CommStat 02/23/17 Rules for CommStat We will be addressing serious - PowerPoint PPT Presentation

CommStat 02/23/17

Rules for CommStat • We will be addressing serious issues; we need to be tough-minded about them • Work collectively to develop creative, innovative solutions, do not focus on deficiencies • Ask direct, difficult questions, but do so respectfully • Provide candid, honest answers, do not be defensive • If you don’t know the answer, it is okay to say “I don’t know” and provide a timeframe for when you can get the answer • Celebrate successes! • Critique ideas and debate issues, not people • Use evidence not opinions, challenge assumptions and inferences • Ask for and offer ideas and solutions • Don’t be afraid to fail • Be present, no distractions – ringers off • Department Heads and Panel are expected to participate in all meetings

Medicare Data Analysis

Data • Medicare Provider Utilization and Payment Data: Part D Prescriber • Individuals prescribed drugs via Medicare Part D health care plan • Individuals above the age of 65 • Individuals with permanent disabilities • Individuals with end-stage renal disease

Findings: Vermont vs Rest of New England In 2014: Vermont an outlier compared to 5 other New England states for opioid scripts/beneficiary Well above average for opioid days supplied/beneficiary Opioid Days Supplied Per Beneficiary by State Opioid Scripts Per Beneficiary by State 80.00 3.50 70.00 3.30 3.20 3.00 3.17 70.33 69.09 68.27 2.89 60.00 64.15 63.76 2.84 2.84 2.84 62.77 2.81 2.82 2.82 2.80 2.75 2.72 60.09 2.70 2.50 59.58 59.40 59.43 2.67 59.16 2.66 2.63 58.46 2.62 CT 56.78 CT 55.71 55.33 50.00 MA MA 2.00 ME 40.00 ME NH 1.50 NH 30.00 58.91 59.02 57.49 RI RI 1.00 VT 20.00 VT 10.00 0.50 0.00 0.00 All Opioids Non MAT Opioids Most Abused Opioids All Opioids Non MAT Opioids Most Abused Opioids Vermont 10 days longer than other NE states Vermont 17% higher than other NE states

Findings: 2013 to 2014 From 2013 to 2014: Doctors increase rate of opioids prescribed and number of days supplied Opioid Days Supplied Per Beneficiary 2013-2014 Scripts Per Beneficiary 2013 to 2014 80 3.5 3.30 70 3.22 3.20 3 3.17 3.14 70.33 3.10 69.09 68.52 68.27 67.60 66.44 60 2.5 50 2 40 2013 2013 1.5 2014 2014 30 1 20 0.5 10 0 0 Days Supplied per Beneficiary Days Supplied per Beneficiary Days Supplied per Beneficiary Opioid Scripts per Beneficiary Opioid Scripts per Beneficiary Opioid Scripts per Beneficiary (non-MAT) (most abused) (non-MAT) (most abused) 1.5 days longer supply periods in 2014 11,000 (9%) more opioid scripts in 2014

Findings: By Specialty Across States In 2014: Vermont Doctors compared to the average for their peers within specialty across other New England states (where difference is stat. sig) Opioid Scripts Per Beneficiary 2014 (p<.05; VT prescriber n>100) Opioid Days Supplied Per Beneficiary 2014 (p<.05; VT prescriber n>100) 4 90 80 3.5 3.62 80.55 80.08 3.44 75.76 3.28 70 3 72.53 3.13 3.00 60 64.15 2.5 2.66 56.71 50 VT 2 VT 40 Other NE States Other NE States 1.5 30 1 20 0.5 10 0 0 Family Practice Internal Medicine Nurse Practitioner Family Practice Internal Medicine Nurse Practitioner 16% diff. 5% diff. 13% diff. 6% diff. 11% diff. 13% diff.

Findings: Prescriber Outliers VT MD Opioid Scripts Filled per Beneficiary 2013 & 2014 4000 3500 B 3000 2500 # Opioid Scripts 2000 K D F J G L 1500 C E I H 1000 A 500 0 0 100 200 300 400 500 600 # Beneficiaries

Findings: Prescriber Outliers VT MD Opioid Scripts Filled per Beneficiary 2014 VT MD Opioid Scripts Filled per Beneficiary 2013 1800 1800 B B 1600 1600 C J 1400 1400 1200 1200 I K 1000 1000 E D K L L D F G F 800 800 G H 600 600 J H A E 400 400 200 200 I 0 0 0 50 100 150 200 250 300 350 0 50 100 150 200 250 300 350 2013

Limitations/Implications • Medicare Part D covers 14% of insured Vermonters • May not be able to generalize findings to entire population of Vermonters receiving prescription drugs • But could be indicative of wider practices • Offers glimpse into population that might be at risk for opioid addiction • Highlights the importance of further transparency in public health • Data only available through 2014 • Demonstrates the need for more timely public health data releases • Why we should push for more inclusive, timely public health prescription data: • Generate public discourse about opioid prescribing practices • Give doctors the opportunity to compare their practices to those of their peers • Allow for monitoring of progress in prescribing practices

New England Drug Overdose Deaths (from VDH) 40 35 30 Deaths per 100,000 Connecticut Maine 25 23.1 Massachusetts New Hampshire 20 Rhode Island 16.7 15 Vermont 10 38% increase 5 2010 2011 2012 2013 2014 2015 2016 Original table (minus 2016 data point for VT) created by Vermont Source: CDC/NCHS, National Vital Statistics System, mortality data. Includes Department of Health opioids and other drugs

New England Drug Overdose Deaths (from VDH) 25 VT Drug Overdose Death Rates Compared to US 20 15 10 5 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 US VT Original table (minus 2016 data point for VT and title) created by Vermont Source: CDC/NCHS, National Vital Statistics System, mortality data. Includes Department of Health opioids and other drugs

Name Date of Call Date of Birth Town of Death Town of Residence Gender Actual tool 1 Decedent known to have been using drugs immediately prior to death; or, Decedent found with used by evidence of active drug use (i.e. needle in arm) 2A Decedent found with illicit drugs or paraphernalia (glassines; syringes, pipes, or straws with deputies residue) in immediate vicinity. 2B Decedent found with prescription opiates or alprazolam in immediate vicinity 3 Decedent has prior history of substance abuse/overdose; or, Hospital toxicology or OCME quick toxicology positive for narcotics; and neither 1 nor 2A applies 4 Decedent found in suspicious circumstances (i.e. unconscious in public area; young person) with no signs of trauma or suicide, and no explanatory medical history (i.e. long term illness)

Overdose Deaths in Chittenden County Monthly Drug Overdose Deaths in Chittenden County* 7 6 6 6 6 6 5 5 5 5 5 5 5 5 5 4 4 3 3 3 3 3 3 3 3 2 2 2 2 1 1 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Likelihood Scale Deaths ME Confirmed Deaths *Artificial data used as example

BPD Overdose Data BPD Days Between Overdose Calls 2012-2017 BPD Overdose Calls for Service 2012-2017 80 30 70 25 60 20 50 40 15 30 10 20 5 10 0 0 1 9 17 25 33 41 49 57 65 73 81 89 97 105 113 121 129 137 145 153 161 169 177 185 193 201 209 217 225 233 241 249 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2012 2013 2014 2015 2016 2017 2012 2013 2014 2015 2016 2017

CC Hub Waitlist and Wait Days Chittenden County Hub # Awaiting Treatment & Average Wait Days* 350 250 211 300 200 250 161 158 147 147 150 200 101 150 97 100 100 61 53 40 50 39 32 50 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec *Artificial data used as example # Waiting Average Days on Waitlist

CC Hub Waitlist and Wait Days Chittenden Hub Active Waitlist # and Avg Wait Days 160 90 80 140 70 120 60 100 50 80 40 60 30 40 20 20 10 0 0 # Waiting Average Days Waiting

CC Spokes Waitlist and Wait Days Chittenden County Spokes # Awaiting Treatment & Average Wait Days* 250 120 110 100 200 89 88 75 80 73 150 64 57 60 46 43 43 100 38 40 30 50 20 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec # Waiting Average Days on Waitlist *Artificial data used as example

https://www.aliem.com/wp-content/uploads/Sam-Quinones.jpg