Opioid-Related Hospital Events in the Medicare Population Mindy - - PowerPoint PPT Presentation

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Opioid-Related Hospital Events in the Medicare Population Mindy - - PowerPoint PPT Presentation

Oct 20, 2023 173 likes •419 views

Opioid-Related Hospital Events in the Medicare Population Mindy Cohen 2018 AcademyHealth Annual Research Meeting Overview 2007-2014 Trends Rates of hospital events per 100,000 beneficiaries By state, age, sex and race

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SLIDE 1

Opioid-Related Hospital Events in the Medicare Population

Mindy Cohen 2018 AcademyHealth Annual Research Meeting

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SLIDE 2
  • 2007-2014 Trends
  • Rates of hospital events per 100,000 beneficiaries
  • By state, age, sex and race
  • Changes to Opioid Diagnosis Codes
  • ICD-10 coding granularity
  • Hospital events by state
  • Rates of death from opioids using National Death Index data

Overview

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SLIDE 3
  • Opioid-related hospital events per 100,000 beneficiaries

Inpatient hospital stays

Hospital outpatient emergency department (ED) visits

  • Opioid-related events identified by ICD-9 diagnosis codes on 2007-

2014 Medicare claims

Includes any event that had a relevant ICD-9 code in either the primary or secondary diagnosis field

Includes codes associated with prescription opioids and illegal opioids

Excludes codes related to opioid dependence or abuse “in remission”

2015 and 2016 not included due to transition to ICD-10

  • Population: Fee-For-Service Medicare beneficiaries only

Excludes Medicare Advantage beneficiaries, and beneficiaries who had a cancer diagnosis or who received hospice care at any point during the year

Ages 65+ and under 65 shown separately

Not risk adjusted

2007-2014 Trends - Methodology

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SLIDE 4

All Opioid-Related Hospital Events, by Age, 2007-2014

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500 1,000 1,500 2,000 2,500

2007 2008 2009 2010 2011 2012 2013 2014

EVENTS PER 100,000 BENEFICIARIES

Under 65 Total 65 and Over

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SLIDE 5

All Opioid-Related Hospital Events, by State, 65 and Over, 2014

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SLIDE 6

Opioid-Related Hospital Events, by State, 65 and Over, 2014

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55 62 64 83 90 94 95 96 97 101 102 107 108 109 111 111 114 115 122 124 125 126 139 139 141 144 144 146 148 159 162 165 167 168 174 176 179 180 185 185 188 190 212 225 234 236 256 344 358 391 418

  • 50

100 150 200 250 300 350 400 450

NE SD IA HI AR KS VA TX WI LA NH MO IL SC OH NJ WV WY VT MS DE KY GA PA MN AL ND IN NM NY FL OK RI ME NC CT TN MA MD CO MI AK NV AZ MT ID CA WA DC UT OR

Events Per 100,000 Beneficiaries

Inpatient Outpatient ED 2014 Average

National average: 157 per 100,000

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SLIDE 7

Rate of Change in All Opioid-Related Hospital Events, by State, 65 and Over, 2007-2014

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  • 7%

24% 39% 51% 54% 56% 63% 68% 68% 69% 73% 75% 76% 77% 79% 82% 83% 87% 92% 93% 95% 95% 96% 99% 101% 102% 104% 107% 108% 109% 114% 115% 117% 120% 120% 125% 127% 131% 142% 155% 162% 172% 180% 186% 203% 209% 209% 214% 272% 280% 314%

  • 10%

40% 90% 140% 190% 240% 290% 340%

NE AR MS KS LA AK WY VT HI NH NJ NV ME VA TX IA AL SD MO IL WI OK CO GA SC NM KY UT ND TN OH WV MD MA AZ IN NY RI CA FL MT CT MI MN PA NC WA ID OR DC DE

2007 – 2014 Percent Change in Events

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SLIDE 8

All Opioid-Related Hospital Events, by State, Under 65, 2014

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SLIDE 9

Opioid-Related Hospital Events, by State, Under 65, 2014

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869 907 934 958 984 1,007 1,090 1,093 1,107 1,133 1,227 1,263 1,297 1,316 1,322 1,441 1,454 1,499 1,594 1,627 1,670 1,705 1,706 1,805 1,855 1,932 1,941 1,979 2,021 2,029 2,033 2,052 2,110 2,131 2,179 2,209 2,340 2,357 2,411 2,484 2,611 2,637 2,654 2,689 2,711 2,985 3,195 3,243 3,526 3,989 5,128

  • 1,000

2,000 3,000 4,000 5,000 6,000

IA TX AR NE LA SD SC MS GA KS ND VA WY OK WV KY MO AL NC WI IN HI MT TN ID NY MI IL NM OH AK FL CA PA NV AZ MN CO DE VT DC OR ME UT NJ CT WA NH RI MD MA

Events Per 100,000 Beneficiaries

Inpatient Outpatient ED 2014 Average

National average: 1,908 per 100,000

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SLIDE 10

Rate of Change in All Opioid-Related Hospital Events, by State, Under 65, 2007-2014

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  • 5%

29% 31% 36% 38% 43% 45% 47% 53% 54% 56% 58% 60% 60% 61% 64% 67% 69% 69% 69% 71% 73% 79% 83% 85% 87% 87% 88% 90% 90% 91% 91% 92% 95% 95% 98% 99% 99% 103% 106% 107% 107% 109% 112% 114% 117% 120% 128% 134% 174% 208%

  • 10%

40% 90% 140% 190% 240%

IL TX HI MS MT MD NY RI LA KS AR NJ AL MI AK NV OK CT NE MA MO AZ ME SC CA GA VA UT OH IN WA WI TN WY DC CO PA MN NM IA KY OR NC WV SD FL ID VT NH DE ND

2007 – 2014 Percent Change in Events

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SLIDE 11

All Opioid-Related Hospital Events, by Age and Metro/Non-Metro Area, 2007-2014

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500 1,000 1,500 2,000 2,500

2007 2008 2009 2010 2011 2012 2013 2014 EVENTS PER 100,000 BENEFICIARIES Metro Under 65 Non-Metro Under 65 Metro Total Non-Metro Total Metro 65 and Over Non-Metro 65 and Over

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SLIDE 12

All Opioid-Related Hospital Events, by Age and Sex, 2007-2014

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500 1,000 1,500 2,000 2,500

2007 2008 2009 2010 2011 2012 2013 2014 EVENTS PER 100,000 BENEFICIARIES Female, Under 65 Male, Under 65 Male Total Female Total Female, 65 and Over Male, 65 and Over

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SLIDE 13
  • 500

1,000 1,500 2,000 2,500

2007 2008 2009 2010 2011 2012 2013 2014 EVENTS PER 100,000 BENEFICIARIES

American Indian/Alaska Native White Hispanic Black Asian/Pacific Islander

Under 65

  • 50

100 150 200 250 300 350 400

2007 2008 2009 2010 2011 2012 2013 2014 EVENTS PER 100,000 BENEFICIARIES

All Opioid-Related Hospital Events, by Age and Race, 2007-2014

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65 and Over

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SLIDE 14

Total Count of Opioid-Related Hospital Events, by Race, 2007-2014

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10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000

AI/AN, 65+ AI/AN, <65 Asian/PI, 65+ Asian/PI, <65 Hispanic, 65+ Hispanic, <65 Black, 65+ Black, <65 White, 65+ White, <65 Total Count of Events

2007 2008 2009 2010 2011 2012 2013 2014

Note: excludes missing and unknown categories

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SLIDE 15
  • In 2014, the national average of total opioid-related hospital events

was 157 events per 100,000 beneficiaries over 65 and 1,908 events per 100,000 beneficiaries under 65

  • Total events per 100,000 beneficiaries ranged from a high of 5,128 in

Massachusetts among the under 65 population to a low of 55 in Nebraska among the 65 and over population

  • Age, location and race all impacted rates and counts of hospital

events

 For example, beneficiaries under 65 had rates more than 25 times those 65

and over in some states in 2014

Summary of Findings – 2007-2014

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SLIDE 16
  • Beginning October 1, 2015, CMS required all providers to submit claims

using ICD-10 diagnosis codes

  • ICD-10 codes provide more granularity than ICD-9 codes for identifying
  • pioid-related events, and therefore more opportunity to identify an
  • pioid related event

Use vs abuse vs dependence

Accidental vs intentional vs assault

Initial encounter vs subsequent encounter vs sequela

  • Certain codes cannot be cross-walked between ICD-9 and ICD-10,

making it difficult to examine trends across years

Large increase in events seen from 2014 to 2016, but unclear if due to increase in actual events or due to changes in coding

ICD-10 Levels of Granularity

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SLIDE 17

Percent of Events by Code Type, 2016

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Adverse Effect 64% Poisoning (Overdose) 36%

Poisoning vs. Adverse Effect

Accidental 82% Intentional/ Assault 18%

Accidental vs. Intentional

All Other Opioids and Narcotics 76% Heroin 19% Methadone 5%

Heroin, Methadone, All Other

Dependence 73% Abuse 18% Use 9%

Use, Abuse, Dependence

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SLIDE 18

Opioid-Related Events, by State, 65 and Over, 2016

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244 284 294 314 317 321 325 327 330 333 337 341 348 351 361 372 382 382 383 387 399 401 407 412 418 425 428 439 456 456 467 468 469 472 473 487 491 525 543 568 576 577 584 596 607 610 650 685 717 760 860

  • 100

200 300 400 500 600 700 800 900 1,000

HI SD SC IA TX MS NY NJ AR LA WV NE VT OH VA KS DE GA IL PA AL MO NM IN WY RI NH CT MA KY OK MD WI ND ME FL TN NC NV CA MI AK AZ DC CO MN MT ID UT WA OR

Events Per 100,000 Beneficiaries Inpatient Outpatient ED 2014 Average 2016 Average

National average: 443 per 100,000

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SLIDE 19

Opioid-Related Events, by State, Under 65, 2016

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1,398 1,536 1,549 1,556 1,662 1,703 1,732 1,750 2,008 2,067 2,106 2,239 2,250 2,251 2,317 2,343 2,368 2,449 2,476 2,580 2,591 2,657 2,728 2,828 2,861 2,874 2,912 2,954 2,966 2,998 3,208 3,228 3,298 3,298 3,305 3,318 3,530 3,572 3,584 3,620 3,632 3,708 3,773 3,885 3,903 3,931 4,087 4,248 4,900 5,401 6,351

  • 1,000

2,000 3,000 4,000 5,000 6,000 7,000

SD TX AR IA LA NE MS GA SC WV HI OK KS WY KY AL VA MO NY NM IN MT WI OH IL AK CA MI NC TN PA ID CO OR ND VT MN FL ME AZ NV NJ DC WA RI DE UT CT NH MD MA

Events Per 100,000 Beneficiaries Inpatient Outpatient ED 2014 Average 2016 Average

National average: 2,874 per 100,000

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SLIDE 20
  • Population: Fee-for-Service Beneficiaries
  • Year: 2016
  • Data Source: National Death Index Data
  • Opioid-related Hospital Events: Inpatient Stay or Outpatient

Emergency Department Visit

Rates of Death Related to Opioids – Methodology

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SLIDE 21
  • Consistent with CDC Methodology
  • Cause of Death:

 Unintentional  Suicide  Homicide  Undetermined Intent

  • Underlying Cause of Death:

 Natural and semisynthetic opioids  Methadone  Synthetic opioids, other than methadone  Heroin  Other Opium

Opioid Overdose Deaths

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SLIDE 22
  • In 2016, 0.4% (n=5k) of FFS Medicare decedents (n=1.4M) died

due to an opioid overdose

  • Among decedents with an opioid-related diagnosis in any setting

(n=46k) in 2016, 4% (n=1.8k) died from an opioid overdose

  • Among decedents with an opioid-related hospital event (n=32k) in

2016, 4% (n=1.2k) died from an opioid overdose

  • After excluding beneficiaries with cancer or hospice, among

decedents with an opioid-related hospital event in 2016 (n=11k), 10% (n=1k) died from an opioid overdose

Deaths from Opioid Overdoses among FFS Medicare Beneficiaries

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SLIDE 23
  • The risk of death from opioid overdose is 50x higher among

decedents < 65 years old compared to those >=65 years old

 Under 65: (4,402 opioid overdose deaths / 138,526 decedents)  65 and Older: (823 / 1,296,606)

  • After excluding beneficiaries with cancer or hospice, this risk

remains 33x higher among decedents < 65 years old compared to those >= 65 years old

 Under 65: (4,114 / 79,679)  65 and Older: (698 / 447,024)

Risk of Death from Opioid Overdose by Age Group

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SLIDE 24
  • The most common causes of death for those with an opioid-

related hospital event were:

 All Other Diseases (10%)  Other Chronic Lower Respiratory Diseases (8%)  Malignant neoplasms of trachea, bronchus, and lung (8%)

  • After excluding beneficiaries with cancer or hospice, the most

common causes of death for those with an opioid-related hospital event were:

 All Other Diseases (15%)  Accidental poisoning and exposure to noxious substance (11%)  Other Chronic Lower Respiratory Diseases (9%)

Other Causes of Death among Beneficiaries with an Opioid-Related Hospital Event

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