Thursday, April 12, 2012

Texas: An Opportunity Revived?

In a post two weeks ago (TX: A Missed Opportunity), I wrote about what appeared to be an unfortunate decision on the part of the Division of Workers' Compensation in Texas to not include a performance-based measure for opioid prescribing on its 2013 provider report card.  This morning's workcompcentral brings news that DWC Commissioner Ron Bordelon has said, "Nothing is final until I sign off on it."  He is apparently willing to consider inclusion of a new measure for opioid prescribing (specifically, the level of narcotics prescribed either two months post-injury or two months post-surgery... definitely not the entire picture, but a start). 

Mr. Bordelon also rightly pointed out that the new closed formulary rules are a solid sign that Texas is doing something about the opioid epidemic in work comp.  Initial signs point to the potential success of the new rules.  PRIUM's analysis showed a nearly two-thirds drop in prescriptions for drugs labeled "N" by the Official Disability Guidelines.  PMSI just released their own analysis which appears to show about a 50% drop in "N" drug prescriptions as proportion of total prescriptions (Q4 2010 vs. Q4 2011).  Interestingly, for the entire fourth quarter of 2011, PMSI saw a total of 142 prescriptions for "N" drugs, 141 of which were blocked at the point of sale.  Only 1 script had a valid pre-authorization associated with it.

As he considers the opportunity, though, to include opioid prescribing behavior on the 2013 provider report card, I offer two management maxims that I personally live by:
1) You cannot manage what you do not measure.
2) Performance measured is performance improved.

I'll add my voice to the chorus of those calling for inclusion of the new measure. 

On Twitter @PRIUM1

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