President Trump’s proposed Fiscal Year 2019 budget for the Department of Health and Human Services would make combating the opioid epidemic one of the agency’s top priorities, including $10 billion in HHS funding to address the crisis.
As part of the effort, a proposal in the administration’s FY 2019 budget is to “require states to monitor high-risk billing activity to identify and remediate abnormal prescribing and utilization patterns that may indicate abuse in the Medicaid system,” HHS Secretary Alex Azar told members of Congress Thursday.
Rep. Michael Burgess, MD (R-Texas), chairman of the House Energy and Commerce Subcommittee on Health, agreed that the Centers for Medicare and Medicaid Services has a lot of data that could be used to “identify a practitioner who is writing an inordinate number of prescriptions.” Burgess added that this information is “actually knowable” within CMS databases.
In testimony before the health subcommittee, Azar said that the HHS initiative may also enlist “states with prescription drug monitoring programs (PDMPs) as a vehicle” for identifying bad actors, as well as using the “authority to make sure that whenever we exclude a provider, it will automatically lead to transmission of that information” to the Drug Enforcement Administration so that agency can “pull the physician’s ability to write (prescriptions for) controlled substances.”
PDMPs are electronic databases that help states to track controlled substance prescriptions by flagging suspicious patient prescribing activities, according to Azar. “In our budget proposal, we actually are asking Congress to require that states have effective programs for this type of risk identification, risk mitigation,” he told lawmakers.
Last year, the President’s Commission on Combating Drug Addiction and the Opioid Crisis called for more data sharing among state-run PDMPs, charging that these databases are being significantly underutilized in the vast majority of states.
Azar said he is interested in looking into the issue of interoperability regarding PDMPs. However, at the same time, the HHS secretary observed that “states have developed these programs already independently, so there is a resource and burden question about forcing that interoperability to try to be nationwide.” A more feasible goal might be to get PDMPs to interoperate and share data among bordering states, according to Azar.
Nonetheless, the final report issued by the President’s Commission on Combating Drug Addiction and the Opioid Crisis noted that providers “often resist using PDMPs because these systems are not well integrated into the electronic health records (EHR) systems they currently use in practice.”
In Thursday’s hearing, Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, complained that while the Office of the National Coordinator for Health Information Technology had been working on “PDMP integration with health IT,” the effort ended in 2013.
However, according to an ONC spokesman, the agency in 2013 engaged in an inter-agency agreement with the Substance Abuse and Mental Health Services Administration (SAMHSA) to identify and harmonize standards to support PDMP and health IT integration and interoperability—an effort that will soon bear fruit.
“While the Standards and Interoperability Initiative (S&I) is now over and closed, the balloted standard which supports PDMP and EHR integration will be released in the summer 2018 via a new version of the NCPDP SCRIPT Standard,” said the ONC spokesman in a written statement. “So in 2013, we turned to standards development via S&I, and soon the results of that will be available via NCPDP standard,” referring to the National Council for Prescription Drug Programs, an ANSI-accredited standards development organization providing healthcare solutions.
“The SCRIPT Standard serves as the framework for an interoperable model that can fortify state PDMPs, providing access to real-time data at the point of prescribing for better informed clinical decision making,” said John Klimek, NCPDP’s senior vice president for standards and IT, in a written statement. “Importantly, it also supports access for patients with a valid medical need.”
Chairman Burgess concluded Thursday’s hearing by telling Azar that “one of the opportunities to reduce the burden on practicing physicians is (finding) a way to seamlessly integrate” PDMPs and EHRs.
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