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Minnesota health care providers to receive reports on their opioid prescribing practices

ST. PAUL — More than 16,000 health care providers who serve Medicaid and MinnesotaCare recipients are about to find out if they prescribe opioids at higher rates than their peers.

The Minnesota Department of Human Services will send them individualized reports over the coming weeks as part of a new effort to make providers more aware of their opioid prescribing behavior. Providers will get feedback on several measures, such as how often they write opioid prescriptions, how many exceed the recommended dose and how many of their patients have become chronic opioid users.

The reports are the culmination of a yearslong effort between DHS and the state Opioid Prescribing Work Group.

“We’re really not using an ax, but we’re using a scalpel to help take care of the prescribing side of the opioid crisis,” said Dr. Jeff Schiff, who served as medical director of the state Medicaid program until his position was eliminated this month. He helped write the legislation that created the Opioid Prescribing Work Group and set the panel’s agendas and direction.

Doctors, dentists, physician assistants and nurse practitioners will be able to see how they stack up to others in their field of practice. The reports did not log data on opioids used to treat opioid use disorder, cancer patients or those who receive hospice or palliative care.

About one-quarter of the health care providers who wrote at least 10 opioid prescriptions last year came in above the recommended threshold for at least one of the measures, according to DHS.

A start to monitoring effort

A look at opioid prescribing rates across the state shows wide variations that cannot easily be explained. Among the findings:

  • Opioid prescribing rates varied by county in 2017, from 27.4 prescriptions to 98.6 prescriptions per 100 residents.
  • The top quartile of opioid prescribers in emergency medicine had a prescribing rate nearly three times higher than the average of their peers.
  • The top quartile of opioid prescribers in family medicine had a prescribing rate nearly four times higher than the average of their peers.

These reports are the start of a multiyear effort to monitor opioid prescribing practices.

DHS will follow up with another set of reports next year and monitor for quality improvement. Providers who are still prescribing opioids above the recommended thresholds will have to submit an improvement plan to the agency.

If providers do not improve their opioid prescribing behavior by 2021, they could be restricted from serving Medicaid and MinnesotaCare enrollees.

“There probably will be some defensiveness, and we’ll have to work through that,” DHS Commissioner Tony Lourey said in an interview. “I think when practitioners see how they stack up against protocols and against others in their practicing field, they really respond.”

Opioid word group members express concern

Dr. Chris Johnson, an emergency medicine physician at Allina Health who chairs the Opioid Prescribing Work Group, said in a recent interview that Lourey’s decision to eliminate Schiff’s position may undermine the credibility of these reports.

As medical director of the state Medicaid program, Johnson said, Schiff lent credibility to the reports and knew how to help providers get their prescribing practices back in line.

“(Schiff’s departure) compromises the integrity of these reports, that compromises the effectiveness of the group,” Johnson said.

In an open letter to Gov. Tim Walz last week, 11 members of the Opioid Prescribing Work Group expressed their “collective astonishment and dismay” at the decision to let go of Schiff. They wrote it “undermines the effectiveness of our group and puts patients’ lives at risk.”

The department chose to break Schiff’s position into two part-time jobs: a behavioral health clinical director and a medical director. Lourey said the restructuring is meant to help address issues with health disparities and access across the state.

“It’s not really about an individual. We were making some strategic changes in how we structure,” Lourey said. “I could have done a better job on the roll-out, and that’s on me.”