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Third-Party Payer: Latest Research on Impact of Rx Drug Abuse on Workers' Compensation - Joseph Paduda and Dr. Richard Victor

Third-Party Payer: Latest Research on Impact of Rx Drug Abuse on Workers' Compensation - Joseph Paduda and Dr. Richard Victor

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    Tpp 5 paduda victor Tpp 5 paduda victor Presentation Transcript

    • Latest  Research  on  Impact  of  Rx   Drug  Abuse  on  Workers   Compensa:on   Joseph  Paduda,  President   CompPharma,  LLC   Dr.  Richard  A.  Victor,  Execu:ve  Director   Workers’  Compensa:on  Research  Ins:tute  
    • Disclosures   •  Joseph  Paduda  has  financial  rela:onships  with   proprietary  en::es  that  produce  health  care   products  and  services.    These  financial   rela:onships  are:  consul:ng  for  CID,   Millennium  Labs,  and  MedRisk,  Inc.   •  Richard  A.  Victor  has  disclosed  no  relevant,   real  or  apparent  personal  or  professional   financial  rela:onships.  
    • Learning  Objec:ves:   1.  Specify  workers'  comp  stakeholders'  current  aQtudes   towards  opioids,  the  programs  they  have  in  place  to   address  opioids,  and  how  they  are  measuring  success.   2.  Explain  the  impact  of  prescrip:on  drugs  on  workers'   compensa:on  costs,  disability,  and  outcomes.   3.  Compare  the  level  of  understanding  of  execu:ves  to  front-­‐ line  staff  to  assess  gaps  in  performance  and  policy   implementa:on.   4.  Specify  what  types  of  physician  dispensing  of  opioids  exist   and  how  common  these  prac:ces  are  used.   5.  Analyze  whether  a  ban  on  physician  dispensing  of  opioids   reduces  the  use  of  opioids  or  merely  shiYs  the  dispensing   to  pharmacies.  
    • Latest  Research  on  Impact  of  Rx   Drug  Abuse  on  Workers   Compensa:on   Joseph  Paduda   President   CompPharma,  LLC  
    • Opioids are the most significant problem facing work comp today.
    • As a society we consume of all the opioids prescribed in the world. 80% pg.  2    
    • DEA definition “opioid”Examples include the illicit drug heroin and pharmaceutical drugs like: OxyContin® Vicodin® codeine morphine methadone and fentanyl pg.  3  
    • Routine use of opioids for the treatment of chronic nonmalignant pain conditions is not recommended.” “ -ACOEM pg.  4  
    • The number of narcotics prescriptions per claim has grown 41%, from 0.56 in 2003 to 0.79 in 2011. -NCCI pg.  5    
    • Respondents 400 total, 2:1 front line: executive ratio 272 completed the survey Response rate is three times greater than any other survey we’ve conducted over 10 years. pg.  6  
    • Defining the Problem pg.  7  
    • When you hear the word “opioids,” what one or two words instantly come to mind? Addiction / Dependence Drug(s) / Narcotics / Drug Name Abuse Appropriate / Pain / Pain Killer / Therapy Cost Over Prescribed / Death / Danger / Epidemic Death pg.  8  
    • How concerned is senior management about opioids in workers’ compensation? pg.  9    
    • Why? Because these drugs drive up costs, duration – most respondents have figured this out and are starting to track the impact. pg.  10  
    • Opioids are perceived as having overwhelmingly negative consequences for payers and claimants. What is the impact of opioids on the costs and outcomes of workers’ compensation claims? pg.  11  
    • Whose responsibility is it to manage opioids? Addicts may be “responsible” but aren’t capable, and many doctors aren’t able to address the issue. pg.  12    
    • How effective or ineffective have PAYERS been in addressing opioids? pg.  13    
    • What is causing PAYERS not to effectively address the issue of opioids? Regulations Don’t Allow Payers to Do Enough Tools Available Are Inadequate Not Able to Identify Claims That Would Benefit From Intervention Other (Please Specify) Not a Top Priority pg.  14  
    • How effective have REGULATORS been in addressing opioids? pg.  15    
    • Conclusion major problem as it directly affects claim costs duration risk ability to control same As with any WC issue, payers look to regulators to enable solutions – however there are some solutions currently in place that are delivering results despite the less than helpful environment. pg.  16    
    • Solutions pg.  17    
    • We’re in the early stages of figuring out the problem and developing effective approaches. pg.  18  
    • What is the goal for the stated opioid program(s)? What is the goal for the stated opioid program(s)? pg.  19    
    • What vendor(s) are you working with to address opioids? pg.  20    
    • Please describe what the vendor(s) is(are) doing to address opioids? There’s a discrepancy between front-line staff and management, which indicates a disconnect with internal communication. pg.  21    
    • What is the vendor doing to address opioids? pg.  22    
    • How are you measuring the impact of the work of the vendor(s)? pg.  23  
    • We’re in this early stage where much of what we’re doing is based on what we think will work, but we don’t yet KNOW. Do you believe the programs are having a positive effect? pg.  24  
    • What should be done? What is being done? 80% of respondents picked best practices. vs. pg.  25    
    • The ideal solution 80% identified: Peer / physician review for claims – 90 / 180 days Drug utilization review Random drug testing Opioid agreement / contracts pg.  26    
    • Please rank the following potential solutions 1-8 in the order that you believe would be most successful in addressing the overall opioid issue starting with 1 as most successful. pg.  27    
    • What percentage of the claims with opioid issues do you think an opioid management program would address? pg.  28    
    • Takeaways pg.  29    
    • Consensus that opioids: Cause addiction / dependency Increase disability duration Increase risk of fraud / abuse Drive up costs pg.  30    
    • Opioid management is in its infancy. pg.  31    
    • There is a wide divergence between ideal and actual opioid management programs. pg.  32    
    • Treating physicians are the crux. pg.  33    
    • Conclusion pg.  34    
    • pg.  35    
    • Impact  Of  Banning  Physician  Dispensing  Of   Stronger  Opioids  In  Florida   Workers  Compensa:on  Research  Ins:tute   April  23,  2014     © Copyright 2014 WCRI. All Rights Reserved.
    • •  Two public policy debates converged – Public health: “Pill mills” that dispense controlled substances – Cost: Physician dispensing of a wide range of Rx in workers’ compensation •  Florida legislature banned physician dispensing of stronger opioids Policy  Context  In  Florida   41© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 41
    • •  High levels of physician compliance with the ban •  Fewer Florida workers received stronger opioids •  Physician-dispensers switched to dispensing other pain medications rather than continuing stronger opioids Major  Findings   42© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 42 Source: Impact of Banning Physician Dispensing of Opioids in Florida (Thumula, 2013)
    • Physician  Dispensing  Was  Common  In   Florida,  Higher  Than  Most  States   0% 10% 20% 30% 40% 50% 60% MA NY TX AR M NLA VA NC WI KS IA SC NJ TN MO PA MI IN GA CT M DIL FL CA 43 Prescriptions For 2011/12 Claims With > 7 Days Of Lost Time Source: The Prevalence And Costs Of Physician-Dispensed Drugs (Wang, Liu, & Thumula 2013) %  Of  All  Rx  For  Physician-­‐Dispensed  Rx   © Copyright 2014 WCRI. All Rights Reserved. 43 Prescriptions For 2011/12 Claims With > 7 Days Of Lost Time Source: The Prevalence And Costs Of Physician-Dispensed Drugs (Wang, Liu, & Thumula, 2013)
    • •  Ban on physician dispensing of schedule II, III controlled substances (effective July 1, 2011) – Few exceptions (can dispense samples, after surgeries, clinical trials, department of corrections) – No limits on physician dispensing of other medications •  Requires counterfeit-proof prescription pads (effective August 29, 2011) •  Register as controlled substance prescribing physicians (effective January 1, 2012) HB  7095  (Florida  Pill  Mill  Bill)   44© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 44
    • •  Early impact of reform on prescribing and dispensing practices •  Only injuries that occurred after the law change were included in treatment group Scope  Of  The  Study   45© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 45
    • •  Pre-post policy implementation –  Treatment group: new injuries arising between July-September, 2011 (Ban effective 7/1/11) –  Comparison group: new injuries arising between July-September, 2010 –  Both groups had Rx filled through December of the year of injury (3-6 months of experience) •  Data: –  25% of Florida claims –  Indemnity and medical-only claims –  Case-mix adjusted Methods  And  Data   46© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 46
    • Pre-­‐  And  Post-­‐Reform  Claim   Characteris:cs  Were  Similar   47© Copyright 2014 WCRI. All Rights Reserved. Pre-­‐Reform   Post-­‐Reform   Number  Of  Claims   11,867   10,623   Average  Age   41   41   %  Female   42%   40%   %  Indemnity  Claims   24%   22%   Average  Medical  Payments   $2,464   $2,521   Average  #  Physician  Visits   3   3   © Copyright 2014 WCRI. All Rights Reserved. 47 Source: Impact of Banning Physician Dispensing of Opioids in Florida (Thumula, 2013)
    • Physician  Dispensing  And  Use  Of  Pain   Medica:ons  Unchanged   48© Copyright 2014 WCRI. All Rights Reserved. Pre-­‐Reform   Post-­‐Reform   Number  of  Rxs   22,255   19,017   %  Physician-­‐Dispensed  Rxs   52%   52%   %  All  Pain  Medica:ons   61%   61%   © Copyright 2014 WCRI. All Rights Reserved. 48
    • High  Physician  Compliance  With  Reform   In  First  3-­‐6  Months  Of  Cases   49© Copyright 2014 WCRI. All Rights Reserved. 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% Pre-Reform Post-Reform ProportionOfClaimsWithRx Physician-­‐Dispensed  Schedule  II,  III  Opioids   © Copyright 2014 WCRI. All Rights Reserved. 49
    • •  Of those with physician-dispensed stronger opioids after the ban: – 69% surgical cases – 21% out-of-state providers Why  Didn’t  Physician-­‐Dispensed     Schedule  II,  III  Opioids  Drop  To  Zero?   50© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 50
    • Physician  Dispensing  Of  Stronger  Opioids   Fell  AYer  The  Ban   3.5% 0.5% Pre-Reform Post-Reform ProportionOfClaimsWithRx 51© Copyright 2014 WCRI. All Rights Reserved. Physician-­‐ Dispensed   Opioids  (II,  III)   © Copyright 2014 WCRI. All Rights Reserved. 51
    • No  Change  In  Pharmacy  Dispensing  Of   Schedule  II,  III  Opioids   12.0% 12.1% 3.5% 0.5% Pre-Reform Post-Reform ProportionOfClaimsWithRx 52© Copyright 2014 WCRI. All Rights Reserved. Physician-­‐ Dispensed   Opioids  (II,  III)   Pharmacy-­‐ Dispensed   Opioids  (II,  III)   © Copyright 2014 WCRI. All Rights Reserved. 52
    • Physician  Dispensing  Of  NSAIDs  And  Weaker   Opioids  Increased  Post-­‐Reform   9.0% 9.8% 23.8% 26.0% 3.5% 0.5% Pre-Reform Post-Reform ProportionOfClaimsWithRx 53© Copyright 2014 WCRI. All Rights Reserved. Physician-­‐ Dispensed   Opioids  (II,  III)   Physician-­‐ Dispensed   Weaker  Opioids   Physician-­‐ Dispensed  NSAIDs   © Copyright 2014 WCRI. All Rights Reserved. 53
    • Recap:  Did  The  Florida  Ban  Reduce  The  Overall   Use  Of  Opioids  By  Injured  Workers?     •  High levels of physician compliance with the ban •  Fewer workers received stronger opioids 54© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 54
    • Ques:on  Raised:    Does  Physician   Dispensing  Lead  To  More  Opioids?   •  Physician-­‐dispensers  switched  to  other  pain   medica:ons  in  the  wake  of  the  ban   — No  change  in  pharmacy-­‐dispensed  schedule  II,  III   opioids   — Increase  in  percentage  of  claims  with  physician-­‐ dispensed  NSAIDs  and  weaker  opioids   •  This  raises  ques:ons  if  physicians  dispensed   unnecessary  opioids  pre-­‐ban     •  Upcoming  study  will  examine  longer-­‐term   impact  of  the  ban   55© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 55
    • •  To purchase the study, Impact of Banning Physician Dispensing of Opioids in Florida, go to: •  WWW.WCRINET.ORG •  For comments/questions about the findings: WCRI@WCRINET.ORG Follow WCRI on social media: For  More  Informa:on   56© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 56