Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large, 

Robert A. Dowling, MD

Eligible clinicians are halfway through the fifth performance year of the Quality Payment Program (QPP), which is the major determinant of any fee schedule adjustments for professional services paid by Medicare Part B. The same legislation that created the QPP Medicare Access and CHIP Reauthorization Act (MACRA) extended the authority of the Centers for Medicare & Medicaid Services (CMS) to publicly report performance information on doctors and clinicians on the Physician Compare website.

 The website is tailored to Medicare beneficiaries looking to compare individual providers in their area, but the entire dataset is available for public consumption.

 CMS recently published data based on the 2019 performance year—the most recent year available. In this article, I will examine urologists’ QPP Merit-based Incentive Payment System (MIPS) performance in 2019 relative to other eligible clinicians, how that information is displayed to patients on Physician Compare, and what this might mean for the future.

First, a brief refresher on the MIPS 2019 performance year. The final MIPS composite score was determined by performance in the following categories (weights): Quality (45%), Promoting Interoperability (25%), Improvement Activities (15%), and Cost (15%). Clinicians needed a final score of 30 or greater to avoid a negative fee schedule adjustment in 2021, and 75 or greater to qualify for exceptional performance. In response to the COVID-19 pandemic, CMS applied an automatic extreme and uncontrollable circumstances policy to all MIPS eligible clinicians for the 2019 performance year that resulted in a neutral adjustment for many clinicians. Before the impact of that policy, clinicians scoring below 30 would have incurred a negative fee schedule adjustment in 2021, and the “savings” from this would have been redistributed to those scoring above 30 via a positive fee schedule adjustment on a prorated basis. This redistribution scheme is among the entire pool of participating clinicians, but it is possible to examine performance by specialty by joining different CMS datasets. Finally, clinicians may report as individuals, as a group, or both. When possible, CMS will calculate the higher of the individual or group score. How did urologists do overall, and how did our specialty perform in 2019 compared with other specialties?

There were 719,244 individual clinicians in 85 specialties with a final MIPS score reported by CMS in 2019. The mean and median final MIPS composite score for the entire pool of clinicians were 85.6 and 92.3, respectively. The data include 6672 individual clinicians identified as urologists, with a mean final score of 85.2, and a median score of 91.4. Additionally, 5651 urologists (84.6%) achieved a score of 75 or greater and qualified for the exceptional pool vs 85.3% of all clinicians. At the other end of the performance spectrum, only 0.38% of all clinicians scored below 30, including 95 clinicians with a score of 0; only 5 (0.07%) urologists had scores below 30—none with a score of 0. The performance metrics of some high-volume specialties are included in 

CMS also publishes measure-level data in each of the categories. The data are reported separately for clinicians reporting individually vs as a group and contains information about which category measures—when there are several to choose from—are being reported. Remember that a urologist may report as part of a group whether they are in a single specialty, multispecialty, or even advanced payment model practice; most urologists reported as part of a group in 2019. In the Quality category, most groups reported EHR measures, followed by registry measures and claims-based measures in 2019. In general, urologists participating in group reporting used the same generic measures as most other clinicians, but with a few exceptions, scored worse on average. This is unsurprising. First, there were only a few urology-specific measures available in 2019. Second, some urologists were/are in multispecialty groups dominated by specialties that report on primary care measures. Third, the common EHRs used in 2019 by urologists were not configured to easily calculate and/or report on urology-specific measures or certified for those measures. Urologists forced to report on primary care measures can be forgiven for not performing as well as primary care colleagues.

In the Promoting Interoperability category, urologists outperformed their peers on e-prescribing and Provide Patients Electronic Access to Their Health Information, and underperformed relative to peers on Supporting Electronic Referral Loops. In 2019, electronic referrals may have still been uncommon among urologists and/or not fully supported by their EHR. Like most clinicians, urologists performed almost perfectly on Improvement Activity measures. CMS did not publish measure-level data in the Cost category for the 2019 performance year.

How is this performance information displayed to patients? I encourage you to go to Physician Compare and see for yourself. Search results for physicians return a page with information about EHR activities—patient view of Promoting Interoperability measures, security risk analysis, and registry reporting—and Improvement Activities. In the Quality section of the page, there are actual performance metrics for each of the Quality category measures and Promoting Interoperability measures. The measures are described in lay terms, such as “giving patients with diabetes a kidney exam” (Diabetes: Medical Attention for Nephropathy) with an explanation of the rationale: “Diabetes can cause complications, like kidney disease. Screening the kidneys of patients with diabetes can help patients receive timely treatment. To give this clinician a star rating, Medicare looked at the percentage of this clinician’s patients with diabetes who had a kidney exam or received treatment for kidney disease.” The performance is displayed as a “star rating,” which is a value from 1 to 5 that is mapped to the actual performance score for that particular measure.

What does this mean for you and your practice? First, almost all clinicians in the 2019 performance year would have avoided a negative adjustment in 2021 because of a low bar, which means few dollars/small positive fee schedule adjustments for those who scored well. Indeed, most clinicians qualified for exceptional performance, which is a temporary benefit under MIPS that is scheduled to expire at the end of the 2022 performance year. However, the threshold to avoid a negative adjustment is rising each year and is currently proposed to be 75 points for 2022. In 2019, about 15% of eligible clinicians scored less than 75, thus bigger fee schedule adjustments may be seen in future years. Second, these individual measure data provide a benchmark in the specialty for urologists to compare with other urologists. This may be helpful if urology-specific measures become more commonly used and data are provided more rapidly. For example, in 2019, a performance rate of 95 on the measure Prostate Cancer: Combination Androgen Deprivation Therapy for High Risk or Very High-Risk Prostate Cancer was significantly above average for all clinicians, but significantly below the mean score for urologists.

Finally, as the QPP matures, there is more information available to patients who are increasingly using tools, like Physician Compare, to evaluate their choices. When urologists start using specialty-specific measures, this information will be published and could directly influence patient choices. The trend is sure to continue as we march slowly—but relentlessly—to “value-based care.” Urologists should view their own data on Physician Compare to understand the full arc of MIPS data, its current limitations, and how their patients may interpret this information. 

1. Physician Compare. Centers for Medicare & Medicaid Services. Accessed August 18, 2021. https://bit.ly/3meEZn9

2. Centers for Medicare & Medicaid Services. CMS Datasets: Doctors and Clinicians. Accessed August 18, 2021. https://bit.ly/3CZ9vqY

Articles

Urologists outscore peers in e-prescribing, providing access to health information.

How does urology’s 2019 MIPS performance stack up?

Payments from industry—pharmaceutical manufacturers and device companies—to physicians continue to be examined by the federal government, policy makers, and watchdog agencies. Speaker programs appear to be under special scrutiny.

 In July 2020, 1 company agreed to pay $678 million to settle charges of paying more than $100 million to physicians for alleged sham speaker programs.

 In November 2020, the Office of Inspector General (OIG) for the US Department of Health and Human Services issued a Special Fraud Alert regarding industry-sponsored speaker programs.

 That alert reads, in part: “OIG has significant concerns about companies offering or paying remuneration (and HCPs [health care providers] soliciting or receiving remuneration) in connection with speaker programs. Based on our investigations and enforcement actions, this remuneration is often offered or paid to induce (or solicited or received in return for) ordering or prescribing items paid for by Federal health care programs. If the requisite intent is present, both the company and the HCPs may be subject to criminal, civil, and administrative enforcement actions.”

In April 2021, a paper linking Open Payments data to Medicare Part B payment data demonstrated that payments from medical device companies generally exceed that of drug companies and appear to be targeted at surgical specialists who are high billers in the Medicare Part B program.

 The Physician Payments Sunshine Act (Section 6002 of the Affordable Care Act) requires that manufacturers of “covered drugs, devices, biologicals, and medical supplies” report payments and other transfers of value to physicians to the Centers for Medicare and Medicaid Services (CMS), which in turn publishes this information. It also requires that manufacturers and group purchasing organizations (GPOs) report physician (or their family) ownership and investment interests. These requirements stem from a concern that payments to individuals could influence or incentivize behavior and a belief that public reporting might deter inappropriate behaviors or relationships. More than 1 study has shown an association between payments and physician behavior.

 On June 30, 2021, CMS released its annual update of Open Payments financial data (calendar year 2020).7 In this article, I will review some information and analysis about the payments to urologists reported under this surveillance program.

In 2020, $9.1 billion in payments or investment value was reported by 1621 unique companies to physicians, teaching hospitals, and other entities. The total amount of general payments to 487,000 individual physician recipients was $2 billion, down from $2.3 billion to 617,000 physicians in 2019. A total of 7922 urologists received a total of $22,861,359 (1.13%) of those general payments from 361 unique manufacturers; total general payments to urologists were down 40% from the previous year. The largest single payment to a urologist was $523,338.17, and the average payment to a urologist in 2020 was $211.17 (up 16%); average and total payments to urologists have been increasing an average of about 7% per year over the last 5 years. In 2020, 35 urologists each received more than $100,000 (average, $271,000 in this subgroup) and collectively represented 42% of all payments to urologists 

. The maximum number of payments to a single urologist in 2020 was 501 (almost all associated with a single medical device totaling over $500,000). As in past years, most of the 2020 payments to urologists came in the form of cash 

, and were compensation for consulting fees, services other than consulting, food and beverage, and royalty or license. Services other than consulting (this category includes speaker programs) dropped sharply in 2020 (about $10 million or 60%) from the previous year, possibly reflecting the impact of the COVID-19 pandemic on meetings and speaker programs.

CMS requires manufacturers and GPOs to associate a general payment with a drug, biologic, device, or medical supply where appropriate (many payments are uncategorized). General payments associated with devices comprised the largest category—$12,686,907.22 from 138 manufacturers to over 6000 urologists—over half of all general payments. Four products (UroLift, Cook medical extractors, da Vinci Surgical System, and Titan) accounted for over half of all payments. Payments associated with drugs and biologics totaled about $5.3 million, down 50% from the previous year; 4 prostate cancer drugs (enzalutamide [Xtandi], apalutamide [Erleada], darolutamide [Nubeqa], and sipuleucel-T [Provenge]) accounted for over half of 2020 total payments in this category.

The Open Payments program tracks payments associated with ownership interest in 2 ways. First, some of the general payments to physicians are categorized as “Current or prospective ownership or investment interest.” In 2020, $807,964 in ownership or investment interest was paid from 9 entities to 51 urologists. Most of these payments appear to come from limited liability companies. The largest single ownership payment to a urologist was $235,000 and was uncategorized.

The second way that payments related to physician ownership are reported is by the “value of interest,” defined as “the current cumulative value of ownership or investment interest held by the physician (or the physician’s immediate family members) in the Applicable Manufacturer or GPO as of the most recent feasible valuation date preceding the reporting date.” A total of $1.12 billion of value was reported in 2020 for all physicians, and $36 million (3%) of that was attributed to 445 urologists from 15 entities. Most of the dollars reported of this type are from a single entity totaling $30 million in value of interest (more than double the 2019 value for that entity) and distributed among 254 individual urologists; the value of interest for each urologist in that entity ranges from $3.5 million to $16,000 and was primarily held as common stock.

The final type of payments in the Open Payments program are payments associated with research, almost all of which are received by teaching hospitals, not individual physicians. Payments to physicians for 2020 total about $73 million, $467,000 (0.56%) of which went to 84 urologists from 20 manufacturers in an average amount of $1980. The maximum amount of research payments reported to a single urologist in 2020 was $122,423.

Bottom line: General payments from manufacturers to urologists in 2020 reported to and by CMS under the Sunshine Act are sharply down from the previous year, represent a small fraction of general payments to all physicians, and average $211 per urologist. Most of these payments are from device manufacturers, and payments are concentrated in just a handful of individual companies, drugs, devices, physician recipients, and disease states. Prostate cancer (drugs), benign prostatic hyperplasia (devices),and overactive bladder (drugs) continue to be associated with most of the collective payments in the specialty. The reported value of cumulative interest/stock of urologists rose sharply from about $21 million in 2019 to more than $36 million in 2020. Research payments to urologists in 2019 were negligible. The majority of urologists appear in the payment data, but payments are generally small. •

1. Adashi EY, Cohen IG. Industry-sponsored speaker programs—end of the line? 

. 2021;325(18):1835-1836. doi:10.1001/jama.2020.26580

2. Acting Manhattan U.S. Attorney announces $678 million settlement of fraud lawsuit against Novartis Pharmaceuticals for operating sham speaker programs through which it paid over $100 million to doctors to unlawfully induce them to prescribe Novartis drugs. News release. The United States Attorney’s Office, Southern District of New York. July 1, 2020. Accessed July 12, 2021. https://bit.ly/3wCD1hJ

3. Special fraud alert: speaker programs. Department of Health and Human Services Office of the Inspector General. November 16, 2020. Accessed July 12, 2021. https://bit.ly/3wBqfQJ

4. Bergman A, Grennan M, Swanson A. Medical device firm payments to physicians exceed what drug companies pay physicians, target surgical specialists. 

2021;40(4)603-612. doi:10.1377/hlthaff.2020.01785

5. Annapureddy AR, Henien S, Wang Y, et al. Association between industry payments to physicians and device selection in ICD implantation. 

2020;324(17):1755-1764. doi:10.1001/jama.2020.17436

6. Mitchell AP, Trivedi NU, Gennarelli RL, et al. Are financial payments from the pharmaceutical industry associated with physician prescribing? A systematic review.

 2021;174(3):353-361. doi:10.7326/M20-5665

7. What is open payments? Centers for Medicare & Medicaid Services. Updated June 30, 2021. Accessed July 12, 2021. https://go.cms.gov/2VKzcu9

All tables and figures are adapted from an analysis of open payments data downloaded from https://www.cms.gov/openpayments/explore-the-data/dataset-downloads by the author, Robert Dowling, MD.

Prostate cancer, BPH, and OAB products are linked with a majority of payments.

Industry payments to urologists see sharp decline in 2020

The United States spends more on health care than any other industrialized nation (almost 18% of gross domestic product [GDP]) and has the lowest rate of publicly insured citizens (36%), third highest rate of completely uninsured individuals (9%, slightly less than Mexico and Costa Rica), and lowest life expectancy (78.6 years). Much of our national political conversation has been dominated for decades by issues related to health care affordability and coverage. The Medicare Modernization Act (2003), Patient Protection and Affordable Care Act (2009), and Medicare Access and CHIP Reauthorization Act of 2015 are examples of laws that have their basis in reducing the cost and improving the value of health care in our country. Government regulations implementing these laws have had a direct effect on patients (eg, increased access for millions) and providers of care (eg, decreased reimbursement and increased complexity). Yet health care in the United States is expensive and getting more expensive by any measure. It is important for practicing physicians on the front lines of care delivery to have a passing knowledge of the cost of health care from a larger perspective than just reimbursement to their practice. The Centers for Medicare & Medicaid Services released their 2019 data on National Health Expenditures, along with the article “National Health Care Spending in 2019: Steady Growth for the Fourth Consecutive Year.”

 This article contains a summary of the key findings in a primer for the practicing urologist.

Spending on health care in the United States reached $3.8 trillion in 2019: $11,582 per person, or 17.7% (relatively unchanged over 4 years) of the US GDP. For context, health care expenditures in this country are usually compared with other economically developed peer countries. Although our delivery systems are significantly different, it is possible to compare costs and in some cases outcomes. The United States leads all 36 peer countries in health care spending as a percentage of GDP, about twice the average, according to the Organisation for Economic Co-operation and Development (OECD).

 US spending per capita is more than 2.5 times higher than the OECD average of $4000 US$. Growth in US spending was stable from last year at 4.6% yet almost twice the average rate of growth in OECD countries over the past 5 years of data available (2.4%). The OECD has robust data on quality and outcomes of care, access to care, health status, and more—the United States is below the OECD average in many of these domains. This forms the basis of arguments by policy makers in our country that the United States is not getting demonstrably better value for the dollars spent on health care compared with peer countries.

In a 2019 published review of the literature, the authors concluded that the cost of waste in the US health care system is between $760 billion and $935 billion, or about 25% of all spending.

 There were 6 categories of waste identified 

. In order of contribution to waste, they were as follows: administrative complexity (billing and coding waste, physician time spent reporting on quality measures), pricing failure, failure of care delivery (lack of preventive practices, hospital acquired events, clinician inefficiency [variability in care]), overtreatment or low-value care, fraud and abuse, and failure of care coordination. Nevertheless, the same authors concluded that targeted interventions in each of these domains would likely return only 25% of the waste, illustrating the complexity of our system and perhaps explaining why we don’t hear more about this beyond fraud and abuse.

To understand what is driving growth in spending in US health care, it is important to understand the major categories of spending as they have different growth rates. Hospital care (31%), physician services (20%), and retail prescription drugs (10%) are the major cost components and together make up 61% of national health expenditures 

. Growth in hospital spending in 2019 was the highest of any spending category, at 6.2%; prescription drug spending rose 5.7%; and spending on physician services rose 4.2%. In the past 10 years, overall annual growth has averaged 4.3%; hospital care growth, 4.5%; and prescription drug growth, 4.4% 

. Physician services have grown at the highest annual average rate in the past 10 years—4.8%.

The most important factor is not the effect of an aging population or increase in prices but the use and intensity of those services, according to the report. This finding is cited as evidence that our fee-for-service model is still driving significant growth in spending and fuels the relentless pressure to transition to “value-based care.”

Private health insurance remains the largest source of funds for paying health care bills. It accounted for 33% of spending in 2019 and grew 3.7% over 2018. Medicare is the second largest source, accounting for 22% of spending. Medicare spending had its highest growth rate in the past 10 years, at 6.7%. Finally, out-of-pocket costs accounted for 11% of spending in 2019 and grew 4.6% over the previous year—also the highest rate of growth in the past 10 years. The source of funds for physician services in 2019 is distributed differently from overall health spending (Figure 4): out of pocket was 8%, private health insurance was 42%, and Medicare was 32%. Again, Medicare spending had its highest growth rate in 10 years in this category at 9%.

Bottom line: So what does this mean for your patients, your practice, and you? First, health care insurance, delivery, and payment policies will probably continue to dominate the conversation because health care is expensive and touches almost everyone in the United States. Urologists should have a working knowledge of these costs and their relevance to their patient population.

Second, because growth in spending on physician services is significant and appears to be largely driven by increased utilization, policy makers will continue to scrutinize this category of spending and attempt to identify opportunities to slow that growth. This concern is punctuated by the near double-digit growth in Medicare spending on physician services in 2019 and supports the case to shift from fee-for-service to fee-for-value payment models like the Merit-based Incentive Payment System and Medicare Shared Savings Program. Urologists should have a detailed understanding of their payer mix and follow the national conversation about insurance and Medicare reform in proportion and to the extent that their livelihood and patient populations are linked to policy decisions.

Finally, behind almost every large category of health care expenditure is a physician order. According to some estimates, 80% of overall health care costs result from the patient-care decisions that physicians make, yet surveys of physicians have shown that only a third feel that they have a major responsibility to control costs.

 This inconsistency reflects the dual role of physicians and the potential conflict of treating individual patients while collectively shepherding health care resources. It is only by understanding the cost drivers of health care that physicians, including urologists, can responsibly fill this dual role.

1. Centers for Medicare & Medicaid Services. National Health Expenditures 2019 Highlights. Accessed April 12, 2021. https://www.cms.gov/files/document/highlights.pdf

2. Martin AB, Hartman M, Lassman D, Catlin A. National health care spending in 2019: steady growth for the fourth consecutive year. 

. 2021;40(1):14-24. doi:10.1377/hlthaff.2020.02022

3. Organisation for Economic Co-operation and Development (OECD) data. OECD iLibrary. Accessed April 12, 2021. https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance_19991312

4. Shrank WL, Rogstad TL, Parekh N. Waste in the US health care system.

. 2019;322(15):1501-1509. doi:10.1001/jama.2019.13978

5. Tilburt JC, Wynia MK, Sheeler RD, et al. Views of US physicians about controlling health care costs.

. 2013;310(4):380-388. doi:10.1001/jama.2013.8278

Physician services see 4.8% annual average growth rate in the past 10 years.

What can be learned from CMS data on health care spending?

Approximately 10.1 million Americans 12 years and older misused opioids in 2019.

 That same year, nearly 50,000 people in the United States died from opioid-involved overdoses.

 The CDC estimates that in 2019, more than 150 million opioid prescriptions were written at a rate of 46.7 prescriptions per 100 persons in this country.

 Although this number has declined from its peak 9 years ago, the opioid crisis remains a serious public health concern.

All but one state in the US (Missouri) have implemented prescription drug monitoring programs to help identify misuse by patients and reportedly improve outcomes and prevent deaths. In this article, I will focus on the urologist’s role as a responsible opioid prescriber in this crisis—and how you can determine whether your prescribing habits are in line with your peers.

The management of postoperative pain, the understanding of potential addiction, and the potential contribution by surgeons to long-term use of opioids has changed dramatically over the past 30 years. It has been estimated that 6% to 9% of urologic surgery patients show evidence of persistent opioid use 3 months after their surgery.

 In a study of 91,000 male patients in Canada undergoing minor urologic surgery (vasectomy, transurethral resection of the prostate, urethrotomy, hydrocelectomy, spermatocelectomy, and circumcision), Welk et al demonstrated that filling an opioid prescription was common (35%) and that although only 2% of those patients showed persistent use 9 to 15 months later, this represented a 43% increased odds of persistent use compared with patients who did not fill a prescription.

Contemporary standards for use of opioids acknowledge the very real risk of persistent use. The American Urological Association (AUA) has issued a position statement on opioid prescribing

 that states in part: “Given increased accessibility of addictive opioids, the [AUA] strongly believes urologists have a responsibility to minimize their patients’ pain and also address serious risks of overprescribing opioids.…When opioids are necessary, [prescribe] the lowest dose and lowest potency to adequately control pain from surgery and other conditions [and discontinue] as soon as possible. Nonnarcotic methods of managing pain, including anti-inflammatories, acetaminophen, and nonmedication approaches, should be used when appropriate and adequate.…The [FDA] recommends all providers counsel patients and/or their caregivers about the safe use of opioids, serious risks, [and] proper storage and disposal with every prescription.”

Many resources are widely available to efficiently accomplish this patient counseling.

 Urologists prescribe opioids most frequently for acute pain, including postoperative discomfort, and should have no issue with these best practices outlined by public health officials and our own specialty society.

Opioids for chronic pain are outside the scope of most urologists, and those who do manage chronic opioid use should familiarize themselves with guidelines and requirements in their local jurisdiction. For example, in Texas, a physician treating chronic pain must develop a written treatment plan, obtain informed consent, and use a written pain management agreement between the physician and the patient outlining patient responsibilities.

The Centers for Medicare & Medicaid Services (CMS) has released 2018 data on the opioid prescribing rates of providers in the Medicare Part D program. (You can view your individual data at 

https://data.cms.gov/d/j2ra-95gh/visualization

.) Keep in mind, however, that Part D prescribing and dispensing habits may not be generalizable to all patients in a urology practice.

In 2018, 1.2 million providers submitted more than 69 million opioid claims in the Medicare Part D program at an average rate of 80 claims per provider. Opioid prescribing rate is measured as the percentage of opioid claims among all Part D claims, and it averages 9% for all specialties. The specialties with the highest opioid prescribing rates are hand surgeons (55%), podiatric assistants (54%), and pain management providers (50%). Urology ranks 64th among specialties in opioid prescribing rate. The specialties with the highest number of opioid claims per provider are pain management (1326), anesthesia (495), and physical medicine and rehabilitation (431); these 4 specialties account for 16% of all opioid claims in Part D in 2018 

In the 2018 CMS opioid data set, 10,754 urologists identified as prescribers, with 7142 identified on an opioid claim. Collectively, urologists prescribed less than 1% of all opioids (417,700 claims) in Part D in 2018. The average opioid prescribing rate for all urologists was 4.9%, and for those with at least 1 opioid claim, it was 5.7%. The average number of opioid claims for urologists prescribing any opioid was 58. These metrics are well below the national average for all specialties. Only 43 urologists were identified with long-acting opioid claims in 2018

The opioid crisis has not affected all states evenly, and opioid dispensing rates/person vary widely across the US. The CDC publishes dispensing data by state and by county, and 11 states have rates over 64 per 100 persons.

The average number of claims per urology provider ranked by state correlates generally with the dispensing data (high rates in the same states), and urologists do not appear to prescribe opioids evenly across the US (per provider) either. If we examine the entire Medicare Part D prescriber database for 2018, we can see the opioid drugs most commonly prescribed by urologists—hydrocodone/acetaminophen and oxycodone HCl/acetaminophen—collectively account for approximately 75% of all opioid prescriptions 

Bottom line: The Medicare Part D data demonstrate that urologists collectively prescribe opioids in numbers and rates lower than the national average of all specialties and unevenly across the US. Very few urologists are linked to claims for long-acting opioids. Urologists should be aware of the small but significant risk of opioid prescription that leads to persistent use or even abuse and follow specialty guidelines for counseling and prescribing. Medicare Part D data on each individual prescriber is readily available to urologists, patients, and the public.

1. Help and resources: national opioids crisis. US Department of Health and Human Services. Accessed April 5, 2021. 

2. Opioid overdose crisis. National Institute on Drug Abuse. March 11, 2021. Accessed April 5, 2021. 

3. U.S. opioid dispensing rate maps. CDC. Updated December 7, 2020. Accessed April 5, 2021. 

4. Ziegelmann MJ, Findlay BL, Britton CJ, Habermann EB. Opioid prescribing after urologic surgery: we are part of the problem and part of the solution-an invited commentary on “an opioid prescription for men undergoing minor urologic surgery is associated with an increased risk of new persistent opioid use.” 

 2020;9(3):997-1000. doi:10.21037/tau-2020-05

5. Welk B, McClure JA, Clarke C, Vogt K, Campbell J. An opioid prescription for men undergoing minor urologic surgery is associated with an increased risk of new persistent opioid use. 

 2020;77(1):68-75. doi:10.1016/j.eururo.2019.08.031

6. AUA position statement: opioid use. American Urological Association. August 2018. Updated January 2019. Accessed April 5, 2021. 

7. Prescription opioids: what you need to know. CDC. Accessed April 5, 2021. 

8. Texas administrative code. Texas Secretary of State. Updated July 13, 2020. 

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=170&rl=3

9. Medicare Part D opioid prescriber summary file 2018. Centers for Medicare & Medicaid Services (CMS). January 7, 2021. Accessed April 5, 2021. 

10. U.S. state opioid dispensing rates, 2018. CDC. Updated December 7, 2020. Accessed April 5, 2021. 

11. Part D prescriber data CY 2018. CMS. Updated December 3, 2020. Accessed April 5, 2021. 

Determine whether your prescribing habits are in line with your peers.

Robert A. Dowling, MD

Articles

How does urology’s 2019 MIPS performance stack up?

Industry payments to urologists see sharp decline in 2020

What can be learned from CMS data on health care spending?

The urologist’s role as a responsible opioid prescriber