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

2.63 2.62 2.70 2.67 2.66 2.72 2.84 2.82 2.89 2.80 2.75 2.84 2.81 2.82 2.84 3.20 3.17 3.30 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 All Opioids Non MAT Opioids Most Abused Opioids

Opioid Scripts Per Beneficiary by State

CT MA ME NH RI VT 55.71 55.33 56.78 59.16 58.46 59.43 63.76 62.77 64.15 58.91 57.49 59.02 59.58 59.40 60.09 69.09 68.27 70.33 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 All Opioids Non MAT Opioids Most Abused Opioids

Opioid Days Supplied Per Beneficiary by State

CT MA ME NH RI VT

In 2014: Vermont an outlier compared to 5 other New England states for opioid scripts/beneficiary Well above average for opioid days supplied/beneficiary Vermont 17% higher than other NE states Vermont 10 days longer than other NE states

Findings: 2013 to 2014

From 2013 to 2014: Doctors increase rate of opioids prescribed and number of days supplied 11,000 (9%) more opioid scripts in 2014 1.5 days longer supply periods in 2014

3.14 3.10 3.22 3.20 3.17 3.30 0.5 1 1.5 2 2.5 3 3.5 Opioid Scripts per Beneficiary Opioid Scripts per Beneficiary (non-MAT) Opioid Scripts per Beneficiary (most abused)

Scripts Per Beneficiary 2013 to 2014

2013 2014 67.60 66.44 68.52 69.09 68.27 70.33 10 20 30 40 50 60 70 80 Days Supplied per Beneficiary Days Supplied per Beneficiary (non-MAT) Days Supplied per Beneficiary (most abused)

Opioid Days Supplied Per Beneficiary 2013-2014

2013 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)

5% diff.

80.08 80.55 64.15 75.76 72.53 56.71 10 20 30 40 50 60 70 80 90 Family Practice Internal Medicine Nurse Practitioner

Opioid Days Supplied Per Beneficiary 2014 (p<.05; VT prescriber n>100)

VT Other NE States 3.44 3.62 3.00 3.28 3.13 2.66 0.5 1 1.5 2 2.5 3 3.5 4 Family Practice Internal Medicine Nurse Practitioner

Opioid Scripts Per Beneficiary 2014 (p<.05; VT prescriber n>100)

VT Other NE States

16% diff. 13% diff. 6% diff. 11% diff. 13% diff.

B H A F C L G D I K J E

500 1000 1500 2000 2500 3000 3500 4000 100 200 300 400 500 600 # Opioid Scripts # Beneficiaries

VT MD Opioid Scripts Filled per Beneficiary 2013 & 2014

Findings: Prescriber Outliers

Findings: Prescriber Outliers

I B H F G L D E K J

200 400 600 800 1000 1200 1400 1600 1800 50 100 150 200 250 300 350

VT MD Opioid Scripts Filled per Beneficiary 2013

2013

B H A F C G L D I J K E

200 400 600 800 1000 1200 1400 1600 1800 50 100 150 200 250 300 350

VT MD Opioid Scripts Filled per Beneficiary 2014

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

16.7 23.1

5 10 15 20 25 30 35 40

2010 2011 2012 2013 2014 2015 2016 Deaths per 100,000 Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont

New England Drug Overdose Deaths (from VDH)

38% increase Source: CDC/NCHS, National Vital Statistics System, mortality data. Includes

• pioids and other drugs

Original table (minus 2016 data point for VT) created by Vermont Department of Health

New England Drug Overdose Deaths (from VDH)

Source: CDC/NCHS, National Vital Statistics System, mortality data. Includes

• pioids and other drugs

Original table (minus 2016 data point for VT and title) created by Vermont Department of Health

5 10 15 20 25 2008 2009 2010 2011 2012 2013 2014 2015 2016

VT Drug Overdose Death Rates Compared to US US VT

Name Date of Call Date of Birth Town of Death Town of Residence Gender 1 Decedent known to have been using drugs immediately prior to death; or, Decedent found with evidence of active drug use (i.e. needle in arm) 2A Decedent found with illicit drugs or paraphernalia (glassines; syringes, pipes, or straws with 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)

Actual tool used by deputies

Overdose Deaths in Chittenden County

5 6 3 5 6 3 5 5 3 6 3 6 3 3 2 5 5 2 3 4 1 5 2 5 1 2 3 4 5 6 7 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Monthly Drug Overdose Deaths in Chittenden County*

Likelihood Scale Deaths ME Confirmed Deaths

*Artificial data used as example

BPD Overdose Data

5 10 15 20 25 30 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

BPD Overdose Calls for Service 2012-2017

10 20 30 40 50 60 70 80 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 2012 2013 2014 2015 2016 2017

BPD Days Between Overdose Calls 2012-2017

CC Hub Waitlist and Wait Days

158 147 161 211 39 147 61 97 101 53 32 40 50 100 150 200 250 50 100 150 200 250 300 350 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Chittenden County Hub # Awaiting Treatment & Average Wait Days*

# Waiting Average Days on Waitlist

*Artificial data used as example

CC Hub Waitlist and Wait Days

10 20 30 40 50 60 70 80 90 20 40 60 80 100 120 140 160

Chittenden Hub Active Waitlist # and Avg Wait Days

# Waiting Average Days Waiting

CC Spokes Waitlist and Wait Days

*Artificial data used as example

75 89 110 46 64 73 57 88 43 30 38 43 20 40 60 80 100 120 50 100 150 200 250 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Chittenden County Spokes # Awaiting Treatment & Average Wait Days*

# Waiting Average Days on Waitlist

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