New research quantifies the impact of the opioid epidemic
BOSTON — A new study of the growing United States opioid epidemic found that deaths from overdoses have nearly doubled over the past seven years, while increasing acute care costs and hospitalizations are taxing health care systems.
The new paper, "The Critical Care Crisis of Opioid Overdoses in the United States" published online ahead of print in the Annals of the American Thoracic Society is believed to be the first to quantify the impact of opioid abuse on critical care resources in the U.S. The findings reveal that opioid-related demand for acute care services has outstripped the available supply.
In the cohort study, researchers from Ben-Gurion University of the Negev in Israel, Harvard Medical School and University of Chicago analyzed nearly 23 million adult hospital admissions at 162 hospitals in 44 states over a seven-year period: January 1, 2009 through September 30, 2015. Among the more than 4 million patients requiring acute care, the researchers found 21,705 who were admitted to intensive care units due to opioid overdoses. Admissions included overdoses for prescription drugs, methadone or heroin.
"We found a 34% increase in overdose-related ICU admissions while ICU opioid deaths nearly doubled during that same period," stated Lena Novack, a lecturer in BGU's School of Public Health. The mortality rates of these patients climbed at roughly the same rate, on average, with a steeper rise in deaths of patients admitted to the ICU for overdose after 2012.
The average cost of care per ICU overdose admission also rose significantly – 58% – from $58,517 in 2009 to $92,408 in 2015. In addition, the study indicated that opioid-related ICU admissions increased an average of more than half a percent each year over the seven-year timeframe, jumping from 7% to 10% by the end of the study period.
Patients admitted to the ICU due to an overdose increasingly required intensive care, including high-cost renal replacement therapy or dialysis.
"Our estimates may actually be on the low side," Novack said. "Since our team of researchers analyzed admissions rather than a manual chart review, we may not have captured every admission if opioid-related complications weren't coded as such."
The researchers found that Massachusetts and Indiana had the highest opioid admission densities in the nation. Pennsylvania experienced the sharpest rise in opioid-related overdoses during the study period, with critical care overdose admissions nearly doubling since 2009. Illinois, California, New York and Indiana have also experienced ICU admission rate increases during the period.
"Our findings raise the need for a national approach to developing safe strategies to care for ICU overdose patients, to providing coordinated resources in the hospital for patients and families, and to helping survivors maintain sobriety following discharge," the researchers concluded.
Medi-Dose and EPS publish white paper on bar coding in healthcare settings
IVYLAND, Pa. — It’s essential for healthcare professionals to follow the five tenets of medication dispensing and administration: the right patient, the right drug, the right dose, the right route and the right time. Within every facility, systems are instituted to ensure these five tenets are observed. Bar codes can play an important role in medication dispensing, helping healthcare professionals ensure they are administering drugs to the right patients correctly. But many people don’t know how bar codes work, or which bar code options are best for their systems.
To help healthcare professionals better understand bar coding, Medi-Dose and EPS have released a white paper called, “Bar Codes and Bar Code Scanners for Unit Dose Medication in a Healthcare Setting.” It explains how bar codes work, the types of bar codes and scanner that are available and how to best termine the best equipment and bar code options for unit dose medications.
Click here to see the white paper.
For more than 45 years, Medi-Dose and EPS have been working with pharmacists and nurses to develop cost-effective solutions that promote medication safety and error prevention.
Government or commercial health plan? The pharmacist’s challenge of uncertainty
While an insurance card contains a lot of information and is an important part of the pharmacy transaction, there are times when it doesn’t tell the whole story.
The insurance card indicates only the current plan covering the patient. What it cannot tell the pharmacist is whether or not there is additional coverage, or what specific type of coverage the patient has. Even when the pharmacy sends the claim to be adjudicated by the plan, the messaging returned does not indicate if the coverage is for a commercial or government plan, such as Managed Medicaid.
Helping patients, preventing problems
When a pharmacist knows the available coverage, he or she may be able to reduce a patient’s financial obligation and prevent improper or inadvertent incentives.
The former is important because a patient’s financial situation may significantly impact medication adherence. A recent report, “Adherence and Health Care Cost,” characterized it as “an important public health consideration, affecting health outcomes and overall healthcare costs.” The report estimated between 20% and 50% of patients are noncompliant with drug therapy, and stated that “reducing out-of-pocket costs leads to better medication adherence across many diagnoses.” A recent report in Annals of Internal Medicine estimated that a lack of adherence causes nearly 125,000 deaths, 10% of hospitalizations and costs between $100 billion–$289 billion per year.
Knowing the full extent of a patient’s insurance coverage helps reduce out-of-pocket costs and can lead to better medication adherence and better overall health/outcomes. If a patient only has commercial coverage, a pharmacist can offer any available manufacturer coupons or incentives, such as a promotional gift card.
Moreover, as stories of recent lawsuits have demonstrated, failing to properly determine coverage can result in inadvertent incentives and may lead to financial penalties. According to news reports, within the last five years, two pharmacy store chains had to pay $1.4 million and $7.9 million to resolve allegations that they violated the False Claims Act. Real-life examples of inadvertent incentives can be as simple as improperly using such in-store or company incentives as gasoline discounts and/or drug manufacturer coupons to reduce costs for Medicare patients. Federal law prohibits influencing a Medicare patient’s choice of provider with this type of offer.
Finding a solution to identifying complete coverage could improve healthcare outcomes and reduce costs, while allowing patients to take advantage of available incentives to save them money, when appropriate.
LexisNexis Risk Solutions Health Care is exploring the use of socioeconomic and claims data for determining if the patient is on a government plan. Additionally, we welcome collaboration with industry stakeholders to develop solutions that would allow pharmacies to identify the plan type in real time, simultaneously with prescriber verification. We invite state governments, pharmacy benefit managers, health plans and data and analytics vendors to join efforts to ensure pharmacies have full and accurate insight into the patient coverage.
Until a viable solution is identified and implemented, there are best practices pharmacies employ to determine a patient’s coverage, including:
- Knowing and engaging the patient to better understand any coverage that patient may have, including commercial, Medicare, Medicaid/Managed Medicaid;
- Working with the pharmacy’s system vendor to use the BIN/PCN/group designations in the industry to help determine if the coverage is commercial or government when assisting with coupons; and
- Reporting suspected cases of fraud to the proper authorities.
Bobbie Riley, RPh, is the vertical market lead, pharmacy, at LexisNexis Risk Solutions – Health Care