Doctors Have Trouble Keeping Up With Painkiller Abusers

Sue Ogrocki/AP

A pharmacy technician counts generic Vicodin tablets at Oklahoma Hospital Discount Pharmacy in Edmond, Okla.

The growing awareness about the abuse of prescription painkillers hasn't kept the problem from skyrocketing. In 2008, 14,800 people died of an overdose, according to the Centers for Disease Control and Prevention, more than overdose deaths from cocaine and heroin combined.

Prescription drug monitoring programs that allow doctors to track who's prescribing and dispensing powerful painkillers, such as OxyContin and Vicodin, can help curb patients' so-called doctor shopping. That's when people go to lots of doctors to load up on painkiller prescriptions.

But the databases for checking up on patients only work if health care providers use them, and often that's not happening. Some insurers are taking matters into their own hands, including a big one in Massachusetts that will soon make doctors justify prescriptions for pain pills that exceed a 30-day supply.

More than 40 states have systems in place to monitor prescription drugs, according to the National Alliance for Model State Drug Laws. Typically, dispensing data from pharmacies is uploaded into a centralized database that physicians and other health care providers can query.

 

But the programs are voluntary, and many clinicians remain unaware of them, according to a recent article published in the New England Journal of Medicine.

There are other difficulties. The data may only be updated once a month. And the systems are often cumbersome to use, a sticking point for busy clinicians.

Utah anesthesiologist Perry Fine, a past president of the American Academy of Pain Medicine, says that it's in patients' best interest that their doctors know which drugs they're taking to ensure proper treatment.

The database in Utah is pretty easy to use, he says. But in many states, that's not the case. "Because they're not very functional or accessible or complete, overall utilization hasn't been very great," he says. As the state systems evolve, that may change, but for now, "They're not mainstream."

And the drug-monitoring systems in some states, such as California, have suffered from cuts in funding.

Still, there's traction in other states. New York Gov. Andrew Cuomo is expected to sign legislation that would require doctors in the state to prescribe drugs using computers rather than paper, the Associated Press reported. Pharmacists would be required to promptly enter information about painkiller prescriptions into a statewide database, too.

Bloodhound Technology's ConVergence Point refines the payment process

DURHAM, NC – Imagine a medical bill that can be accurately rendered before the patient leaves the doctor's office.

Bloodhound Technologies is working toward that ideal with ConVergence Point, its newly released claims editing platform that aims to process single or multiple claims against a patient's history, complete payer policy customizations and millions of sourced clinical edits in less than a second.

"This allows us to take a process that used to be in the claims transaction system ... and move it up to the front," said Gary Twigg, CEO and president of the Durham, N.C.-based claims editing services and analytics provider. "It's more robust, more sophisticated."

"The technology now exists to have a completely adjudicated claim even before the patient leaves the office," he added. "That's in the future. We'll be there someday."

Developed with $14 million in financing, ConVergence Point draws upon a patient's complete medical history, payer rules and reimbursement policies and Bloodhound's 16 million sourced clinical edits to process claims in 350 milliseconds. The company also offers a pre-adjudication editing platform, allowing providers to identify operational efficiencies as well as identify overpayments and correct miscoded claims before submission. 

Among the beta-testers for ConVergence Point was Senior Whole Health, a voluntary healthcare plan for low-income seniors in Massachusetts and New York.

"From the get-go, Bloodhound Technologies was able to take our data and immediately respond with a comprehensive analysis," said Mike Levoshko, the group's CTO, in a press release prepared by Bloodhound.  "What's more, ConVergence Point is a three-dimensional system that lets you turn its edit rules on and off at any point. The fact that ConVergence Point can control and archive these rules dynamically is worth its weight in gold."

Twigg says ConVergence Point should not only help providers and their patients establish a proper medical bill in real time, but improve communications between providers and payers.

"Real time adjudication processes are important to support the emerging consumerism market, providing clear payment liability information to both providers and consumers," said Janice Young, program manager for payer research with Health Industry Insights. "Solutions that improve the consistency, transparency and timeliness of claims processing deliver a new level of accuracy that will lead to improved relationships among payers, providers and consumers."