Tackling the Opioid Measure Intelligently

Like just about every health care system in America, Southwestern Vermont Healthcare has witnessed firsthand the effects of our nation’s opioid crisis—and they have decided to use every tool in their power to make a difference.

“When CMS announced the opioid measure, I realized that participating in the voluntary reporting could be another way for us to make sure that we are doing the best that we can as a healthcare system to address the disease,” says Marie Johnson, the quality systems and analytics manager for Southwestern Vermont. “It could provide insight on improvements that may be beneficial for our inpatient population, to complement all the work our ED has already done to address this crisis.”

Put Your Data Under a Magnifying Glass

So, Marie did what all quality people do. She dug into the data and started building something meaningful.

“After I finished setting up the opioid measure in Medisolv and our data from the prior year became available, I decided to review all of the cases,” she explains. “I exported all the numerator cases to Excel to create a list for review. Then I used data from our EHR to add more fields to that list, specifically the patient’s primary diagnosis, the discharge disposition, which drugs hit, and what action was taken on those prescriptions.”

Interview Your Providers & Pharmacy Staff

Marie then took her findings straight to the source: the providers and pharmacy personnel. Her goal was twofold: to understand their prescriber practices inside and out, and to make sure they understood the measure and their impact on it.

“The most important part of the process is listening to providers about their concerns because then you can find opportunities for improvement and education,” Marie says. “For example, I have learned that many providers do not feel it is appropriate for them to change a patient’s home medications, because those are drugs that were given by the patient’s PCP or specialists, and they do not want to change other providers’ regimens of care.”

A simple five-minute conversation with a pharmacy informatics staff member yielded equally valuable insights.

“They explained to me that the pharmacy had built a pop-up in the provider ordering screens for when a high-dose narcotic is prescribed,” she says. “So, when a high-dose narcotic is prescribed, the system will remind the provider to order naloxone as well.  This creates a numerator case in the measure appropriately, as these are safe prescribing practice recommendations put forth by CMS.”

Always Continue to Learn

Marie continues to follow this collaborative learning process as new cases hit and her Excel spreadsheet grows. Admittedly, it’s a lot of boots-on-the-ground work, but she believes the effort is worth it.

“I want to make sure that the numbers we are required to report are reflective of our care and not a result of us failing to dive into the process and educate ourselves ahead of time,” she explains. “And, of course, if we can use tools like this measure to understand our prescribing practices, then we will ultimately make our community stronger. That’s what it’s all about.”