EHR information indicates reduction in opioids prescription by doctors

As the opioid issues reaches epidemic proportions, latest electronic heath record data show that physicians are giving opioids prescription to fewer sufferers, and they are also being stingy when it comes to prescribing drugs to treat opioid dependence.

Athenahealth, a cloud-based electronic health record (EHR) vendor, observed data from more than 2 million sufferer visits from the first quarter of 2014 to the first quarter of 2017 year.

While the misuse of opioids prescription has emerged as an urgent public health crisis, what researchers discovered is that opioids prescription have been steadily reducing over that time period.

“We have seen doctor prescribing patterns decreasing,” claims Josh Gray, vice president of athenaResearch. “It is been specifically notable, for instance, that orthopedic surgeons and primary care physicians have seen decline.”

Based on the EHR data, both orthopedic surgeons and primary care physicians are prescribing opioids to fewer patients.

At the similar time, Gray points out that more sufferers have opioid addictions but there has only been a slight increase in providers prescribing drugs to treat opioid dependence, which he observes as a troubling development.

“If you are a doctor and you are reducing the frequency with which you give patients opioids prescription, some of those sufferers might be dependent,” observes Gray. “You would like to think that at least the healthcare system would be giving medication-assisted treatment to patients that are addressing with dependence or active addiction.”

He adds that the proportion of doctors in athenaResearch’s dataset that prescribe buprenorphine, a medication that decreases or eliminates withdrawal symptoms linked with opioid dependence, has “barely nudged up” which Gray explains as a “terrible” trend.

“Doctors are being much more parsimonious in terms of opioids perscription, but the accessibility to medication-assisted treatment—such as buprenorphine and similar pharmaceutical compounds—is not increasing,” in accordance to Gray. “I am not a physician, but that might be one of the reasons we are seeing continued immensely high levels, if not increases, in overdose deaths. It is not that difficult to procure opioids illegally. So, sufferers who are dependent that cannot get medication to treat their dependence then go to other sources that are not medically supervised, which is highly dangerous.”

Since the year of 2000, more than 300,000 Americans have lost their lives to an overdose from either prescription or illicit opioids, in accordance to the Centers for Disease Control and Prevention. The CDC has been working to make better the opioid prescribing to reduce unessential exposure to opioids and stop addiction.

In the month of December 2016, President Obama signed the 21st Century Cures Act which provides $1 billion in new funding to combat the opioid crisis. Previous week, Health and Human Services Secretary Tom Price, MD, announced that HHS will soon give $485 million in grants to assist states and territories target opioid addiction—the first of two rounds provided for in the Cures Act.

HHS has prioritized 5 particular areas: strengthening public health surveillance, advancing the practice of pain management, making better access to treatment and recovery services, targeting availability and distribution of overdose-reversing drugs, and supporting cutting-edge research.

 

The fed's latest 'war on drugs': Obama suggests $1.1 billion to extend care for opioid addicts

Amid a proposed prescription opioid abuse and heroin use epidemic highly fueled by over prescribing among the doctors, President Obama has recommended giving $1.1 billion to extend affected people individuals’ approach to care— a suggestion that has garnered bipartisan support. However few professionals question whether throwing money at the problem will be enough, several consider that, if utilized properly, the funding has the possibility to save lives.

In accordance to the Centers for Disease Control and Prevention (CDC), almost half a million Americans lost their lives from drug overdoses between the years of 2000 and 2014. Opioid overdose deaths, involving those from heroin, hit record highs in the year 2014 and observed a 14% increase in only 1 year.

Baltimore City Health Commissioner Dr. Leana Wen, who has served as an emergency room doctor in 1 of the nation’s opioid addiction hotspots, claimed the proposal offers a shift in views about addiction as an individual’s issue best controlled with law imposition, to a chronic medical condition such as diabetes or heart disease that can be stopped and treated.

“That science has been around for many decades, and society’s view point has grabbed up.”

“A pill for every pain”

In the year 2014, 259 million opioids— or sufficient for every American adult— were prescribed, in accordance to the CDC. The most usual prescribed opioid pain relievers were natural or semi-synthetic opioids such as oxycodone and hydrocodone, which are included in the most overdose deadly deaths among opioids. The CDC observed 813 more deaths, a 9% increase, from these kinds of opioids in the year 2014 than 2013.

Over the previous decades, the deaths resulting from the extreme opioid abuse and abuse of illegal narcotics such as heroin have reached on peaks.

A study issued in the month of November 2015 issue of the journal Proceedings of the National Academy of Sciences recommended overdoses from drugs such as opioids is believed to be one of the primary reasons why deaths of middle-age white Americans are rising while the overall death amount in USA has fallen.

HIPAA Change Allows Mental Health Informing to Background Check System

The Department of Health and Human Services has changed the HIPAA Privacy Rule to allow few covered entities to reveal to the FBI’s National Instant Criminal Background Check System the identities of people who are prohibited from having a firearm, for causes regarded to mental health.

Under the Privacy Rule modification, few covered entities are now allowed to reveal limited data to the National Instant Criminal Background Check System (NICS), which considers criminal records and other prohibiting information to determine whether federally licensed firearms dealers can legally transmit a gun to a prospective buyer or purchaser.

Office for Civil Rights Director Jocelyn Samuels made the declaration on Monday. In accordance to Samuels, the data that can be revealed to NICS is the minimum essential identifying data about people who have been involuntarily devoted to a mental institution or otherwise have been determined by a lawful authority to be a threat to themselves or others, or who lack the mental ability to handle their own affairs.

However states have normally reported criminal history data to NICS, various report little data about people prohibited by federal law from possessing or acquiring a gun for particular mental health reasons.

“The modification declared today better enables the reporting of the identities of these persons to the background check system, while sustaining to powerfully protect individuals’ privacy interests,” wrote Samuels in a blog. “Particularly, this final rule offers states improved flexibility to ensure correct but limited data is reported to the NICS.”

The OCR head emphasized that the HIPAA Privacy Rule change is “carefully and narrowly tailored to secure the patient-provider relationship and make sure that people are not discouraged from finding voluntary treatment,” arguing that the principle “applies merely to a minor subset of HIPAA covered entities that either make the mental health determinations that disqualify people from having a firearm or are designated by their states to report this data to NICS – and it permits such entities to report merely bounded identifying, non-clinical data to the NICS.”

Congress in the year 1993 mandated the creation of NICS under the Brady Handgun Violence Prevention Act to execute eventual background checks on those trying to purchase handguns and large guns.

“It is significant to note that the huge majority of Americans with mental health situations are not violent and that those with mental sickness are in fact more likely to be victims than perpetrators,” Samuels wrote. “A people who seeks assistance for mental health conditions and/or acquires mental health services is not automatically legally prohibited from having a firearm; nothing in this final principle changes that.”

2 years ago, OCR issued a Notice of Proposed Rulemaking (NPRM) in the Federal Register to change the HIPAA Privacy Rule. In response, the American Medical Association claimed it considered the agency struck the suitable balance in the between securing public safety and securing the patient-physician relationship by narrowly defining the scope of who can be informed to the NICS and by which HIPAA-covered entities.

Although, Deborah Peel, MD, founder and board chairman of Patient Privacy Rights, considers the issue with this access is that it further stigmatizes mental sickness and, as a result, fewer persons will be willing to seek treatment for mental sickness—on top of the already skyrocketing numbers of persons who hide health data, and delay or ignore treatment because of deficiency of trust in health IT.

The last HIPAA Privacy Rule modification was declared on Monday, the similar day President Obama met with Attorney General Loretta Lynch at the White House to elaborate options for decreasing deaths and wounds caused by firearms. In a New Year’s address, Obama made fighting the “epidemic of gun violence” a resolution for the year 2016, calling it a huge piece of “unfinished business” for his administration.

As part of its latest executive actions to lessen gun violence, the Obama administration is proposing a new $500 million investment to help involve peoples with critical mental sickness in care, as well as improve approach to care by increasing service capacity and the behavioral health workforce.

“The real issue is that the majority of persons with mental sicknesses, involving addiction and substance abuse, are ‘treated’ through incarceration in U.S. jails, which are now the nation's greatest psychiatric hospitals,” states Peel. “The U.S. has criminalized mental sickness and addiction, wreaking harms on families and kids. We pay prisons, not doctors, to treat persons with serious mental sicknesses. Treatment outside jails is approximately nonexistent. The percentage of the U.S. health dollar spent on mental sickness treatment by health experts is 1 to 2%. We have replaced and moved the mental health hospitals with county jails, which are more expensive with poorer results.”

White House Declares National Health IT Week

Celebrate National Health IT Week by Making EHRs Part of Your Practice

In a proclamation on Monday, President Obama declared the week of September 11 – 17 as National Health Information Technology Week.

In his proclamation, President Obama spoke about how health IT connects doctors and patients to more complete and accurate health records and how tools like EHRs and electronic prescriptions help patients and providers make safer, smarter decisions about health care. By providing financial incentives to those providers who successfully meet meaningful use of certified EHRs, CMS hopes to encourage providers and hospitals to adopt this technology.

Providers are already beginning to see the benefits of using EHRs. Recently, CMS interviewed providers at a Delaware Meaningful Use Recognition Ceremony on how EHRs are positively affecting their practices. Dr. Jerome Abrams, a doctor of Family Medicine from Delaware, whose practice successfully attested to meeting meaningful use, said that EHRs have allowed his practice “to capture information on patients a lot more efficiently and a lot more completely.”

Over 90,000 providers and hospitals have registered for the Medicare and Medicaid EHR Incentive Programs, and over $652 million has been paid to providers and hospitals that have successfully demonstrated meaningful use.

If you are interested in learning more about the Medicare and Medicaid EHR Incentive Programs or would like to find resources to help you register and attest to meeting meaningful use, visit the CMS EHR website.

Want more information about the EHR Incentive Programs?Make sure to visit the Medicare and Medicaid EHR Incentive Programs websitefor the latest news and updates on the EHR Incentive Programs.

Commentary: Your Plate Just Spilled Over

If you think the perfect storm was having to comply with electronic health records meaningful use criteria, HIPAA 5010 transactions, ICD-10 and the Red Flags rule at the same time, you are not alone.

In public comments to federal officials about the proposed meaningful use criteria, one message came through loud and clear: "We already have a lot of regulatory deadlines on our plate and the meaningful use criteria are too much, too soon."

Well, your plate just got fuller. Assuming the Senate holds its end of the bargain, President Obama within days will sign health reform legislation into law. And that law will have a lot of new electronic data interchange/transactions processing mandates imposed on the health care industry with the first deadlines only three years away (see story).

On the surface, the EDI mandates are good for the industry, and especially good for providers who should see improvements in their revenue cycle management processes. Providers will have a much better idea at the point of service of how much insurance will pay and how much the patient will owe. Providers, ideally, will experience fewer denied or pended claims because they thoughtlessly forgot how each of the dozens or hundreds of payers they deal with like their transactions to be sent to them.

The EDI mandates in the reform bill are designed to, finally, make the HIPAA transaction standards far more standardized. They also will add new transactions, such as electronic funds transfer and claims attachments, as well as a unique health plan identifier. The mandates require consensus-based "operating rules" be adopted for each HIPAA transaction to make the movement of electronic claims and related transactions as easy as ATM transactions. Payer advocacy organization CAQH has championed these operating rules and has prodded industry stakeholders to negotiate and develop them to make transactions more uniform.

In theory, that means you'll fill out and send your claims, eligibility and claims status inquiries, authorizations and other transactions to Aetna the same way you send them to Cigna, UnitedHealthcare, the Blues and everyone else. And the payers will send their responses back in a uniform manner. And who owes what and when it will be paid will be far more clearer than today. And you'll save money by having fewer employees spend large parts of their day on the phone, on hold, waiting to talk to insurers. And more claims will get adjudicated on the first pass through payer systems, improving your cash flow. And auto-posting of payments to patient accounts will be a breeze.

But many providers may view the deadlines for all this nifty administrative simplification stuff to be as unrealistic as they viewed the meaningful use deadlines.
The reform bill calls for a unique health plan identifier by October 2012; and operating rules in place for eligibility and claim status transactions by January 2013; EFT and payment/remittance advice transactions by January 2014; and claims/encounters, enrollment/disenrollment, premium payment, referral certification/authorization and attachments transactions by January 2016.

That means that by the time HIPAA 5010 transactions go into effect in January 2012, work will be well underway to significantly change those transactions--and add new transactions--within just a few years.

And that also means all this transactions/operating rules developing, building, testing and implementation will come during the same time providers are handling ICD-10, Red Flag, and meaningful use requirements.

If that doesn't seem realistic, then the transactions timetables must be extended and that means getting amendments approved to a health care reform bill that just passed after decades of trying. That won't be easy. Still, maybe the 5010 transactions shouldn't go into effect in January 2012 as scheduled. But that argument can't be made to policymakers until it is clear how a delay in 5010 would affect ICD-10's deadline of October 2013--and the degree to which a 5010 delay would impact the industry migration to ICD-10.

Regardless, it won't take long for the ink to dry once President Obama signs the reform legislation, and that's when a new round of questions will arise.

--Joseph Goedert

Obama Dedicates $88M More for Health IT

As part of the new Recovery Act funding, President Obama pushes health information technology systems for community health care centers.President Obama is seeding the health care industry with another $88 million in funding for health care centers to adopt new health information technology systems to manage their administrative and financial matters and transfer old paper files to electronic medical records. The initiative is part of $600 million in stimulus money that will go toward improving community health centers across the country.

"These investments won't just increase efficiency and lower costs, they'll improve the quality of care as well –- preventing countless medical errors, and allowing providers to spend less time with paperwork and more time with patients," Obama said Dec. 9.

The new Recovery Act funds are the latest in a series of grants awarded to community health centers, which deliver preventive and primary care services at more than 7,500 service delivery sites around the country to patients regardless of their ability to pay. Health centers serve more than 17 million patients, about 40 percent of whom have no health insurance.

Both programs will be administered by the HRSA (Health Resources and Services Administration), an agency of the HHS (U.S. Department of Health and Human Services).

Obama also directed the HHS to implement a demonstration program designed to evaluate the impact of the advanced primary care practice model on access, quality and cost of care provided to Medicare beneficiaries served by community health centers.

This model, known as the "medical home," promotes accessible, continuous and coordinated family-centered care. Developed and administered by the CMS (Centers for Medicare and Medicaid Services), the demonstration will last three years. CMS anticipates that up to 500 health centers will participate.

According to a Dec. 8 PricewaterhouseCoopers report, the market for personalized medicine in the United States is already $232 billion, and it is projected to grow 11 percent annually.The personalized medical care portion of the market -- including telemedicine, health information technology and disease management services offered by traditional health and technology companies -- is estimated at $4 billion to $12 billion and could grow tenfold to more than $100 billion by 2015 if telemedicine takes off.

"These three initiatives –- funding for construction, technology and a medical home demonstration –- they won't just save money over the long term and create more jobs, they're also going to give more people the peace of mind of knowing that health care will be there for them and their families when they need it," Obama said. "And ultimately, that's what health insurance reform is really about."