Texas’ DWC misses the mark

Texas will be publishing ‘report cards’ for physicians treating workers comp patients, but won’t include opioid prescribing patterns as a criterion. That’s unfortunate – at best.
According to a piece by Bill Kidd in WorkCompCentral, the DWC – not the group tasked with developing criteria – made the decision to exclude opioid prescribing patterns, which will include data on timeliness and completeness of filing paperwork (really…), release to return to work, and use of MRIs for low back claims. This despite the ‘bi-partisan’ backing of the metric by theTexas Medical Association and the Insurance Council of Texas. (I really don’t like the term ‘report cards’ as it is viewed by many providers as pejorative and somewhat insulting, thus the information can, and often is, given short shrift by providers who hate the term.)
The good news is DWC will consider adding opioid prescribing patterns in 2015 and has already decided to include the criterion in the “medical quality review audit plan’. [opens pdf] However, the group working on the report cards had been actively discussing including assessing opioid prescribing two months after the date of injury and surgery; that discussion is now moot. Including opioids in the report cards would have sent a clear message to providers, one that is long overdue and critically important.
This is unfortunate. WCRI data indicates the Lone Star State is well above the median in almost all opioid utilization categories: volume of narcotics prescribed; number of narcotic scripts per claim; number of pills per script;percentage of claimants prescribed narcotics. Despite the lower potency of narcotics prescribed in Texas, the greater volume of claimants prescribed these drugs, longer duration of care, higher volume of scripts and pills per scripts combined to give Texas claimants more morphine equivalents than the median WCRI state.
Hydrocodone usage alone in Texas has gone up 350% over the last ten years while the death count from other opioids increased over 400%.
Inclusion of the metric would certainly help payers and claimants avoid the worst of the worst; for example, an Oklahoma physician was just indicted for the deaths of five patients after they died of prescription drug overdoses.
There’s very little credible evidence that long term (more than six months) opioid use is appropriate treatment for work comp injuries. These are drugs primarily developed – and approved by the FDA for – treating end-stage cancer pain. Not much cancer in work comp.
There’s ample evidence that long term opioid use leads to longer claim duration, long term disability, higher costs and much more medical expense. And that’s on top of the damage it does to relationships, families, and society.
What does this mean for you?
By not adding opioid prescribing patterns to the assessment of physicians, DWC is missing a chance to shine more light on what may well be the biggest problem in workers comp today.