Tpp 5 paduda victor

Latest
Research
on
Impact
of
Rx

Drug
Abuse
on
Workers

Compensa:on

Joseph
Paduda,
President

CompPharma,
LLC

Dr.
Richard
A.
Victor,
Execu:ve
Director

Workers’
Compensa:on
Research
Ins:tute

Disclosures

•  Joseph
Paduda
has
financial
rela:onships
with

proprietary
en::es
that
produce
health
care

products
and
services.

These
financial

rela:onships
are:
consul:ng
for
CID,

Millennium
Labs,
and
MedRisk,
Inc.

•  Richard
A.
Victor
has
disclosed
no
relevant,

real
or
apparent
personal
or
professional

financial
rela:onships.

Learning
Objec:ves:

1.  Specify
workers'
comp
stakeholders'
current
aQtudes

towards
opioids,
the
programs
they
have
in
place
to

address
opioids,
and
how
they
are
measuring
success.

2.  Explain
the
impact
of
prescrip:on
drugs
on
workers'

compensa:on
costs,
disability,
and
outcomes.

3.  Compare
the
level
of
understanding
of
execu:ves
to
front-‐
line
staﬀ
to
assess
gaps
in
performance
and
policy

implementa:on.

4.  Specify
what
types
of
physician
dispensing
of
opioids
exist

and
how
common
these
prac:ces
are
used.

5.  Analyze
whether
a
ban
on
physician
dispensing
of
opioids

reduces
the
use
of
opioids
or
merely
shiYs
the
dispensing

to
pharmacies.

Latest
Research
on
Impact
of
Rx

Drug
Abuse
on
Workers

Compensa:on

Joseph
Paduda

President

CompPharma,
LLC

Opioids are
the most
significant
problem
facing work
comp today.

As a society we consume
of all the opioids prescribed
in the world.
80%
pg.
2

DEA definition
“opioid”Examples include the illicit drug heroin and
pharmaceutical drugs like:
OxyContin®
Vicodin®
codeine
morphine
methadone
and
fentanyl
pg.
3

Routine use of opioids
for the treatment of
chronic nonmalignant
pain conditions
is not recommended.”
“
-ACOEM
pg.
4

The number of narcotics
prescriptions per claim
has grown 41%, from
0.56 in 2003 to 0.79 in 2011.
-NCCI
pg.
5

Respondents
400 total, 2:1 front line:
executive ratio
272 completed the survey
Response rate is three times
greater than any other
survey we’ve conducted
over 10 years.
pg.
6

Defining the Problem
pg.
7

When you hear the word
“opioids,” what one or two
words instantly come to mind? Addiction /
Dependence
Drug(s) /
Narcotics /
Drug Name
Abuse
Appropriate /
Pain / Pain Killer /
Therapy
Cost
Over Prescribed /
Death / Danger /
Epidemic
Death
pg.
8

How concerned is
senior management
about opioids
in workers’
compensation?
pg.
9

Why? Because these drugs drive up
costs, duration – most respondents have
figured this out and are starting to track
the impact.
pg.
10

Opioids are perceived
as having
overwhelmingly
negative
consequences for
payers and claimants.
What is the impact of opioids on the
costs and outcomes of workers’
compensation claims?
pg.
11

Whose responsibility is
it to manage opioids?
Addicts may be
“responsible” but
aren’t capable, and
many doctors
aren’t able to
address the issue.
pg.
12

How effective or ineffective
have PAYERS been in
addressing opioids?
pg.
13

What is causing PAYERS
not to effectively address
the issue of opioids?
Regulations Don’t Allow
Payers to Do Enough
Tools Available
Are Inadequate
Not Able to Identify Claims That
Would Benefit From Intervention
Other (Please Specify)
Not a Top Priority pg.
14

How effective have
REGULATORS been in
addressing opioids?
pg.
15

Conclusion
major problem as it directly affects
claim costs
duration
risk
ability to control same
As with any WC issue, payers look
to regulators to enable solutions –
however there are some solutions
currently in place that are delivering
results despite the less than
helpful environment.
pg.
16

We’re in the early stages of
figuring out the problem and
developing effective approaches.
pg.
18

What is the goal for the stated opioid
program(s)?
What is the goal for the
stated opioid program(s)?
pg.
19

What vendor(s) are you working
with to address opioids?
pg.
20

Please describe what
the vendor(s) is(are)
doing to address
opioids?
There’s a discrepancy
between front-line staff
and management, which
indicates a disconnect with
internal communication.
pg.
21

What is the vendor doing to address opioids?
pg.
22

How are you measuring the impact
of the work of the vendor(s)?
pg.
23

We’re in this early stage
where much of what we’re
doing is based on what we
think will work, but we
don’t yet KNOW.
Do you believe the programs
are having a positive effect?
pg.
24

What should be done?
What is being done?
80% of respondents picked best practices.
vs.
pg.
25

The ideal solution
80% identified:
Peer / physician review for claims – 90 / 180 days
Drug utilization review
Random drug testing
Opioid agreement / contracts
pg.
26

Please rank the following potential solutions
1-8 in the order that you believe would be
most successful in addressing the overall
opioid issue starting with 1 as most successful.
pg.
27

What percentage of the claims with opioid
issues do you think an opioid management
program would address?
pg.
28

Consensus
that opioids:
Cause addiction /
dependency
Increase disability
duration
Increase risk of
fraud / abuse
Drive up costs
pg.
30

Opioid
management
is in its
infancy.
pg.
31

There is
a wide
divergence
between ideal
and actual
opioid
management
programs.
pg.
32

Treating
physicians
are the crux.
pg.
33

Impact
Of
Banning
Physician
Dispensing
Of

Stronger
Opioids
In
Florida

Workers
Compensa:on
Research
Ins:tute

April
23,
2014

© Copyright 2014 WCRI. All Rights Reserved.

•  Two public policy debates converged
– Public health: “Pill mills” that dispense
controlled substances
– Cost: Physician dispensing of a wide range of
Rx in workers’ compensation
•  Florida legislature banned physician
dispensing of stronger opioids
Policy
Context
In
Florida

41© Copyright 2014 WCRI. All Rights Reserved.© Copyright 2014 WCRI. All Rights Reserved. 41

•  High levels of physician compliance with the ban
•  Fewer Florida workers received stronger opioids
•  Physician-dispensers switched to dispensing
other pain medications rather than continuing
stronger opioids
Major
Findings

Source: Impact of Banning Physician Dispensing of Opioids in Florida (Thumula, 2013)

Physician
Dispensing
Was
Common
In

Florida,
Higher
Than
Most
States

0%
10%
20%
30%
40%
50%
60%
MA
NY
TX
AR
M
NLA
VA
NC
WI
KS
IA
SC
NJ
TN
MO
PA
MI
IN
GA
CT
M
DIL
FL
CA
43
Prescriptions For 2011/12 Claims With > 7 Days Of Lost Time
Source: The Prevalence And Costs Of Physician-Dispensed Drugs (Wang, Liu, & Thumula 2013)
%
Of
All
Rx
For
Physician-‐Dispensed
Rx

© Copyright 2014 WCRI. All Rights Reserved. 43
Prescriptions For 2011/12 Claims With > 7 Days Of Lost Time
Source: The Prevalence And Costs Of Physician-Dispensed Drugs (Wang, Liu, & Thumula, 2013)

•  Ban on physician dispensing of schedule II, III
controlled substances (effective July 1, 2011)
– Few exceptions (can dispense samples, after
surgeries, clinical trials, department of corrections)
– No limits on physician dispensing of other
medications
•  Requires counterfeit-proof prescription pads
(effective August 29, 2011)
•  Register as controlled substance prescribing
physicians (effective January 1, 2012)
HB
7095
(Florida
Pill
Mill
Bill)


•  Early impact of reform on prescribing and
dispensing practices
•  Only injuries that occurred after the law
change were included in treatment group
Scope
Of
The
Study


•  Pre-post policy implementation
–  Treatment group: new injuries arising between
July-September, 2011 (Ban effective 7/1/11)
–  Comparison group: new injuries arising between
July-September, 2010
–  Both groups had Rx filled through December of the year
of injury (3-6 months of experience)
•  Data:
–  25% of Florida claims
–  Indemnity and medical-only claims
–  Case-mix adjusted
Methods
And
Data


Pre-‐
And
Post-‐Reform
Claim

Characteris:cs
Were
Similar

47© Copyright 2014 WCRI. All Rights Reserved.
Pre-‐Reform
Post-‐Reform

Number
Of
Claims
11,867
10,623

Average
Age
41
41

%
Female
42%
40%

%
Indemnity
Claims
24%
22%

Average
Medical
Payments
$2,464
$2,521

Average
#
Physician
Visits
3
3

Source: Impact of Banning Physician Dispensing of Opioids in Florida (Thumula, 2013)

Physician
Dispensing
And
Use
Of
Pain

Medica:ons
Unchanged

Pre-‐Reform
Post-‐Reform

Number
of
Rxs
22,255
19,017

%
Rxs
52%
52%

%
All
Pain
Medica:ons
61%
61%


High
Physician
Compliance
With
Reform

In
First
3-‐6
Months
Of
Cases

0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
Pre-Reform Post-Reform
ProportionOfClaimsWithRx
Schedule
II,
III
Opioids


•  Of those with physician-dispensed stronger
opioids after the ban:
– 69% surgical cases
– 21% out-of-state providers
Why
Didn’t

Schedule
II,
III
Opioids
Drop
To
Zero?


Physician
Dispensing
Of
Stronger
Opioids

Fell
AYer
The
Ban

3.5%
0.5%
Physician-‐
Dispensed

Opioids
(II,
III)


No
Change
In
Pharmacy
Dispensing
Of

Schedule
II,
III
Opioids

12.0% 12.1%
3.5%
0.5%
Physician-‐
Dispensed

Opioids
(II,
III)

Pharmacy-‐
Dispensed

Opioids
(II,
III)


Physician
Dispensing
Of
NSAIDs
And
Weaker

Opioids
Increased
Post-‐Reform

9.0% 9.8%
23.8% 26.0%
3.5%
0.5%
Physician-‐
Dispensed

Opioids
(II,
III)

Physician-‐
Dispensed

Weaker
Opioids

Physician-‐
Dispensed
NSAIDs


Recap:
Did
The
Florida
Ban
Reduce
The
Overall

Use
Of
Opioids
By
Injured
Workers?

•  High levels of physician compliance with the ban
•  Fewer workers received stronger opioids

Ques:on
Raised:

Does
Physician

Dispensing
Lead
To
More
Opioids?

•  Physician-‐dispensers
switched
to
other
pain

medica:ons
in
the
wake
of
the
ban

— No
change
in
pharmacy-‐dispensed
schedule
II,
III

opioids

— Increase
in
percentage
of
claims
with
physician-‐
dispensed
NSAIDs
and
weaker
opioids

•  This
raises
ques:ons
if
physicians
dispensed

unnecessary
opioids
pre-‐ban

•  Upcoming
study
will
examine
longer-‐term

impact
of
the
ban


•  To purchase the study, Impact of Banning
Physician Dispensing of Opioids in Florida, go
to:
•  WWW.WCRINET.ORG
•  For comments/questions about the findings:
WCRI@WCRINET.ORG
Follow WCRI on social media:
For
More
Informa:on


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