Thursday, October 4, 2012

WCRI Report on Opioids: Only Part of the Story

WCRI published a very revealing report this week on long term opioid use and adherence to medical treatment guidelines.  The findings were disheartening, though not terribly surprising. 

The 21-state median percentage of long term opioid users receiving psychological evaluations was 7%.  For psychological treatment the number was 4% (vs. 6% is the prior period studied two years before).  Claims with indications of urine drug testing stood at 24%.  This means that more than 9 out of 10 long term opioid users aren't receiving any kind of psychological screening or treatment.  Only 1 in 4 is being tested to ensure the drugs are being taken properly. 

What's potentially more interesting is what WCRI didn't measure (or perhaps more appropriately, couldn't measure).  The component of the "medical treatment guidelines" for which WCRI was able to collect and analyze data was limited to urine drug monitoring, psychological evaluation, psychological treatment, and physical medicine.  These components of the the medical treatment guidelines all have one thing in common: each can be associated with one or more CPT codes, making data collection and analysis feasible. 

But what about other components of the medical treatment guidelines that doctors should consider in light of chronic opioid therapy?  I'm thinking mainly about functionality.  You can't measure that via a CPT code, but all too often long term opioid use leads to decreased functionality, not improved functionality. 

The WCRI study, along with this basic issue of functionality, begs a broad and important question:

If, theoretically, medical treatment guidelines were properly considered and adhered to for 100% of claims where opioids might have been prescribed... what percentage of opioid spend would disappear from work comp?  What's your best guess?

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