Presentation Transcript

1. KASPER Update - 2014 David R. Hopkins KASPER Program Manager Office of Inspector General Kentucky Cabinet for Health and Family Services Kentucky Coalition of Nurse Practitioners/Nurse Midwives April 15, 2014
2. Disclosure David R. Hopkins No relevant financial relationships. No conflicts of interest. Cabinet for Health and Family Services
3. Contents Controlled Substance Abuse and Pill Mills KASPER Program Update Legislative Changes Affecting APRN Use of KASPER HB1 Preliminary Results and Evaluation Cabinet for Health and Family Services

4. Controlled Substance Abuseand Pill Mills

5. Misuse, Abuse, Diversion Misuse: When a schedule II – V substance is taken by an individual for a non-medical reason. Abuse: When an individual repeatedly takes a schedule II – V substance for a non-medical reason. Diversion: When a schedule II – V substance is acquired and/or taken by an individual for whom the medication was not prescribed. Cabinet for Health and Family Services
6. Most Common Drug Treatment Admissions by State Laura Dimon, MIC Network, Inc., February 10, 2014. Image credit: Fiona Breslin. Cabinet for Health and Family Services
7. Prescription Drug Abuse in Kentucky 4.5% of Kentuckians (ages 12+) used prescription pain relievers for nonmedical reasons in past year. (KY ranks 31st in the nation) National average = 4.6% Kentucky down from 6.6% (tied for 2nd) in 2009 Source: Data from the 2007through 2011 National Surveys on Drug Use and Health, published by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Statistics and Quality. Cabinet for Health and Family Services
8. Drug Overdose Deaths in Kentucky Cabinet for Health and Family Services
9. Drug Overdose Death Rates in Kentucky Cabinet for Health and Family Services
10. Kitson Clothing Collection Story: WXIX Fox 19 Digital Media Staff, June 21, 2013 Cabinet for Health and Family Services
11. Philip Seymour Hoffman US Weekly Celebrity News, February 3, 2014 Cabinet for Health and Family Services
12. Jeff and Chris George Photos from Palm Beach Post Cabinet for Health and Family Services
13. Dr. Paul H. Volkman Story: Bill Estep, Lexington Herald-Leader, February 14, 2012. AP Photo released by U.S. Marshals Service (undated) Cabinet for Health and Family Services
14. Care More Pain Management Clinic Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012 Cabinet for Health and Family Services
15. Care More Pain Management Clinic Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012 Cabinet for Health and Family Services
16. Care More Pain Management Clinic Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012 Cabinet for Health and Family Services
17. Ernest William Singleton Photo: Lexington Community Corrections, January 2013 Cabinet for Health and Family Services

18. KASPER Program Update

19. KASPER KASPER is Kentucky’s Prescription Monitoring Program (PMP). KASPER tracks Schedule II – V controlled substance prescriptions dispensed within the state as reported by pharmacies and other dispensers. Enhanced KASPER (eKASPER) is the real-time web accessed database that provides a tool to help address the misuse, abuse and diversion of controlled pharmaceutical substances. Cabinet for Health and Family Services
20. Status of Prescription Drug Monitoring Programs (PDMPs) VT ME WA NHMARICTNJDEMD DC MT ND MN NY OR WI SD ID MI WY PA IA NE OH IL IN NV WV UT VA CO KS KY CA MO NC TN OK SC AZ NM AR GA AL MS TX LA AK FL Operational PDMPs Enacted PDMP legislation, but program not yet operational Legislation pending HI GU Research is current as of February 1, 2012
21. 2011 KASPER Reports Requested Cabinet for Health and Family Services
22. Annual KASPER Records Total / Per Person 2.39 2.43 2.65 2.65 2.72 2.72 2.47 Number of Controlled Substance Prescriptions per Person Cabinet for Health and Family Services
23. KASPER Reports Requested Cabinet for Health and Family Services
24. Top Prescribed Controlled Substances byTherapeutic Category by Doses - 2013 Lorazepam 4.0% Ativan Zolpidem 3.4% Ambien Amphetamine 3.2% Adderall Phentermine 2.9% Adipex-P Hydrocodone 41.8%Lortab Lorcet Vicodin Diazepam 4.3% Valium Clonazepam 6.8% Klonopin Tramadol 6.8% Ultram Alprazolam 11.3% Xanax Oxycodone 15.5%OxyContin Percodan Percocet Cabinet for Health and Family Services
25. KASPER Stakeholders Licensing Boards – to investigate potential inappropriate prescribing by a licensee. Practitionersand Pharmacists – to review a current patient’s controlled substance prescription history for medical or pharmaceutical treatment. Law Enforcement Officers, OIG employees, Commonwealth’s attorneys, county attorneys - to review an individual’s controlled substance prescription history as part of a bona fide drug investigation or drug prosecution. Medicaid – to screen members for potential abuse of pharmacy benefits and to determine “lock-in”; to screen providers for adherence to prescribing guidelines for Medicaid patients. A judge or probation or parole officer – to help ensure adherence to drug diversion or probation program guidelines. Medical Examiners engaged in a death investigation Cabinet for Health and Family Services
26. Goals of KASPER KASPER was designed as a tool to help address prescription drug abuse and diversion by providing: A source of information for health care professionals An investigative tool for law enforcement and regulatory agencies KASPER was not designed to: Prevent people from obtaining prescription drugs Cabinet for Health and Family Services

27. Legislative Changes AffectingAPRN Use of eKASPER

28. eKASPER Reporting KRS 218A.202 Controlled substance administration or dispensing must be reported within one day effective July 1, 2013 Cabinet for Health and Family Services
29. eKASPER Accounts – KRS 218A.202 eKASPER registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans. Cabinet for Health and Family Services
30. KASPER Master Accounts *Includes physicians, dentists, optometrists and podiatrists Cabinet for Health and Family Services
31. eKASPER Prescriber Usage - KRS 218A.172 eKASPER must be queried: Prior to initial prescribing or dispensing of a Schedule II controlled substance, or a Schedule III controlled substance containing hydrocodone No less than every three months Before issuing a new prescription or refills for a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone Cabinet for Health and Family Services
32. Kentucky Board of Nursing Regulations The Kentucky Board of Nursing has established additional KASPER query and prescribing standards that apply to an APRN with a CAPA-CS when prescribing a controlled substance Please review: 201 KAR 20:057 Cabinet for Health and Family Services
33. eKASPER Report Request Cabinet for Health and Family Services
34. What if I cannot “Query” KASPER? If eKASPER indicates “manual process” Record the eKASPER report request number in the patient’s chart If the eKASPER system is unavailable or Internet access unavailable Document circumstances why eKASPER could not be queried If eKASPER outage, record the date and time, and eKASPER system outage logs will confirm lack of system availability Cabinet for Health and Family Services
35. eKASPER Delegate Accounts eKASPER delegate accounts allowed for: An employee of the practitioner’s or pharmacist’s practice acting under the specific direction of the practitioner or pharmacist Cabinet for Health and Family Services
36. eKASPER Delegate Account Request Cabinet for Health and Family Services
37. eKASPER Prescriber Reports CS prescribers can obtain an eKASPER report on themselves: To review and assess the individual prescribing patterns To determine the accuracy and completeness of information contained in eKASPER To identify fraudulent prescriptions Cabinet for Health and Family Services
38. eKASPER Prescriber Report Cabinet for Health and Family Services
39. eKASPER Patient Reports eKASPER reports can be shared with the patient or person authorized to act on the patient’s behalf eKASPER reports can be placed in the patient’s medical record, with the report then being deemed a medical record subject to disclosure on the same terms and conditions as an ordinary medical record Cabinet for Health and Family Services
40. eKASPER Error Correction Patient or provider should contact the dispenser to correct records in error Inaccurate KASPER reports due to system errors should be reported to the Drug Enforcement and Professional Practices Branch 502-564-7985 Cabinet for Health and Family Services

41. House Bill 1 Preliminary Resultsand Evaluation

42. Controlled Substance Dispensing – One Year Comparison Figures shown in doses dispensed Cabinet for Health and Family Services
43. Hydrocodone Cabinet for Health and Family Services
44. Oxycodone Cabinet for Health and Family Services
45. Alprazolam Cabinet for Health and Family Services
46. Methadone Cabinet for Health and Family Services
47. Oxymorphone Cabinet for Health and Family Services
48. Tramadol Cabinet for Health and Family Services
49. Buprenorphine Cabinet for Health and Family Services
50. Controlled Substance Prescribing 2013 Cabinet for Health and Family Services
51. Controlled Substance Usage 2013 Cabinet for Health and Family Services
52. House Bill 1 Impact Study Comprehensive assessment of HB1’s impact on patients, prescribers, and other stakeholders Overall goals: Evaluate the impact of HB1 on reducing prescription drug abuse and diversion in Kentucky Identify unintended consequences associated with implementation of HB1 that impact patients, providers and citizens of the Commonwealth Develop recommendations to improve effectiveness of HB1 and mitigate identified unintended consequences Final study report planned for July 2014 Cabinet for Health and Family Services
53. Additional KASPER Projects Improve KASPER data quality and patient identifiers (ongoing) Reduce manual reports Reduce “blended” reports Technology platform upgrade (April 2014) Improve system availability and response time Prescriber compliance reporting (June 2014) Expand interstate data sharing to all border states (except MO) (December 2014) Integrate KASPER with the Kentucky Health Information Exchange and EHR systems 2014-2015 Cabinet for Health and Family Services
54. QUESTIONS? David Hopkins 502-564-2815 ext. 3333 Dave.Hopkins@ky.gov