those together and voluntary reporting is a donation. Some organizations make it. Most reasonably do not, and no amount of exhortation changes an incentive structure.
What we think follows
The policy conversation about opioids has been organized almost entirely around a single number: how much is prescribed. That number is cheap to collect, because pharmacies already generate it. The numbers that would tell you whether a patient is actually better — function, sleep, whether they are still alive and still in care — are expensive to collect, so they are not collected, so they do not appear in the policy conversation.
We are not neutral about which of those is worth funding. A program built on measurement gives a clinician something other than a blunt instrument, and building the measurement is the part nobody pays for. That argument is set out at greater length in monitoring is the alternative to abandonment.
One practice publishing its own figures does not change the field. It does make the absence elsewhere visible, which is the first useful thing an outlier does.
The connection to the other divisions
All four divisions of this foundation are the same bet in different settings: that attention paid on a schedule, by someone competent, to something nobody is watching, is the highest-yield intervention available. A building nobody walks. A patient nobody can find. A therapy nobody measures. A medication list nobody reviews. See one foundation, four divisions.
Frequently asked questions
What is voluntary outcome reporting?
It is a practice releasing numbers about its own patients that nobody required it to report: not a case series sent to a journal, and not a mandated quality measure. To do it, a practice must decide what to measure, measure it the same way every time, keep it in a form that can be counted, and then accept whatever the count says.
What should opioid outcome data measure besides the dose?
The policy debate tracks one number, how much is prescribed, because pharmacies already generate it. The numbers that show whether a patient is actually better are function, sleep, and whether the person is still alive and still in care. Those are expensive to collect, so they rarely are, and they rarely reach the policy conversation.
Does Sevadar Foundation evaluate the practice’s figures?
No. The figures belong to the practice that published them, and this foundation does not evaluate them. They were carried by AP News and published in full through a press release. What matters here is the act itself: almost nobody publishes, and the reason is the same funding gap the foundation exists to address.
Why does one practice publishing its numbers matter?
One outlier does not change the field. It does make the absence elsewhere visible, which is the first useful thing an outlier does. It also shows the cost plainly: reporting results at 90 days and at one year takes decisions, consistency and records, and none of that work is reimbursed.
Further reading
For readers who want the clinical literature this argument sits beside — not evaluated here, and not endorsed by this foundation:
- Agnoli A, Xing G, Tancredi DJ, Magnan E, Jerant A, Fenton JJ. Association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids. JAMA. 2021;326(5):411–419. PMID 34342618 · DOI 10.1001/jama.2021.11013.
- Fenton JJ, Magnan E, Tseregounis IE, Xing G, Agnoli AL, Tancredi DJ. Long-term risk of overdose or mental health crisis after opioid dose tapering. JAMA Network Open. 2022;5(6):e2216726. PMID 35696163 · DOI 10.1001/jamanetworkopen.2022.16726.
- Sandhu HK, Booth K, Furlan AD, et al. Reducing opioid use for chronic pain with a group-based intervention: a randomized clinical trial. JAMA. 2023;329(20):1745–1756. PMID 37219554 · DOI 10.1001/jama.2023.6454.
Bibliographic records were retrieved from PubMed. Sevadar Foundation is not a medical provider and makes no treatment claims; nothing on this page is medical advice.
