Analysis Finds Lax CMS Oversight of Prescribers in Medicare Part D
Despite repeated warnings from experts and patient advocates, CMS has done little to monitor unsafe prescription patterns and investigate or restrict unsafe practitioners in Medicare Part D, according to a ProPublica analysis, ProPublica/Washington Post reports.
About the Analysis
Congress created Medicare's prescription drug program in 2003. ProPublica's analysis of Medicare Part D data from 2007 through 2010 -- obtained under the Freedom of Information Act -- makes public for the first time the prescribing practices and identities of physicians and other health care providers.
The data showed that 1.1 billion claims were filed in 2010, including prescriptions and refills dispensed. Among those, about 70 providers wrote more than 50,000 prescriptions and refills each in 2010, an average of 137 per day.
The analysis highlighted widespread prescribing of drugs that are potentially harmful, disorienting or addictive for elderly U.S. residents, such as antipsychotic medications. In recent years, regulators have tried to discourage the use of such drugs in nursing homes and FDA has issued a warning against their use for dementia patients, citing increased risk of death.
However, the analysis of hundreds of millions of Medicare records showed that in 2010 nearly 340 doctors and other providers accounted for more than 1,000 antipsychotic prescriptions each for patients ages 65 and older.
In addition, the analysis showed that U.S. health care providers commonly prescribe drugs that have been pulled from foreign markets for safety reasons.
For example, providers in 2010 wrote more than 500,000 prescriptions for the muscle relaxant drug carisoprodol that was pulled from European markets in 2007. The American Geriatrics Society has listed the drug, also known as Soma, on its list of drugs elderly U.S. residents should avoid.
The analysis also showed that U.S. health care providers commonly prescribe drugs in unapproved ways that could be unsafe or ineffective. There are several reasons why doctors improperly prescribe medications, such as being involved in a pill mill where patients can pay cash for prescriptions, influence from pharmaceutical companies and pressure from families or facilities.
In addition, ProPublica's examination found that CMS failed to act against providers who have been suspended or disciplined by other regulatory authorities, such state Medicaid programs or state medical boards.
Further, the data showed that 50% of the top 20 prescribers of OxyContin in 2010 have been either criminally charged, convicted or settled fraud claims, or have been disciplined by their state medical boards. Among those, eight have been charged, convicted or barred from prescribing controlled substances, or been disciplined by licensing boards. However, all but one of those doctors still are able to prescribe drugs for Medicare.
Doctors, CMS Officials Respond
In interviews, some physicians noted that those working in institutional settings, such as nursing homes, or operating busy clinics will have higher prescribing rates. In other cases, doctors said they believed they were being attributed for their colleagues' prescriptions. However, most noted that their numbers should have triggered questions.
CMS officials say Congress did not give CMS the authority to second-guess doctors and that oversight of the Part D program falls to private health plans.
In an interview, Jonathan Blum, CMS' director of Medicare, said, "CMS' payments don't go to physicians, don't go to pharmacies. They go to plans, which is how our oversight framework has been established."
Unlike other Medicare programs, in which the federal government is responsible for contracting with physicians, reviewing medical claims and paying bills, beneficiaries enrolled in Part D get their drugs through private insurers. Under the plan, private insurers are responsible for alerting pharmacies to potentially harmful drug interactions, monitoring doctors with unsafe prescribing habits and identifying fraud.
However, experts say private insurers -- which only have access to their members' prescriptions -- are ill-equipped for the task. Some experts say Medicare -- which is the only entity that can see providers' prescriptions across multiple health plans -- should use its data to identify unusual prescribing patterns and take action to identify and restrict unsafe practitioners.
In addition, HHS' Office of Inspector General repeatedly has issued reports advising CMS officials to be more watchful of prescribing practices (Weber et al. , ProPublica/Washington Post, 5/11).
The authors of the ProPublica analysis outlined a list of eight recommendations by former government officials, analysts and researchers that could help improve oversight of Medicare Part D, ProPublica/Washington Post reports.
They recommend that officials:
Compare prescriptions with CMS data containing patient diagnoses;
- Regularly examine data to identify physicians who frequently prescribe drugs with a high risk of misuse;
- Regularly obtain state Medicaid prescribing records;
- Require health providers to disclose past license sanctions and criminal convictions when enrolling in Medicare Part D;
- Require physicians to use diagnosis codes on prescriptions;
- Require private insurers in Part D to report suspected cases of abuse, fraud and waste to Medicare's fraud contractor;
- Share prescribing data with state medical boards; and
- Seek congressional authority to bar providers who have been indicted or arrested on prescription drug charges from Part D (Weber et al. , ProPublica/Washington Post, 5/11).
New Online Tool
ProPublica also has created an online tool called the Prescriber Checkup that allows consumers to search for individual providers and see which drugs they prescribe.
The tool contains data on nearly 350,000 health care providers -- including doctors, nurses, physician assistants, and others who can prescribe -- who have written at least 50 prescriptions for one drug within Medicare Part D during 2010.
The tool also allows consumers to sort prescribers by drug. Users can select a drug from a list of the 500 most-prescribed drugs to see the top prescribers. In addition, the tool contains a chart for elderly U.S. residents that detail the most prescribed drugs listed by the American Geriatrics Society as risky or inappropriate for those patients.
The authors cautioned that some doctors treat higher numbers of seniors and disabled patients and their inclusion on the tool does not necessarily mean they should be avoided (Weber et al. , ProPublica/Washington Post, 5/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.