Issue link: https://beckershealthcare.uberflip.com/i/879374
43 SPOTLIGHT ON THE OPIOID EPIDEMIC OIG: 1 in 3 Medicare Part D Beneficiaries Received Opioids in 2016 By Brian Zimmerman H eavy opioid use among beneficiaries and questionable opioid prescribing practices poses an issue for Medicare, according to a report from the HHS Office of Inspector General. In the report, which assesses Medicare Part D data for 2016, the OIG determined "[t]he extreme use of opioids and apparent doctor shopping described in this study put beneficia- ries at risk and may indicate that opioids are being prescribed for medically unnecessary purposes and then diverted for resale or recre- ational use." Here are five things to know. 1. One–third of Medicare beneficiaries were prescribed opioids in 2016. 2. More than 500,000 beneficiaries received high amounts of opioids in 2016. The report defined high amounts of opioids as an average morphine equivalent dose of 120 milligrams a day for at least three months. 3. The report identified nearly 90,000 Medicare Part D beneficiares at serious risk of opioid misuse or overdose. Among them, 69,563 received extreme amounts of opioids — defined as a daily average MED greater than 240 milligrams — and 22,308 appeared to be shopping for physicians, as they re- ceived opioids from four or more prescribers and used four or more pharmacies. 4. About 400 prescribers displayed question- able prescribing practices. Among them, 264 ordered opioids for numerous beneficiaries seeking opioids from many physicians. 5. The OIG report found one Texas physi- cian wrote 1,199 opioid prescriptions for 103 beneficiaries. In 2016, this physician gave one patient 24 opioid prescriptions, each valid for an eight-month period. The prescriptions included three opioid medica- tions — oxycodone, morphine and hydroco- done-acetaminophen. n Primary Care-Focused Intervention Cuts Prescription Drug Use Among Chronic Pain Patients By Anuja Vaidya A new team-based model lowered prescription opioid use among pa- tients with chronic pain by almost half, according to a study published in JAMA Internal Medicine. The primary care model, called TOPCARE (Transforming Opioid Prescribing in Primary Care), involves allowing nurse care managers to discuss treatment plans with chronic pain patients and to ensure monitoring occurs. The model also involves providing drug prescribers online resources and coordinating a customized educational session for primary care providers conducted by an opioid prescribing expert. For the study, researchers examined data for nearly 1,000 chronic pain pa- tients who received opioids through four primary care practices. Half of the primary care providers were involved in the TOPCARE model and the other half received only electronic decision support tools. Patients whose providers participated in the TOPCARE model were pre- scribed lower doses of opioids and had a 40 percent greater likelihood of having their opioid medications discontinued compared to the control group. TOPCARE patients were six times more likely to receive care that followed American Academy of Pain Medicine opioid monitoring guidelines. n Man Kills Indiana Physician Who Refused to Prescribe Wife Opioids By Brian Zimmerman A n Indiana man killed himself on July 26 shortly after shooting and killing a local physician who refused to prescribe opioids to his wife, according to The Washington Post. Todd Graham, MD, a physician at Mishawaka, Ind.-based South Bend Or- thopedics, refused to prescribe opioids to Petra Jarvis for chronic pain. Her husband, Michael Jarvis, returned to the facility a couple hours later and followed the physician to St. Joseph Rehabilitation Institute, also in Mishawa- ka. Mr. Jarvis confronted Dr. Graham in the facility's parking lot and, after an argument, shot and killed him. Mr. Jarvis then drove to a friend's home where he "gave indication that he was no longer going to be around," said Ken Cotter, St. Joseph County prose- cutor, during a press conference. The friend called the police, but Mr. Jarvis killed himself outside his friend's home before police could arrive. It is unclear whether Mr. or Mrs. Jarvis were addicted to opioids, according to the Post. "He did what we ask our doctors to do: Don't overprescribe opioid[s], and, unfortunately, for whatever reason, [Mr.] Jarvis made that choice to take his life," Mr. Cotter told reporters. "Every homicide is tragic, but this one in particular, I think, hits home to everyone. It hits home to all of our medical professionals. Their job is to try to help people, and that certainly [is] what Dr. Graham was doing." n