Quality improvement program
The Opioid Prescribing Improvement Program requires a quality improvement program for prescribers who serve Minnesotans on public health care programs and prescribe above specific thresholds for the sentinel opioid prescribing measures. The intent is to support providers whose opioid prescribing behavior is outside the normal practice of their specialty group. A provider whose prescribing rate exceeds the quality improvement threshold for at least one measure must participate in a quality improvement review.
Participation in the quality improvement program is based on the data provided in the opioid prescribing reports. The opioid prescribing reports are a one-page report of a provider’s opioid prescribing metrics compared to the average of their specialty group. Sign up to get your opioid prescribing reports electronically.
The Department of Human Services is currently developing the quality improvement program with the Opioid Prescribing Work Group and members of the medical community. Additional information will be available as the program progresses.
The quality improvement program will begin after the second set of opioid prescribing reports are released. Prescribers who serve Minnesotans on public programs whose prescribing rate exceeds the quality improvement threshold for any of the sentinel measures must participate.
Participating providers will submit a quality improvement plan to DHS for review. The Opioid Prescribing Work Group and DHS will develop a list of key activities that must be included in the plan. The intent is to have the provider develop a plan consistent with existing efforts at their clinic or health system. DHS will use external reviewers to review the quality improvement plans.
DHS will provide assistance and resources (e.g., templates) to providers who participate in the quality improvement program.
DHS will monitor progress over time using administrative claims data.
Special cause exemption
Providers may request special cause exemption from the quality improvement program based on specific criteria. DHS, the Opioid Prescribing Work Group and partners in the medical community are currently developing the special cause exemption criteria and process.
Criteria under consideration for special cause exemption include the proportion of a provider’s patient panel with chronic pain, or with very severe, acute pain of extended duration (e.g., burn victims, major orthopedic surgical procedures).
Disenrollment from program
State law (Minn. Stat. § 256B.0638) permits DHS to terminate providers who do not demonstrate improvement in opioid prescribing behavior over time. The disenrollment thresholds will differ from the quality improvement thresholds and will consider additional factors such as time and degree of improvement.