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Rates in Washington

This project consists of three main elements:

Developing a statewide overview of opioid use among Washington's Medicare beneficiaries

Reaching out to healthcare providers with Medicare patients:

  • Who experienced a non-fatal overdose after being prescribed an opioid, or
     
  • Whose opioid use might have been avoided or reduced by following the latest clinical guidelines and/or using the Prescription Monitoring Progam
     

Providing detailed analyses of several key opioid measures for specific subpopulations within the state, so that communities can better understand and monitor opioid use among those groups of Medicare beneficiaries

The work is being performed with Special Innovation Project funding from CMS. We are also conducting similar studies of potentially unnecessary care as part of the Choosing Wisely initiative.

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In Washington:
More than 4,300 non-fatal opioid overdoses occurred among the state’s Medicare population—which amounts to a rate of 5 per 1,000 beneficiaries.
 
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Over 21,000 Medicare beneficiaries have “chronic” prescriptions for opioids.
Chronic = More than 60 days’ dosage prescribed (total amount from all providers) for use within a calendar quarter
 
Source: Medicare claims data, July 2016 - June 2017

While Americans' use of opioids has attracted the attention of healthcare professionals, politicians, and the media, the substantial impact of these medications on the Medicare population is often overlooked.

Qualis Health is hoping to redirect some of that attention—especially since Washington has one of the highest rates of opioid-related hospitalizations for individuals aged 65 or older.

We developed seven opioid-related measures (see methodology) and stratified the results by the location and demographics of Washington's Medicare beneficiaries.

As part of an outreach intervention, we also connected those measures with individual prescribers.

Results by location

It is important to keep in mind that the ACH- and county-specific results reflect where the Medicare beneficiary lives; the relevant care and/or prescriptions may have been provided elsewhere.

 
 

Data source: Medicare claims, July 2016 - June 2017
Learn about the analytic methodology and the clinical guidelines.

Measure
Statewide
Comments
 
 
Count
Rate
Any beneficiaries, regardless of opioid use level
 
Non-fatal opioid overdose among Medicare beneficiaries
ODmap
4,300
overdoses
5.0
per 1,000 beneficiaries
Variation by county was particularly high for this measure. Nearly half of the counties' rates were different, by a statistically significant margin, from the statewide rate.
Three of the four counties in the North Central Accountable Community of Health have rates worse than the state.
 
Beneficiaries prescribed any opioid during the measurement year
275,000 beneficiaries
35% of Medicare beneficiaries with Part D coverage
 
Beneficiaries with a new opioid prescription (no prescription during the previous quarter)
 
Opioid prescription for beneficiaries with new low back pain
LBP map
4,000 prescriptions
16.4%
of beneficiaries with new low back pain
Current guidelines discourage opioids for new low back pain and other types of acute pain. The guidelines further specify that if opioids are used, prescribing should be limited to no greater than 210 morphine equivalents over no longer than 7 days.
 
High-dosage opioid prescription (>210 MMEs) for opioid-naïve beneficiaries
13,000
high-dose prescriptions
2.5%
of beneficiaries meeting criteria for opioid-naïve
Ten counties had high-dosage rates that were better, and two counties (Benton and Yakima, both in the Greater Columbia Accountable Community of Health) had rates that were worse, by a statistically significant margin, than the statewide rate.
Beneficiaries who use opioids at a chronic level
 
Beneficiaries with chronic opioid prescriptions
21,000 beneficiaries
11%
of eligible beneficiaries
 
 
High-dosage opioid prescription (>50 MMEs per day) for beneficiaries who use opioids at a chronic level
75
high-dose prescriptions
<0.5%
of beneficiaries using opioids at a chronic level
Local and national experts consider doses of 50 morphine equivalents or more per day as "high dose." Further, they recommend against escalation and in favor of reducing such high doses over time.
 
 
Chronic benzodiazepine prescription for beneficiaries using opioids at a chronic level
benzo map
5,600 beneficiaries
26.7%
of beneficiaries using opioids at a chronic level
It is dangerous to combine these medications.
This measure showed less variation by county (just 25% had rates with statistically significant different results from the state). The three counties with worse rates (Clark, Pierce, and Benton) are distributed across the state.
 
Results by demographics

Results of our analyses by Medicare beneficiaries' gender, age, and race/ethnicity will be available soon. In some cases, there are dramatic differences across these characteristics.

Results by individual prescribers

Using Medicare claims data, Qualis Health identified the healthcare professionals (primary care, emergency care, surgeons, dentists, and others) who wrote the prescriptions included in our data set. In some situations, there were multiple providers who prescribed opioids and/or benzodiazepines to a single beneficiary; consistent use of the Prescription Monitoring Program would likely reduce the number of these cases.

Please note that by law, we cannot release an individual provider's data to anyone other than the provider him/herself.

Non-fatal opioid overdose

  • 1,024 providers prescribed an opioid to at least one Washington Medicare beneficiary who later suffered a non-fatal opioid overdose. (The relevant time period was defined as the number of days' supply for the selected prescription, plus 10%. For example, the risk period for a 30-day supply would be 33 days after the prescription was written.)
     
  • 2,301 providers prescribed an opioid to at least one beneficiary who had already suffered a non-fatal opioid overdose during the measurement year. (Our results are consistent with a 2016 study showing that nearly all patients with an opioid overdose received subsequent opioid prescriptions.)
     

Low back pain 

  • 422 providers prescribed an opioid to at least one beneficiary with new low back pain. While the prescribing rate for most was close to the statewide average of 16.4%, there were 34 outliers with rates that were higher by a statistically signficant margin.
     
 

High-dosage prescriptions

  • Our analysis flagged beneficiaries who filled a high-dosage (over 210 MMEs) opioid prescription when they did not have an opioid prescription in the previous quarter. We found 534 prescribers associated with this measure
     
  • Our analysis also flagged beneficiaries who were chronic opioid users when they filled prescription(s) totaling over 50 MMEs per day. We found 75 prescribers associated with this measure.
     

Chronic benzodiazepine in combination with chronic opioid

  • 3,312 providers wrote prescriptions for chronic benzodiazepines to at least one Washington Medicare beneficiary who was already using opioids at a chronic level; 75 providers were in this situation for 10 or more of their patients.