Author: P Hasselbacher

Is HB-1 Working To Decrease Prescription Drug Abuse And Diversion?

Summary.
House Bill-1 passed in 2012 was a landmark legialstive effort to deal with Kentucky’s exploding epidemic of substance abuse. It clearly was effective in acheiving some of its goals, but it seems to have had less effect in some parts of the state and may have done as much as it can. We have improved our ability to collect data about prescription of controlled substances, but we have lagged in taking advaitage of what we have learned. We need to keep trying to do other things. Not all will work as well as hoped for either, but doing nothing is a non-starter.

Press conference(s).
In July, Governor Steve Beshear, Attorney General Jack Conway, Senate President Robert Stivers and House Speaker Greg Stumbo presided over a press conference to provide an update on House Bill 1, the comprehensive prescription drug abuse legislation passed in 2012.  Details presented included that the number of overdose deaths were down, the numbers of prescriptions for commonly abused drugs had dropped, and that 20 pain clinics had been shut down since HB-1 took effect.  Recall that prescriptions for controlled drugs dispensed in Kentucky must be reported to the Kentucky All Schedule Prescription Electronic Reporting (KASPER) database. The number of prescribers enrolled in the KASPER program increased from 75,45 to more than 24,000 with a tripling of queries to the KASPER database for reports on their patients from 811,000 to 2.7 million.  Over a ten-month period, the number of doses of hydrocodone dispensed dropped 9.5% from 198 million to 179 million doses. The number of doses of oxycodone dropped 10.5% from 72 million to 64 million does. Some of the other improvements were not so impressive.  Overdose fatalities over the previous year dropped, but only from 1023 to 1004. The number of physicians disciplined for prescribing violations by the the Kentucky Board of Medical Licensure rose from 53 to only 64.  Some bad news was that the number of overdose deaths attributed to heroin rose from 22 to 143, a forerunner of worse to come.

There is no doubt that HB-1, enacted in July 2012, has had an impact in the right directions, but some of the observed effects were relatively modest and some of the major impacts were probably one-time benefits.  Most of the immediate impact of the bill was either predictable or the result of picking the low-hanging fruit.  The 20 or so “pain clinics” that were shut down were obvious pseudo-medical pill-mills in disguise.  Enrollment in KASPER by prescribers became mandatory with the new law which also required prescribers to make at least some inquiries about their patients before prescribing selected high-risk drugs.  A stunning number of out-of-state licensed prescribers all of a sudden discovered it was too risky to use Kentucky as the drugstore of choice for their prescriptions to abusing co-conspirators.  These changes to the prescriber population alone would be expected to decrease the overall volume of controlled substances entering the system.  The distressing observation remained that use and diversion of controlled prescription drugs remains huge and pervasive.

Oops— Start over!
Even though I had heard last week’s press conference live, I was a few paragraphs into the document summarized above before I realized I was erroneously reading a press release from July 25, 2013 that I had just downloaded from the Internet!   The players from last week’s press conference were the same, but the occasion was the release of a study commissioned by the Cabinet for Health and Family Services and prepared by a unit of the University of Kentucky’s College of Pharmacy.  The report compared two year’s prescribing of controlled substances before HB-1 to that of the following full year ending July 2013.  The July 27, 2015 press conference therefore had a longer follow-up to draw upon but the results were not all that different and not always better than those of two years before. Continue reading “Is HB-1 Working To Decrease Prescription Drug Abuse And Diversion?”

Executive Compensation at UofL— A Tipping Point?

Over the past few years there has been a plethora of events, reports, investigations, prosecutions and miscellaneous scandals involving the University of Louisville that should have made the Louisville and Frankfort communities sit up and take notice that all may not be well or even legal within the Cardinal Citadel.  However, a recent series of investigative and other reports about the amount and mechanisms of executive compensation have proven to be the tipping point for public outrage. The income disparity between a select few in leadership and the not-keeping-up-with-inflation salaries of faculty and staff– supported as they are by soaring student tuitions– became too great for University of Louisville spin-meisters to stonewall, to facilely explain away, or to blame on the Commonwealth’s lack of funding.  Prominent among the recent reports are those of Chris Otts of WDRB, Andrew Wolfson  of the Courier Journal, and Stephen George of Insider Louisville. The faculty and staff of the University are also understandably outraged.  I put my two cents in also.

I don’t have the patience or space to detail how the story unfolded. The journalists above have published detailed analyses of “how much, how come, and who knew?”  The story has gone nationwide.  Troubling is the observation that numbers and other details from different sources do not always agree.   Official UofL and UofL Foundation documentation is shockingly sparse, inconsistent, and embarrassingly incomplete. The recollections of present and former Trustees of what actually transpired vary, in my opinion, proportionally to obvious personal loyalty to President Ramsey and to the detriment of University credibility.

In its typical effort to deflect the widespread criticism, the University hired an outside consultant to prepare a comparison, or more correctly a justification for the Board of Trustees of how President Ramsey’s compensation compares to that of presidents of other selected universities.  However, at the very session at which the consultant presented its report to a formal meeting of the Trustees, it was revealed that the necessary supporting information given to the consultant by the University was incomplete and grossly understated Ramsey’s compensation!  [Incomplete disclosure? Has that ever happened before?] Additionally and following subsequent full disclosure, the consultant expressed concern about some elements of Ramsey’s compensation that were atypical at other universities.  Despite this revelatory debacle, a majority of the full Board voted to give Ramsey a (reduced) raise and a bonus! It is apparent to me that UofL Board members, both old and new, have no idea how much money Ramsey has been getting nor how he came to receive it!  Shame on them! Ramsey recently forcefully complained that his credibility was being challenged by those asking for accurate information.  It is clear that somebody’s credibility is in tatters.  It is now the responsibility of President Ramsey to tell us whose. Continue reading “Executive Compensation at UofL— A Tipping Point?”

Potpourri of Health Policy Issues in June.

My cup runneth over with potential issues to explore.

June has been a busy month both locally and nationally insofar as things I like to write about. The shame-on-me is that I have not carved out enough time to do so!  In part I am still picking up the pieces after my early spring travels. Exploring how to unpack and deal with the new Medicare prescription drug data base also took a lot of time.  The truth is that I am a slow writer handicapped by a default and probably over-wordy professorial style.  I haven’t even been able to update the Institute’s Facebook and Twitter pages!  What follows is a list of things that occured during the month that I wanted to write about and hope to do so in more detail later.  These are not necessarily in chronological order or of importance.

The Supremes Rock & Rule!
We were presented with two back-to-back major decisions by the U.S. Supreme Court. The first, King v. Burwell, allows federal subsidies of health insurance premiums for low income individuals and their families to continue even if their insurance was purchased in states that chose to allow the federal government to operate their health insurance exchanges.  The lawsuit brought by Obama/Obamacare-haters to limit premium support to insured individuals in states like Kentucky that chose to operate their own exchanges would have essentially gutted the Affordable Care Act (ACA) and tossed millions back into the uninsured category. For the time being, Obamacare stands intact for at least the next year and a half, despite promises by opponents to throw up additional challenges. All our legislators should be working together to deal with a major remaining deficiency of the ACA.  The Act has been very successful in decreasing the number of uninsured people, but it makes little headway against the exploding costs of unnecessary, marginally effective, or for that matter even necessary medical care.  Continuing to forbid the federal government to negotiate over the prices of drugs is a case in point. Subsidies were deemed necessary for a reason! Continue reading “Potpourri of Health Policy Issues in June.”

Narcotic Analgesic Drug Use By Medicare Patients: Continued

What drugs and by which specialties?
When I first looked at the recent release of outpatient prescription drug utilization by Medicare patients, I was immediately struck by how many narcotics were being prescribed by physicians and other medical providers for so many patients. The vast majority of providers prescribed a handful of different and mostly inexpensive opioid drug products to a relatively few patients, On the other hand, a smaller number of providers wrote for many different opioid formulations, some fantastically expensive, for large numbers of patients.  Is good medicine being practiced?  Is it possible to tell? Should we even care?  Of course we should. In this analysis I break down further the utilization of a subset of the most common opioid analgesics, show which medical specialties prescribe the most, and begin to highlight the vast discrepancy in narcotic use among individual providers. From the full CMS database, I extract and make available an Excel file enumerating  prescriptions of selected narcotic analgesics by Kentucky medical providers . Continue reading “Narcotic Analgesic Drug Use By Medicare Patients: Continued”