Opioid Prescribing to Medicare Part D Enrollees, 2013–2017: Shifting Responsibility to Pain Management Providers

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (–19.9%) and orthopedic surgery (–16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by –5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.</jats:p> </jats:sec>

Uncomplicated Distal Radius Fractures: An Opportunity to Reduce Emergency Medicine Opioid Prescribing?

“…1,6,7 Despite the collective efforts to reduce opioid prescribing, 92% of the emergency physicians who responded to our survey prescribed an opioid the last time they discharged an adult patient with a Colles fracture. Although emergency physicians are generally less likely to prescribe opioids than most other physicians, 5 this potentially represents an opportunity to further reduce EM opioid prescribing. The reported rate of opioid prescribing among our respondents was higher than that reported in previous studies evaluating emergency physicians' use of opioids in patients with long bone fractures (51%-65%), [10][11][12][13] although those studies included undifferentiated long bone fractures (eg, radius, humerus, tibia, femur, clavicle) in both admitted and discharged patients, and-with one exception 13 -did not distinguish between analgesia in the ED and prescriptions for analgesics at the time of discharge.…”

“…We did not ask how long it had been since that last patient encounter, and emergency physician opioid prescribing is generally trending downward. 5 We do not know how these physicians will treat the next patient they encounter with a Colles fracture. Finally, we have not assessed pain relief or satisfaction at the individual patient level.…”

“…4 Although emergency physicians prescribe opioids less often than most other physicians, they still write millions of opioid prescriptions each year. 5 Reducing opioid prescribing is a priority for the Centers for Medicare & Medicaid Services 6 and the American College of Emergency Physicians (ACEP). 7 Understanding emergency physician pain management practices for isolated extremity fractures is important to identify opportunities to reduce opioid prescribing and to improve transdisciplinary uptake of the AAOS guidelines.…”

A Work in Progress: National Opioid Prescription Reductions Across Orthopaedic Subspecialties in a Contemporary Medicare Sample of 5,026,911 Claims

“…Analyses evaluating changes in opioid prescribing patterns over time have primarily been limited to other medical and surgical subspecialties, 6 , 7 with significant limitations demonstrated among studies exploring these temporal trends in orthopaedic surgery. Notably, although Romman et al 8 demonstrated a 16% reduction in opioid claims among providers classified under orthopaedic surgery between 2013 and 2017, these authors failed to include orthopaedic hand surgeons, did not stratify by subspecialty, and did not report any statistics in their analysis. Therefore, given the limitations in the current literature, more comprehensive analyses of how opioid prescription habits among orthopaedic surgeons have changed over contemporary time frames are needed.…”

Opioid prescription trends among American Head and Neck Society fellowship graduates

“…10,11 This reality has, in part, given rise to a growing body of studies analyzing opioid prescription trends among physicians across surgical subspecialties, including orthopedic surgery, plastic surgery, neurosurgery, and otolaryngology. 2,[4][5][6][7][9][10][11][12][13] The American Academy of Otolaryngology-Head and Neck Surgery published a clinical practice guideline in 2021 outlining recommendations for safe and effective opioid prescribing after common otolaryngology procedures, highlighting the continued need for quality improvement. 14,15 While research has been done in otolaryngology, minimal research exists focusing specifically on opioid prescribing practices among head and neck surgeons.…”