Behavioral Health in PACE: Substance Abuse

Transcription

1 Behavioral Health in PACE: Substance Abuse NPA s Quality Symposium 2017 June 9th, 2017 Bharati Srivastava MD MBA FACP AGSF Mercy LIFE Sharon Hill Mercy LIFE Southeastern PA Trinity Health Inc.

2 Objectives Learn how to identify drug diversion Gain tools to address opioid use and misuse.

3 Agenda Overview Mercy LIFE Background Opioid Misuse and Narcotic Diversion Current Model Practice/ Work in Progress

4 Background Mercy LIFE SEPA Overview Capitated PACE program began: 1998 (St. Agnes LIFE) Current participants: 755 over 2 cou 4 Centers in 2 Counties 2 centers in Philadelphia 2 centers in Delaware County One of the DelCo PACE centers is a residential facility Deaf seniors. Also affiliated is religious community of 85 Sisters 2017 Awarded Montgomery County opening 2018

5 CMS CMS Take Fraud Waste and Abuse seriously FWA responsibility is under Division of Plan Oversight and Accountability, Center for Program Integrity Drug Diversion Hot Area Drug diversion/misuse starts with reviewing drug use (Part D/PDE)- data mine drug claims CDC prescription drug abuse national epidemicmore fatalities

6 Opioid Mortality

7 Drug Diversion Channeling drugs for recreational purposes (opioids) Transferring controlled substances to others knowingly or unknowingly (narcotics) Prescriber prescribes MORE than is medically necessary Every controlled substance legally dispensed must bear the patient s name (i.e HIV)

8 DRUG DIVERSION Patient/ Participant Pain Management Red Flags Lack of objective findings Physician treating solely on subjective complaints Rapid increase in the amount of medication needed Multiple prescriptions pain/rx cocktail Early refills Family calling for refills Refusal to leave a urine sample or aberrant results Going to the ER 65

9 Current Model Participants identified as "high risk" due to history (e.g. history of abuse, diversion, etc.) or suspicion of narcotic diversion discussed by the IDT and added to the high risk med list by the Nurse Manager. IDT participant discussion documented as an IDT note. A team problem added to the care to reflect the risk for narcotic misuse. High alert list communicated to Pharmacy and only one PCP renews narcotics for participants on the high alert list.

10 Current Model cont d Participants on the high risk med list receive narcotics in mac adherence packaging delivered to the med room and given to the participants in intervals decided by the team (e.g. weekly supply, daily supply, etc.). The med room nurse, or designee, in collaboration with the PCP, inform the contracted pharmacy of the alternate packaging needed for narcotics. An EMR alert "High Risk for Narcotic Misuse" is put in the status bar for all participants on the high alert list. (education with appropriate staff, including on-call staff completed)

11 Contract Discussion A meeting is held with the participant/caregiver and appropriate members of the IDT to discuss changes in narcotic med dispensing and to have the participant sign the Pain Treatment with Opioid Medications: LIFE Participant Agreement. If a participant can no longer receive narcotics due to things such as diversion or abuse, the PCP places this information in the EMR medication allergy section.

12 Sample Contract- page1 Pain Treatment with Opioid Medications: LIFE Participant Member Agreement We at Mercy LIFE want to work with you in a respectful and caring way to help you feel better. In order to prescribe opioid narcotics (such as Oxycontin, Percocet, Fentanyl) we must have a pain treatment plan that helps patients be safe including: We will schedule regular appointments for medicine refills. We will make sure that this treatment is a safe as possible. We will check regularly to make sure you are not having side effects. We will keep track of your prescriptions, goals and test for drug use regularly to help you feel like you are being monitored well. We will work with any other doctors or providers you are seeing so that they can treat you safely and effectively. If you become addicted to these medications, we will help you get treatment and safely get off of the medications that are causing you problems.

13 Sample Contract- page 2 Participant Member agrees to all of the following: I will treat the staff at the office respectfully at all times. I will not call between appointments, or at night or on the weekends for refills. I understand that prescriptions will be filled only during scheduled office visits with the treatment team I will keep all my scheduled appointments with the nurse practitioner and/ or doctor. I will keep the medicine safe and secure. If the medicine is lost, misused or stolen, I understand it will not be replaced until my next appointment, and may not be replaced at all. If medicine is reported stolen; a police reported must be filed and a docket number supplied to Mercy LIFE. I will not sell this medicine or share it with others. I will be honest with the nurse practitioner and/or doctor and tell them all other substances that I take.

14 Sample Contract- page 3 I will use only the LIFE pharmacy to get all of my medicines. I will not take any other medicines that can be addictive (e.g. Xanax, Ritalin) unless prescribed by my LIFE Nurse Practitioner/ Medical Doctor. I will not use illegal drugs such as heroin, cocaine, nonprescribed marijuana, amphetamines or "street drugs". I understand that if I do, my life is at risk and my treatment may be stopped. I will come in for drug testing and counting of my pills, as requested. Pain control is part of my plan care. I understand that Mercy LIFE has the right to consider disenrollment if I break this agreement and I am not following the plan care. Add Signatures

15 Treatment Solutions Determine the difference Pain associated with pathology or not -and treat effectively IDT must not split IDT must support PCP if decision is to NEVER prescribe a narcotic Even if P is crying to nurse, reception, a staff member who is a relative or neighbor Be confident in treatment Be consistent Use your toolbox- behavioral modification, narcotic contracts, disenrollment

16 Questions? Summary