GAO: CMS failed to identify thousands of Medicare beneficiaries at risk for opioid addiction

https://www.beckershospitalreview.com/opioids/gao-cms-failed-to-identify-thousands-of-medicare-beneficiaries-at-risk-for-opioid-addiction.html

The U.S. Government Accountability Office called on CMS last week to improve its oversight of opioid use among Medicare Part D beneficiaries after identifying flaws in the agency’s monitoring of opioid prescriptions.

CMS estimated 33,223 Medicare recipients were at risk of opioid overutilization based upon its recently revised prescribing guidelines. However, the GAO believes CMS guidelines, which rely on prescription monitoring information from private organizations that implement Medicare drug plans, miss many Medicare patients at-risk for addiction and misuse. The GAO determined more than 727,000 enrollees in Medicare’s prescription drug program in 2015 were at risk of opioid addiction or misuse due to opioid prescriptions not aligned with CDC prescribing guidelines, according to a GOA report released on Nov. 6.

“CMS oversees the prescribing of drugs at high risk of abuse through a variety of projects, but does not analyze data specifically on opioids,” wrote the authors of the GAO report. “However, GAO found that CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers. As a result, CMS is lacking information that it could use to assess how opioid prescribing patterns are changing over time, and whether its efforts to reduce harm are effective.”

To improve CMS’ opioid oversight, the GAO recommended the agency gather information on beneficiaries receiving high doses of opioids, identify providers who write high amounts of opioid prescriptions and require plan sponsors to report potentially inappropriate provider prescribing practices.

In 2016, providers prescribed more than 14 million Medicare Part D beneficiaries opioids.

Imagine that, 48 million people on Medicare (40 million 65+ & 8 million disabled) and 14 million Medicare folks got at least one prescription for a opiate.. that is about 30% of the Medicare population. Since it is claimed that there are some 100 + million chronic pain pts.. and we have a population of 320 million – that is 31%.

According to the GAO 727,000 Medicare folks are “at risk” of opiate use disorder which is abt 1.5% of the Medicare population…  which is not that much different that the per-cent of the overall adult population that could be defined as having a “opiate abuse disorder”

It would also seem like CMS has “adopted” the CDC “guidelines”… that was NEVER SUPPOSE TO CARRY THE WEIGHT OF LAW… so much for that.

Here is four quotes from the CDC opiates guidelines:

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”

“Clinicians should consider the circumstances and unique needs of each patient when providing care.”

“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”

“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”

Since there is nothing in the CDC guidelines to take into consideration of CYP-450 opiate enzyme deficiencies to account for higher/more frequent dosing…

So apparently the definition of “high doses” is going to be by some fairly rigid “cookie cutter formula” and what the individual needs of the pt will not be a consideration.

Filed under: General Problems