Emergency Rooms: A New Focus on Eliminating Prescription Drug Abuse and Reducing Waste

Studies show that 71% of national emergency room visits are unnecessary or avoidable, equating to billions of dollars in unnecessary healthcare expense annually. Unfortunately, a large portion of these visits are not only non-urgent and avoidable, but are made with the sole purpose of obtaining prescription painkillers common to the Emergency Department (ED) such as Vicodin, Oxycodone, and Percocet. A recent study has confirmed a long-suspected theory that 77% of frequent ED users (defined here as those who visit the ED more than 10 times a year) have a substance addiction. The ED setting moves at a faster and more chaotic pace, which some have identified as a far easier place to procure prescription drugs as patients are much less likely to receive probing questions than they would from a primary care physician. The issues surrounding frequent ED users and prescription drug abusers have led both governmental bodies and private companies alike to focus on monitoring and eliminating the problem.

Last week, the Minneapolis Star Tribune shed light on these “frequent flyers”, as well as some of the recent efforts that the Minnesota government has taken in order to eliminate unnecessary ED usage. Their program, the Minnesota Restricted Recipient Program (MRRP), is targeting a list of roughly 4,500 individuals who have been flagged as high emergency room use patients, some recording over 150 visits to the ED in a given year. As part of the program, these individuals are restricted to a single primary care provider, hospital, and pharmacy for a period of 24-36 months in order to create accountability and transparency into the care that these individuals require and are receiving. According to state data, the program has helped reduce ED visits and prescription drug fills across the target list by 50% and 40%, respectively, saving taxpayers a reported $7 million a year on these individuals alone.

Minnesota isn’t the only state Medicaid program that has taken notice of the issue. Forty-nine states now have a program that allows doctors to look up the prescription history of patients that they find suspicious. In addition, hospitals in some states, including New Mexico, Texas, and Wyoming, have adopted advanced tracking systems tailored towards the emergency room as well.

As is the case with most problems in healthcare, the solution to this system abuse could be new technology that can help to identify inappropriate trips to the ED through more efficient data sharing and collaboration across facilities.  One company that has developed a solution is Utah-based Collective Medical Technologies, which offers a product that links large networks of interconnected EDs on a state / regional level in order to identify and target opioid abuse. Their product assists in closing the provider information and communication gaps within the high-paced ED environment, a difficult task given the high levels of interoperability and EHR system expertise required to do so effectively.

Other companies are utilizing data analytics to directly address the issue of opioid abuse. RxAssurance offers a product called OpiSafe that performs risk stratification for each patient on the basis of morphine equivalent dosing ranges, pain and function scores, opioid misuse risk scores, and automated Prescription Drug Monitoring Program (PDMP) checks. PDMPs are state programs that collect, monitor, and analyze electronically transmitted prescribing and dispensing data in support of education, research, and abuse prevention.

There are significant cost and behavioral complexities surrounding the waste and abuse caused by ED frequent flyers looking to take advantage of the system. TripleTree suspects that given the recent influx of government programs established to combat the issue, companies that focus on technology for prescription drug management and ED coordination will continue to receive attention and thrive well into 2017 and beyond as payers and providers continue to battle these issues. We will continue to monitor these developments and their impact on the healthcare system in the coming months and beyond. Until then, let us know what you think.