On Monday, I attended the announcement of Gov. Greitens’ prescription drug misuse initiative. Held at Express Scripts in St. Louis, the news conference was the first during a week of opioid-related events at locations throughout the state.
Greitens’ proposal differs from the conventional prescription drug monitoring program approach. Rather than creating a database accessible by providers and pharmacists to identify patients’ interactions with clinicians and opioid prescriptions — similar to the St. Louis County program — the initiative would use data from pharmacy benefit managers like Express Scripts. Patient-identifiable data wouldn’t be included. Rather, the data would identify providers and pharmacies that are outliers in prescribing and/or dispensing controlled substances. These are two very different approaches to addressing the opioid crisis — a prospective model focused on at-risk patients and a retrospective model targeting prescribers and dispensers.
Greitens’ leadership on the issue is a very positive sign. He and his administration have been engaged on this issue from the beginning. However, there are a lot of unknowns.
It is unclear at this time how state government will determine a rate that is excessive. Since pain management, hospice and oncology physicians may all have clinical conditions that justify rates that exceed a set standard, how the rules are written becomes paramount. The stakes are high. The proposal includes enforcement powers — identified prescriber and dispenser outliers’ names will be given to state licensing boards and law enforcement.
Physicians must be engaged partners in the struggle to curb opioid abuse. They also have a responsibility to provide safe and effective care. Although the intent of the initiative is to identify “pill mills,” if the program isn’t implemented properly it could have a chilling effect on care delivery. It is possible that physicians may significantly reduce or eliminate opioid prescriptions even for entirely appropriate care if physicians and physician practices are targeted. That would be a significant unintended consequence. And, it could drive addicted patients to seek opioids on the street.
Although it isn’t clear that the proposal will have any effect on the St. Louis County PDMP, the Greitens’ plan should be in addition to, not instead of, a more traditional PDMP. A PDMP can help providers and pharmacies understand a patient’s prescription history in real-time. A system that retrospectively examines past behavior doesn’t help providers identify problems, make decisions or help patients at the point of care. In a nutshell, no single solution will resolve the state’s opioid crisis. It will take hospitals, physicians, policymakers, insurers, benefit managers, and — of course — patients and their families, working together.
Greitens’ leadership on the issue is worth recognizing and applauding. On Monday, he discussed how this was both a policy and personal issue — he lost a family member to opioids. Too many Missourians have similar experiences.
There will be multiple opportunities to better understand the plan and provide input to increase the value of the information. All Missouri health care providers need to work together with Gov. Greitens to help shape the details of this new system. We need to make sure the program is not, as some have suggested, a physician monitoring program, but instead a tool in the states multipronged effort to combat the opioid epidemic. At the same time, MHA and provider community partners must continue to identify and invest in the systems and refinements in clinical practices that build our capacity to address the crisis.
There isn’t a single approach that will solve the crisis. Missouri may have a new approach in the coming months. We’ll know more when additional information is released.
Tell me what you’re thinking.
P.S. — The Senate will continue its discussion on the Affordable Care Act repeal next week. Hospitals are urged to contact Missouri’s senators to ask them to oppose the measures.
Herb B. Kuhn
MHA President and CEO
CMS Announces Dry Run Of Chemotherapy Measure
Staff Contact: Sherry Buschjost
The Centers for Medicare & Medicaid Services has announced a dry run of the admissions and emergency department visits for patients receiving outpatient chemotherapy measure (OP-35, PCH-30/31) for hospital outpatient departments and PPS-exempt cancer hospitals. The measure dry run is scheduled Tuesday, Aug. 15, through Thursday, Sept. 14. CMS will provide facilities with facility-specific reports for the measure through the QualityNet Secure Portal during that time. Additional details are available.
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July 20, 2017
Senate Continues Work On Health Care Legislation
MO HealthNet Posts Physician Services Rate Cuts
MLN Connects Provider eNews Available
Missouri Foundation For Health Provides Grant Opportunities
CMS Publishes 2018 QRDA Category I HQR Implementation Guide
Gallup Releases Report: Combatting Turnover And Improving Performance
July 19, 2017
Trajectories — Opioid Use Disorder
CDC Releases National, County-Based Map Of Opioid Prescribing Practices
U.S. Court Of Appeals Rules On Employer Disparagement
July 18, 2017
MO HealthNet Posts Ambulance, Behavioral Health Payment Changes
Senate Leader Shifts Efforts On ACA Repeal
CMS Announces Next Open Door Forum
July 17, 2017
Governor Issues Executive Order On Opioid Abuse
Greitens Approves Health Legislation
Governor Vetoes Legislation On Involuntary Medication Hearings
CMS Issues Changes To PFS And Other Part B Services
CMS Releases Proposed CY 2018 OPPS And ASC Payment And Policy Updates
CMS Announces IQR Education Session
CMS Releases October 2017 Hospital Compare Preview Reports
CMS Releases OQR Times Newsletter