More than 16,000 Minnesota health care providers serving Minnesotans on Medicaid and MinnesotaCare will receive reports in coming weeks comparing their opioid prescribing rates to those of their peers as part of a quality improvement effort led by the Department of Human Services in collaboration with the medical community.
The first-ever reports in Minnesota aim to create awareness among providers about their individual prescribing behavior. That knowledge can signal a dramatic turning point, as evidenced in this short video
about how one Greater Minnesota doctor reframed the conversation about pain management and opioids with his patients after learning how his opioid prescribing rates compared to his peers.
“The health care community plays an important role in addressing the opioid crisis, and these opioid reports give health care providers invaluable insight and information into how their prescribing stacks up against others in their specialty,” said DHS Commissioner Tony Lourey. “Such awareness is always the first step toward change.”
Minnesota law requires DHS to share the individualized, anonymous opioid prescribing reports annually and manage a quality improvement program for providers whose reports show they continue to prescribe outside of community standards.
Health care providers who prescribed at least one opioid to a Medicaid or MinnesotaCare enrollee in 2018 will receive their report over the coming weeks. This includes physicians, dentists, physician assistants and nurse practitioners. The reports assess prescribing behavior based on seven key measures
using claims data, excluding data on opioids used to treat opioid use disorder and those prescribed to individuals in inpatient settings, with cancer, or who receive hospice or palliative care services.
DHS and the Opioid Prescribing Work Group developed the prescribing measures used in the reports in collaboration with the medical community. The measures are supported by clinical recommendations in the Minnesota Opioid Prescribing Guidelines
This first set of prescribing reports serve as baseline information only. A quality improvement program begins next year based on the release of a follow-up set of opioid prescribing reports.
Starting in 2020, providers required to participate in the quality improvement program will submit improvement plans to DHS for review. State law (Minn. Stat. § 256B.0638) permits DHS to terminate providers from serving Medicaid and MinnesotaCare enrollees if they fail to demonstrate improvement in opioid prescribing behavior over time. Disenrollment will occur in 2021 or subsequent years only for those whose prescribing is considered unsafe.
The need to improve opioid prescribing behavior and reduce overprescribing is demonstrated in the wide variation in the state’s opioid prescribing rates, which cannot be fully explained by differences in patient demographics or geography. For example:
• County-based opioid prescribing rates in Minnesota varied from 27.4 prescriptions to 98.6 prescriptions per 100 residents in 2017.
• In Emergency Medicine, the top quartile of opioid prescribers has a prescribing rate 2.8 times higher than the median of their peers.
• In Family Medicine, the top quartile of opioid prescribers has a prescribing rate 3.8 times higher than the median of their peers.
The good news: A culture shift has already begun in opioid prescribing behavior, as health care professionals weigh the risks and benefits of opioids for each individual patient. DHS launched an education campaign in March to help medical providers weigh the appropriateness of opioid therapy, determine if tapering should be discussed, have conversations with their patients about opioid therapy and pain management, and answer difficult questions. See the Flip the Script campaign
. The state also previously released opioid prescribing guidelines
to provide a framework for safe and judicious opioid prescribing for pain management.
“DHS is committed to these quality improvement efforts and will work closely with health care professionals to ensure safe, appropriate opioid prescribing in Minnesota,” Commissioner Lourey said. “The Opioid Prescribing Work Group has been and will continue to be vital to these efforts, particularly as we move into designing the quality improvement program. I thank the health care professionals and other members for their public service.”