Opioid-Naïve
Beneficiaries with an opioid prescription, who did not have an opioid prescription the previous quarter (Bree Collaborative's specification)
Opioid Prescription
Medicare Part D record with a relevant National Drug Code (all opioid medications, excluding methadone and buprenorphine)
Benzodiazepine Prescription
Medicare Part D record with a relevant National Drug Code
Chronic Use
More than 60 days' dosage prescribed (total amount from all providers) for use within a calendar quarter; based on the Bree Collaborative definition
Non-Fatal Overdose
An emergency department visit or inpatient stay with relevant ICD-10 codes; identical to specifications used in the Bree Collaborative's Metric 8
MMEs
Morphine milligram equivalents (MMEs); calculated using the CDC algorithm
The measure criteria and analysis methods used in our recent among Washington's Medicare beneficiaries is described below. (See results for the Medicare population and for healthcare professionals.)
Qualis Health analyzed the following metrics for Washington's Medicare population:
Any beneficiaries, regardless of opioid use level
Beneficiaries with a new opioid prescription (no prescription during the previous quarter)
Beneficiaries who use opioids at a chronic level
The overdose measure complements the work being done in the state by the Bree Collaborative, and the remaining measures are directly related to the CDC's prescribing guidelines.
Analyses were conducted using Medicare Part A, Part B, and Part D claims. The most recent 12-month period of data available at the start of this work was July 2016 - June 2017.
Medicare beneficiaries were included in the initial data set if they met all of the following criteria:
The steps taken by Qualis Health to select the appropriate data sets are outlined in the following table.
Measure
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Time Period: Q3 2016 - Q2 2017 |
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Selected Data
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Exclusions
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Non-fatal opioid overdose
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Beneficiaries with qualifying diagnosis and an opioid prescription before or after the event
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None
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Denominator
Time Period: Q3 2016 - Q2 2017 |
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Numerator
(within the selected denominator) |
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Selected Data
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Exclusions
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Selected Data
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Time Period
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Exclusions
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Beneficiaries prescribed any opioid
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Medicare beneficiaries
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Cancer or hospice in the past year
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Opioid prescriptions
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Q3 2016 - Q2 2017
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None
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Opioid prescription for beneficiaries with new low back pain
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Beneficiaries with qualifying diagnoses
(Aligns with HEDIS low back pain measure) |
Cancer, trauma, or hospice in the past year; other low back pain in previous 6 months
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Opioid prescriptions
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Within 7 days following diagnosis
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None
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High-dosage opioid prescription for acute pain in opioid-naïve beneficiaries
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Beneficiaries meeting criteria for opioid-naïve
(See definition, above)
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Beneficiaries' first quarter of Part D eligibility
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High-dosage (over 210 MMEs in total) opioid prescription for acute pain
(Aligns with Ohio specifications) |
Q3 2016 - Q2 2017
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Cancer or hospice within last 2 years
(CMS measure specification uses a two-year window)
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Beneficiaries with chronic opioid prescriptions
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Medicare beneficiaries
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Cancer or hospice within last 2 years
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Beneficiaries meeting criteria for chronic use of opioids
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Q3 2016 - Q2 2017
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None
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High-dosage opioid prescription for beneficiaries who use opioids at a chronic level
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Beneficiaries meeting criteria for chronic use of opioids
(See definition, above) |
Cancer or hospice within last 2 years
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Opioid prescription(s) totaling over 50 MMEs per day
(Aligns with Bree Collaborative specifications) |
Q3 2016 - Q2 2017
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None
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Chronic benzodiazepine prescription for beneficiaries using opioids at a chronic level
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Beneficiaries meeting criteria for chronic use of opioids
(See definition, above |
Cancer or hospice within last 2 years
(CMS measure specification uses a two-year window)
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Beneficiaries meeting criteria for chronic use of benzodiazepine
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Within the same calendar quarter that qualified for chronic opioid use
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None
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A two-phase approach was used to analyze the data—first in several aggregate groupings focused on the beneficiary, then by individual provider.
The results were aggregated by several levels of location (state, Accountable Community of Health, county). It is important to note that these locations were determined by the beneficiary's residence, not where the care was provided.
Using the 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.
In order to increase the number of prescribers who consistently use the Prescription Monitoring Program and are following the latest clinical guidelines regarding opioids, as well as to alert providers that some of their patients experienced an opioid-related overdose, we are contacting a subset of the prescribers identified from our data set.
We mailed the following subset of providers their individual results:
The individualized results were mailed in February 2018. In the spring of 2018, a sampling of these providers will also be contacted by phone for further discussion.