New rule allows Medicare to drop doctors for irresponsible prescribing

Medicare physicians who prescribe drugs in abusive ways can now be expelled by the federal government, Charles Ornstein reports for ProPublica.

This increased oversight of Medicare Part D prescribers could help
decrease the availability of prescription drugs to abusers in Kentucky. More than 1,000 Kentuckians die each year from prescription drug overdoses, and the state has the third-highest overdose death rate in the nation.

Opoids, which are often found in pain medicine, are the most commonly abused prescription drugs, according to the National Institute on Drug Abuse. Hydrocodone, an opoid, is the most
commonly prescribed
controlled substance in
Kentucky, according to the Kentucky All Schedule Prescription Electronic
Reporting (KASPER) system, and is also the most prescribed drug in Part D program, according to ProPublica’s Prescriber Checkup, a tool that compares physicians’ prescribing patterns among specialties and states.

The Centers for Medicare and Medicaid Services proposed the new rule after ProPublica documented “how Medicare’s failure to oversee Part D effectively had enabled doctors to prescribe inappropriate or risky medications, had led to the waste of billions of dollars on needlessly expensive drugs and had exposed the program to rampant fraud,” Ornstein writes.

Part D covers 37.5 million seniors and disabled patients, and one in every four prescriptions in the U.S. is paid for by Medicare, costing taxpayers $62 billion in 2012, and experts have complained that Medicare is more interested in providing drugs to patients than in targeting problem prescribers, Ornstein notes. The U.S. Department of Health and Human Services‘ inspector general has called for tighter controls.

The new rule allows Medicare to drop doctors “if it finds their prescribing abusive, a threat to public safety or in violation of Medicare rules,” or if their Drug Enforcement Administration registration certificates are suspended or revoked, Ornstein writes. Problem providers will be identified by prescribing data, disciplinary actions, malpractice lawsuits and other information.

Opponents of the rule have called its definition of “abusive” prescribing too vague. Some worry that patients will lose access to necessary medication if their doctor is removed from the program, Ornstein writes. Medicare officials said they intend to expel providers only in “very limited and exceptional circumstances,” saying “It will become clear to honest and legitimate prescribers . . . that our focus is restricted to cases of improper prescribing that are so egregious that the physician or practitioner’s removal from the Medicare program is needed to protect Medicare beneficiaries.”

The new rule also allows the Medicare center to “compel health care providers to enroll in Medicare to order medications for patients covered by its drug program, known as Part D,” Ornstein writes. Now, doctors not enrolled in Medicare can prescribe for Part D patients; they will have to enroll or opt out of the program by June 1, 2015.

The doctors most affected by this will be dentists and Department of Veterans Affairs physicians who provide services not covered by Medicare but have patients who fill prescriptions covered by the program, Ornstein notes. Most health providers are already enrolled. (Read more)

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