Opioid prescribing reports
Minnesota Statute 256B.0638 requires the Department of Human Services (DHS) to provide confidential, individualized opioid prescribing reports to all health care providers who prescribe opioids for pain management to people enrolled in MinnesotaCare or Medicaid. The data provided in the reports are from Medicaid and MinnesotaCare administrative claims data, not from the Prescription Monitoring Program.
The opioid prescribing reports compare prescribers’ opioid prescribing rates to the average rates of their peers in their specialty. The reports do not identify prescribers’ peers or patients. The goal of sharing this data with providers is to support quality improvement.
Visit the sample opioid prescribing report webpage to see a sample report. For information about elements found in the report, see the Understanding your DHS opioid prescribing report webpage.
Go to the Provider Feedback Form webpage to provide feedback or submit a question about your report. Submit general questions about the program via email to firstname.lastname@example.org.
Access your report
Providers who prescribed at least one opioid analgesic in an outpatient setting to a Medicaid or MinnesotaCare member in the measurement period will receive a report. The first prescribing reports were issued in summer 2019. Updated reports were sent in December 2019. Both reports are intended to familiarize providers with the state’s prescribing measures and provide an opportunity to ask questions about the data. The quality improvement program will begin with the reports issued in late 2020.
The December reports were mailed to providers to the public address on file with their respective licensing boards: medical, nursing or dental. Podiatrists received their reports at the address on file with DHS. Providers who registered for a MN–ITS mailbox can also access electronic reports by logging in to the MN–ITS portal. Reports are confidential and have not been shared with employers or licensing boards.
Providers who have not received a report should contact DHS at email@example.com.
Interpreting the reports
The reports show providers how their prescribing habits compare to their peers. Information about interpreting the reports is available on the Provider education webpage.
The data in each report is from Medicaid and MinnesotaCare administrative claims data. This means that only data on Medicaid and MinnesotaCare patients is included in the DHS prescribing reports. The opioid prescribing reports exclude individuals who received a cancer diagnosis or treatment in the measurement year and individuals receiving hospice services. Procedural sedation or anesthesia and medications administered in an emergency department or from an inpatient pharmacy are also not included.
The reports also exclude medications prescribed to treat opioid use disorder. All other Medicaid and MinnesotaCare members for whom DHS receives a pharmacy claim are included, including children and individuals with both Medicaid and Medicare coverage.
All providers who prescribed an opioid analgesic to a Medicaid or MinnesotaCare enrollee in an outpatient setting will receive a report. A provider would not receive a report only if they did not prescribe an opioid analgesic to a Medicaid or MinnesotaCare enrollee or if they only prescribed to patients whose data are excluded from the reports.
The reports compare providers’ metrics to the average rates within their specialty group. DHS used the National Plan and Provider Enumeration System (NPPES) database to locate providers’ National Provider Identifier (NPI) primary taxonomy code. Providers are included in one of 30 specialty groups based on their NPI primary taxonomy code.
It is important to note that the quality improvement thresholds do not vary by specialty. The thresholds are the same for all providers regardless of specialty (except for those in surgical practice). Providers whose specialty designation is not accurately reflected on their report can still view the comparative data for their correct specialty by requesting it using the Provider Feedback Form.
Providers who would like to update their specialty listing, should complete the following:
- Visit the NPPES website npiregistry.cms.hhs.gov and update your specialty directly.
- Update your provider enrollment information with DHS by completing the Provider Feedback Form.
A special note to Physician’s Assistants and Advanced Practice Nurses (APNs)
The NPPES system and DHS provider enrollment data do not include a comprehensive list of specialty designations for physician’s assistants and APNs. Therefore, many physician assistants and APNs are included in a general category in the reports. DHS recognizes that many physician assistants and APNs practice is specialty settings, and will collect correct specialty data from these providers in early 2020.
Quality improvement program participation
There are quality improvement thresholds for five of the seven opioid prescribing sentinel measures. Providers whose prescribing rate is above the threshold for any of the five measures will be required to participate in the quality improvement program if they also prescribed above a certain volume of opioid analgesic prescriptions to Minnesota Medicaid and MinnesotaCare enrollees during the measurement year. The reports present the comparative rates in bar graphs, and the quality improvement threshold is clearly marked in each graph. The threshold is static, and does not change relative to how your peers are prescribing. Prescribers will receive additional information about participating in the quality improvement review.
DHS will issue another round of reports late in 2020. Providers over one or more quality improvement thresholds at that time will be required to participate in the state’s quality improvement program. At that point providers as well as their employers will be notified about the mandatory participation in quality improvement.
DHS has yet to determine how providers and their employers will be notified about mandatory quality improvement participation. DHS will communicate information about the quality improvement program primarily through email. Providers and health systems are encouraged to sign up for email updates.
Expectations of providers who must participate in the quality improvement program
DHS, the Opioid Prescribing Work Group and partners in the medical community are currently developing the quality improvement program and will identify activities — based on pain phase — that a provider would need to incorporate into their quality improvement plan. The activities will take into account different measures that are over set thresholds, provider practice types, system capacity and existing quality improvement efforts within clinics or systems. DHS will work with providers and health systems with existing quality improvement programs in place to avoid duplicative efforts.
Under Minnesota Statute 256B.0638, the opioid prescriber reports are confidential to individual prescribers. DHS does not share provider reports with others, such as patients, journalists, health systems, practice groups or licensing boards. The law requires DHS to notify a provider’s health system or practice group in the event the provider is required to participate in the quality improvement program starting in late 2020.
Have a question?
Visit our Frequently Asked Questions webpage or submit questions to firstname.lastname@example.org.