Providers

Letters From CMS (Medicare) to Employers Regarding Group Health Plan Reporting Are Causing Some Confusion

Many employers are receiving letters from CMS (Medicare) requesting information and it’s causing some confusion. The actual title of the letter reads “Requirement to Submit the Group Health Plan Report for the IRS/SSA/CMS Data Project”.

Here’s an overview that may help clarify for you.

This letter from CMS is separate and apart from the new ACA employer reporting requirements that recently went into effect (employers with 50+ employees). Employers are required to provide the requested information but it’s pretty basic and, other than complying with the request, not anything to really be concerned about.

If You Want A Pragmatic Understanding of the Opioid Epidemic You May Want to Listen to This

This post follows up on last week’s primer on how abuse of prescription pain medications has led to what’s now recognized as a true national crisis. The new podcast Embedded provides a riveting inside look at how the use of one particularly powerful prescription painkiller, Opana, impacted life in a small Indiana town.

Pain Meds and The Opioid Epidemic: 10 Things To Know

There’s a lot in the news these days about what’s referred to as the opioid crisis or epidemic.

Just yesterday for instance —  highly respected healthcare consultant (and close friend) Joe Paduda, fresh off of speaking at a national drug summit in Atlanta, wrote an insightful but grave piece on the impact of opioid abuse for Managed Care Matters. Joe nets out the massive increase in the death toll stemming from prescription pain killers (opioids) and how the increased use of heroin has been driven by users who started with prescription opioids .

And, in an article appearing in Thursday’s Wall Street Journal (The Accidental Deadly Drug Prescription) a Baltimore physician writes how doctors and patients alike are unaware of the threat of accidental death posed when opioids interact with other frequently prescribed drugs.

Got me thinking. Despite all the news, despite being in a healthcare related field and working with prescription drug plans, and despite having had family, friends, and colleagues at work touched by this crisis, I realized I don’t really know nearly enough about the overall issue. I wanted to better comprehend the basics and so I dug in a little bit to get a better grasp. Thought I’d share in case you’re in the same boat as me.

Here are 10 things about the growing pain med problem that may help you better understand:

1.) Per the National Institutes for Health (NIH), Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain by diminishing the effects of a painful stimulus. In other words, they reduce the patient’s perception of pain.

2.) Medications in the opioid class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs.

 3.) Hydrocodone products are the most commonly prescribed for a host of painful conditions, including dental and injury-related pain.

 4.) Morphine is often used before and after surgical procedures to alleviate severe pain.

 5.) Codeine is often prescribed for mild pain. In addition to their pain relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for example—can be used to relieve coughs and severe diarrhea. (In other words, just about anyone could have been prescribed an opioid at one time or another.)

 6.) Addiction may develop due to the euphoric response some people experience when taking opioid medications. The drugs affect the brain regions involved in reward. Those who abuse opioids may look to step up and intensify their experience by taking the drug in ways other than those prescribed or switching to heroin after becoming addicted because heroin may be less expensive and or more easily accessible.

 7.) Over the course of almost two decades overprescribing of opioids has led to a huge increase in the frequency of opioid addiction. This in turn has led to the steep rise in overdose deaths and increased heroin use. Use of hydrocodone has more than doubled and consumption of oxycodone has increased by nearly 500%. The number of deaths due to opioid overdose death nearly quadrupled.

 8.) This acceleration in the prescription and use of opioids was fueled in large part by the combination of the introduction of OxyContin in 1995, more aggressive identification and treatment of pain, and, an overall increase in emphasis on Pain Management as a treatment modality.

 9.) The group with the highest death rate from opioid prescription pain meds is the 45-to-54 age group — more than four times the rate for teenagers and young adults. The rate of overdose deaths for adults ages 55 to 64 has soared sevenfold.

 10.) Everyday 46 Americans die from using prescription painkillers.

I guess my take away is for me to tune in more. And, encourage our team and our clients and their employees to tune in more.  Maybe at one time it seemed mostly just on the streets. Not any more. It’s at the office; it’s at home; and it’s over the roads. From classrooms to locker rooms to board rooms, pain med addiction has become a real and costly issue that in some way shape or form has touched most of us.

New Source of Over-Utilization? Study Indicates Use of Retail Clinics May Be Increasing Healthcare Costs

Use of retail clinics leads to higher costs.

Seems a bit counter-intuitive doesn’t it?

You’d think that the use of retail clinics like those found in some CVS and Kroger stores and typically staffed by nurse practitioners would be apt to lower total costs. In fact it’s based on this premise that some employers and carriers are encouraging employees to use these clinics by covering more of the cost of the visit.

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