Providers are urging the CMS to drop a proposal aimed at combating prescription drug abuse. They say mandating a review of state-run drug prescription databases could lead to inaccurate information and would be an administrative burden for them. They also say frequent prescription changes might reveal a lack of coordination among providers, not drug abuse.
As part of a proposed rule on changes to discharge plans, the CMS suggested mandating that providers consult a patient's history on their respective state's prescription-drug monitoring program (PDMP). The goal is to identify a patient's risk of nonmedical use of controlled substances by tracking substance-use disorders.
PDMPs are state-run electronic databases used to track controlled prescription drugs that are prescribed and dispensed to patients.
The rule received 299 comments by the Jan. 4 deadline. The idea was heavily panned.
“PDMP information is often incomplete, out of date and hard to access,” the Federation of American Hospitals, which represents investor-owned and -managed community hospitals throughout the U.S, said in a comment letter reacting to the proposal.
The FAH said that the information on PDMPs is of “questionable benefit.”
The CMS believes PDMPs can help reduce the prescription-drug abuse epidemic and improve patient care if it's part of a discharge plan. The CMS says the oversight could also help prevent doctor shopping, the practice of visiting multiple doctors to obtain otherwise illegal drugs.
The American Medical Association said the database's information doesn't tell the patient's whole history.
The AMA notes that a patient who receives multiple prescriptions for controlled substances from multiple pharmacies may reveal uncoordinated care, a patient who needs counseling or a referral for treatment, or a patient who has legitimately been issued those prescriptions.
“We urge caution when looking at a data point rather than trying to understand the full scope of a patient's experience,” the AMA said.
Many comments reference the logistics of the possible requirement, noting that only some pharmacists and certain physicians can access the databases. Hospitals, on the other hand, can't access the database at all.
Another issue is patient residency.
“Establishing a database or connection with local and international pharmacies as well as across state lines would be required,” The University of Michigan Health System said in a comment letter. “Such a program will require substantial financial investment.”
If the CMS finalizes the rule, it should allow providers to independently determine which patients' use needs to be reviewed.
“Requiring their use for all patients would overwhelm current systems and make it impossible for them to focus on the true at-risk groups they are intended to serve,” the National Association of Psychiatric Health Systems said.
Johns Hopkins Medicine agreed, adding that the required use of the PDMP for all patients will slow down the discharge process unnecessarily without adding value for patient care.
Under the proposed rule, first announced in a November overhaul of the discharge process for hospitals, rehabilitation facilities and home health agencies, providers would be required to develop a discharge plan within 24 hours of a patient's admission or registration. They would have to complete that plan before the patient is discharged.
The change would apply to all inpatients and some outpatients, including patients under observation; patients who are undergoing surgery or other same-day procedures where anesthesia or moderate sedation is used; and emergency department patients who have been identified by a practitioner as needing a discharge plan.
A date for the final rule is not known.
