Monday, December 22, 2014

Florida has a Large Percentage of Medicare's top "Controlled-Drug" Prescribers

A story was recently published on the WUSF website, Health News Florida. It says that the "prolific prescribers" of some medications are facing "Medicare scrutiny."

A chart in the story reflects the distribution of 192 top prescribing medical providers in 12 states. Of these, 52, or 27% are located here in the Sunshine State. 

The article notes that in 2012, "Medicare covered nearly 27 million prescriptions for powerful narcotic painkillers and stimulants with the highest potential for abuse and dependence." 

Despite efforts at addressing narcotic use, the article notes that this was a "9 percent" increase compared to 2011. 

Thankfully, though Florida has the largest volume of providers represented in this chart, the top prescriber is not in Florida. Dr. Shelinder Aggarwal of Huntsville, Alabama has that distinction. He prescribed "more than 14,000 Schedule 2 prescriptions in 2012." This amounted to "more than 80 percent of his Medicare patients" receiving "at least one prescription for a Schedule 2 drug, in many cases oxycodone."Apparently he is no longer a physician, the article notes he "surrendered his medical license" in 2013. 

The prescription practices are a "real area of concern" for the federal Centers for Medicare and Medicaid Services, according to the director, quoted in the article. 

The article suggests that data in existing resources can help identify potential problems such as "pill mills." There are "red flags" that could focus attention on potential problems. It notes that Dr. "Aggarwal's Medicare prescribing history" indicated he was a "top prescriber of narcotics." 

As part of the reaction to the data that has been identified, "in September, Medicare sent 760 letters to doctors who prescribe far more Schedule 2 drugs than others in their medical specialty and state." It cautions that the data is not conclusive, and there are appropriate uses of narcotics; "simply being an outlier doesn't establish that you're doing something wrong." The point is to allow physicians an opportunity to see that her or his practice is generating the volume and type of prescriptions that raise questions. 

The article praises the efforts of "New York, Kentucky, and Tennessee" with prescription databases aimed at addressing similar questions or concerns. Florida has a prescription drug database, but did not merit mention in the article praise. Some have been critical of Florida's effort in that it requires creation and maintenance of prescription data, but physicians are not required to consult it before writing a script. 

There has been ample coverage of the "pill mill" issue. There has been significant improvement. The DEA data supports that the "pill mill" doctors are not in Florida any longer. This data is more current than the Medicare data from 2012. Perhaps the database effect will be sufficient without any mandate that it be referenced prior to each script. Perhaps Medicare's efforts will support and enhance those efforts.  

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