Government Watchdog Group Finds Shortcomings in Efforts to Stem Opioid Abuses
By Christopher A. Parrella, J.D., CHC, CPC, CPCO
Two new reports from the U.S. Government Accountability Office (GAO) point out lapses in efforts to stem the tide of opioid abuse among veterans, as well as Medicare beneficiaries.
In a report released on May 29, the GAO noted that while the Veterans Affairs Department was doing a good job of reducing the use of opioids among U.S. veterans, the agency has not “fully met all of its opioid safety goals.”
In reviewing more than 100 veterans’ medical records at five VA facilities, the government watchdog agency said they did not always adhere to key opioid risk mitigation strategies.
For example, it found that among 53 veterans who were prescribed long-term opioid therapy (defined as a 90-day supply in the last 6 months), the GAO found:
- Forty did not have their names queried in a state-run prescription drug monitoring program database. The databases are used to identify patients who are receiving multiple prescriptions that may put them at greater risk for misusing opioids or overdosing;
- Twenty-one did not have a urine drug screening within the year prior to having their prescription filled. The screenings are used to determine whether veterans are taking their opioid medications as prescribed; and
- Twelve did not provide written informed consent. Informed consent is a formal acknowledgement that the veteran has been educated on the risks and benefits of opioid use prior to initiating long-term opioid therapy.
On the other hand, the GAO noted that it has seen a reduction in the number of opioid prescriptions at the VA. Between the fourth quarter of FY 2013 and the first quarter of FY 2018 that number fell by about 267,000 veterans.
In its report, the GAO made five recommendations including that the VA document actions and develop measurable outcomes related to its Opioid Safety Initiative (OSI) goals, ensure that providers are adhering to opioid risk mitigation strategies, ensure that all its regional networks have implemented academic detailing programs, and that all VHA medical facilities have a designated primary care pain champion, as required.
The Department of Veterans Affairs agreed with those recommendations and described steps it will take to implement them. Among those steps would be the formation of a workgroup to review and develop ways to increase adherence. The VA said it expects to complete all of its actions no later than April 2019.
In its other report titled “Medicare Needs Better Information to Reduce the Risk of Harm to Beneficiaries” also issued on May 29, the GAO pointed out that it had previously found problems such as doctor shopping and questionable prescribing practices in Medicare’s prescription drug benefits.
The report is based on findings from October 2017, at which time the GAO noted that in 2016, 14 million Medicare Part D beneficiaries received opioid prescriptions, with spending for opioids at almost $4.1 billion.
The GAO noted that The Centers for Medicare & Medicaid (CMS), which administers the federal government programs, lacks the necessary information to effectively determine the full number of beneficiaries at risk of harm, as well as other information that could help CMS assess whether its efforts to reduce opioid overprescribing are effective.
In the October 2017 report, GAO made three recommendations:
- CMS should gather information on the full number of at-risk beneficiaries receiving high doses of opioids;
- Identify providers who prescribe high amounts of opioids;
- Require plan sponsors to report to CMS on actions related to providers who inappropriately prescribe opioids.
Although HHS agreed with the first two recommendations, it did not concur with the third. The GAO said it continues to believe the recommendation is valid.
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