Running head: OUR OPIOID EPIDEMIC 1. Evidence That Our Opioid Epidemic Is Only Weakly Correlated with Provider Avarice.

Transcription

1 Running head: OUR OPIOID EPIDEMIC 1 Evidence That Our Opioid Epidemic Is Only Weakly Correlated with Provider Avarice Eugen Tarnow Avalon Business Systems, Inc. Avalon Working Paper Maple Avenue, Fair Lawn, NJ 07410, , etarnow@avabiz.com

2 OUR OPIOID EPIDEMIC 2 Abstract The majority of Medicare opioid prescriptions come from family practice and internal medicine providers. I show that the tendency of these providers to prescribe opioids has only a very small correlation with provider list prices suggesting that provider avarice is only weakly correlated with opioid prescribing. Keywords: opioid prescriptions, family practice, internal medicine, government intervention

3 OUR OPIOID EPIDEMIC 3 Evidence That Our Opioid Epidemic Is Only Weakly Correlated with Provider Avarice The current opiate epidemic has many reasons: pharmaceutical marketing, naïve and/or unscrupulous doctors, availability of cheap and cleverly sold Mexican heroin and inappropriate policy changes to encourage the idea that pain was something curable with drugs that were not addictive (Quinones, 2015). In healthcare, the financial incentive is a powerful driver though its effect is typically discounted in the research literature, often it is thought only as a poor way to improve the quality of care (Scott, et al, 2011; Chaix-Couturier et al, 2000). In this paper I want to consider whether provider avarice allow the financial incentive to influence whether they write prescriptions for opioids. That there is a financial incentive is obvious: a prescription for an addictive drug that forces the patient to keep coming back for more prescriptions creates an automatic income stream. The forces that might counteract responding to this incentive include the Drug Enforcement Agency which the doctors must report to and, of course, the moral imperative of not doing harm to patients. Definitions & Data Sources I analyze the Medicare provider datasets for the presence of opioid prescription claims (Medicare_Part_D_Opioid_Prescriber_Summary_File.csv can be downloaded from data.cms.gov). Different types of providers will have different reasons to prescribe opioids. To simplify the analysis, I limit it to family doctors and internal medicine doctors, they are responsible for 2/3 of all opioid prescriptions (see Table 1). To avoid statistical noise, I further limit the investigations to those doctors with at least 200 Medicare claims per year.

4 OUR OPIOID EPIDEMIC 4 As a measure of provider avarice I use the ratio of the dollar value of claims to allowed claims: the higher the ratio the higher the provider s avarice (Medicare_Provider_Util_Payment_PUF_CY2014.txt can be downloaded from data.cms.gov). Results & Discussion The ratio of opiate claims to all Medicare claims roughly obeys a lognormal distribution (Fig. 1). This by itself suggests that there is no qualitative difference between providers, only a quantitative difference. The ratio of the dollar value of submitted claims to allowed claims, a measure of the avarice of the provider, is displayed in Fig. 2. This is not a lognormal distribution because Medicare functions as a price floor (Tarnow, 2012). In Fig. 3 is shown the logarithm of the ratio of opiate claims versus the logarithm of the ratio of claimed to allowed charges. There is only a small correlation between the two variables. Thus I find that the willingness to prescribe opiates at least to Medicare patients is relatively insensitive to avarice. This suggests that in order to get providers to write fewer opiate prescriptions, a financial incentive might not be successful. The distribution of opiate prescriptions was close to a lognormal distribution suggesting that the providers are not qualitatively different from each other. Accordingly, any marketing campaign to encourage providers to write fewer opioid prescriptions would have to address just one audience.

5 OUR OPIOID EPIDEMIC 5 References Chaix-Couturier, C., Durand-Zaleski, I., Jolly, D., & Durieux, P. (2000). Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues. International Journal for Quality in Health Care, 12(2), Quinones, S. Dreamland: The True Tale of America's Opiate Epidemic. Scott, A., Sivey, P., Ait Ouakrim, D., Willenberg, L., Naccarella, L., Furler, J., & Young, D. (2011). The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev, 9(9), CD Tarnow, E. (2012) Medicare provides a price floor which increases list prices by an average of 45%. Avalon Working Paper...

6 OUR OPIOID EPIDEMIC 6 Table 1 Medicare opioid claims by provider specialty Tables Specialty Description Opioid Claims Percent Family Practice % Internal Medicine % Nurse Practitioner % Physician Assistant % Orthopedic Surgery % Physical Medicine and Rehabilitation % Anesthesiology % Interventional Pain Management % Emergency Medicine % General Practice % Rheumatology % Pain Management % Neurology % General Surgery % Dentist %

7 OUR OPIOID EPIDEMIC 7 Figures Fig. 1. Frequency distribution of the log of the percentage of opioid claims. The line shows a best-fitting lognormal distribution.

8 OUR OPIOID EPIDEMIC 8 Fig. 2. Frequency distribution of the log of the ratio of dollar value of Medicare claims to the dollar value of Medicare allowed claims. This distribution is not lognormal since Medicare functions as a price floor (Tarnow, 2012).

9 OUR OPIOID EPIDEMIC 9 Fig. 3. Plot of opioid claims versus charge ratios.