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CMS cracks down on Medicare opioid prescription with public data

The Centers for Medicare and Medicaid Services have publicly provided data on Medicare Part D prescription rates across the country in a bid to curb opioid abuse that another government agency has called a crisis and epidemic.

In a strategy paper published this year, CMS laid out an approach to both identify doctors who are overprescribing opioids and patients who are at a high risk for abuse, or "opioid use disorder." The agency said it would use the data to sanction overprescribers and provide help to those who use too much.

On Dec. 16, 2016, the Centers for Disease Control and Prevention said that more than 33,000 people died from opioid overdose, including prescription and illicit use, in 2015 — the highest number of opioid-related deaths on record. The data threw a spotlight on what has been a persistent and growing problem related to highly addictive pain management medicine.

CMS said patient information will remain private, although the agency has made information on the number of prescription claims for opioid drugs in 2013 and 2014, as well as each provider's name, specialty, state and zip code, available on its website.

This public data, updated this month, shows a 26% decrease in high-risk, or "outlier," Medicare enrollees from 2011 to 2014. In the fourth quarter of 2014, there was a 47% drop in new outlier enrollees identified as high risk for the first time.

According to the data, opioid prescription rates in 2014 were still higher than the national average in several Pacific Northwest, Southwest and Rust Belt states. On a statewide level, prescriptions increased most in Utah and Alabama from 2013 to 2014, but only marginally — 9 and 11 basis points, respectively.

Large cities such as Houston, Chicago and New York, with thousands of Medicare Part D beneficiaries, each showed small declines — less than 1% — in opioid prescriptions. The most significant highs and lows happened in towns with as few as two Medicare beneficiaries.

The information can be used to explore the impact of prescribing practices of controlled substances on vulnerable populations, CMS said.

While opioid usage has grown steadily across communities, the Medicare population has among the highest and fastest-growing rates of opioid use disorder, Shantanu Agrawal, former CMS director for program integrity, and Kate Goodrich, CMS director for clinical standards and quality, said in a recent blog.

Agrawal and Goodrich cited a September 2016 research letter in JAMA Psychiatry that found that more than 6 out of 1,000 Medicare beneficiaries are abusing opioids, compared to 1 out of every 1,000 privately insured patients. According to the research, opioid-related hospitalizations for Medicare patients have risen 10% each year. Medicare patients include people age 65 and older as well as those with certain disabilities and end-stage renal disease.

The issue of rising opioid abuse came up in the first confirmation hearing for Rep. Tom Price, President Donald Trump's pick to head the U.S. Department of Health and Human Services. Answering a question posed by Sen. Tammy Baldwin, a Democrat from Wisconsin, on insurance coverage for substance abuse, Price said opioid abuse is "rampant" and "harming families and communities across the country."

Price added that it is "absolutely vital" to address the problem but stopped short of pledging to support legislative protections for substance abuse coverage if the Affordable Care Act is repealed.