What are you prescribing?

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Members don't see this ad :)
whats the point?

the data is flawed. it is only if a doctor has written for 50 scripts and had it covered under Medicare part D.

no private insurance patients.
no straight medicaid patients.
no self-pay patients.
no academic physicians that i can find (all the ones i looked up that i know - over 10 of them - are not listed, because it is the resident/fellow that is writing the physical prescription).
 
Data is flawed.

I just searched me and the numbers are incompatible with my Rx habits. I have not written Soma and yet I have a bunch of Soma Rx's.

And my patients are way older than everyone else's.
 
Bench marking is a good thing, and it makes us uncomfortable. Yes the data are flawed, and
incomplete, but it's a good start.
 
George Orwell was brilliant:

Big Brother is watching.
 
NP and PA scripts for a physician are also not listed. So indeed there are flaws in the data, but it is indeed interesting the range of data. I looked up the info for my state and most of the top prescribers are PCPs....
 
algosdoc said:
NP and PA scripts for a physician are also not listed. So indeed there are flaws in the data, but it is indeed interesting the range of data. I looked up the info for my state and most of the top prescribers are PCPs....
Click to expand...

In my state PA's and NPs are listed. The caveat is that some NP's prescribe independently and you have to have inside knowledge, or go here: https://techmedweb.omb.state.or.us/Clients/ORMB/Public/VerificationRequest.aspx

to find out who the supervising physician is.
 
101N said:
Bench marking is a good thing, and it makes us uncomfortable. Yes the data are flawed, and
incomplete, but it's a good start.
Click to expand...

yet when i got done reviewing some of the info, i felt better about myself. maybe like zaphod beeblebrox in the Electronically Synthesised Universe box....

My most prescribed meds were, 2nd, 11th, 1st and 10th respectively compared to other physicians in my specialty. those are gabapentin, tramadol, hydrocodone and lyrica. statewide, the top 4 are hydrocodone, gabapentin, oxycodone, and morphine.
 
lobelsteve said:
Data is flawed.

I just searched me and the numbers are incompatible with my Rx habits. I have not written Soma and yet I have a bunch of Soma Rx's.

And my patients are way older than everyone else's.
Click to expand...

apparently 50% of my patients get opiates. and only hydrocodone. wow is that off.
 
This kind of data is useless if it is not accurate and incorporate all payors. That being said I'm glad my name doesnt even show up for my state
 
specepic said:
This kind of data is useless if it is not accurate and incorporate all payors. That being said I'm glad my name doesnt even show up for my state
Click to expand...

that is because you are either a pure interventional pain specialist (in which case, ugh:thumbdown:) or you do not take medicare (in which case, congrats!:thumbup:)
 
Members don't see this ad :)
http://www.propublica.org/article/part-d-prescriber-checkup-mainbar

Rx for Narcotics

Medicare does little to stop some doctors with criminal or disciplinary histories from continuing to prescribe to patients.

Perhaps the most striking example: its inaction on prolific prescribers of OxyContin and oxycodone, two often-abused narcotics with a high street value.

Half of Medicare's top 20 prescribers of OxyContin in 2010 have been criminally charged, convicted or settled fraud claims, or have been disciplined by their state medical boards, records show.

Similarly, eight of the top 20 prescribers of 30-milligram oxycodone pills - the strongest dose - have been charged, convicted or barred from prescribing controlled substances, or face discipline by licensing boards.

Yet as of today, only one of those doctors has been barred from Medicare - and that wasn't until nearly a year after his conviction for drug trafficking and health-care fraud.

Medicare shares responsibility with the HHS inspector general for allowing the doctors to remain in the program. Medicare has not sought authority from Congress to suspend providers from Part D - as experts say it should. The inspector general, which is responsible for excluding providers, hasn't done so in these cases.

Criminal charges alone are not enough to bar a practitioner, said Don White, a spokesman for the inspector general. The office must exclude providers convicted of certain offenses, including fraud, and has discretion to do so if they have lost licenses. But White said his office relies on other agencies to flag these cases.

"The legal process is sure but not fast," he said.

Blum said CMS is now taking steps to search for doctors and patients who may be engaged in fraud involving painkillers. The agency has encouraged insurance plans to send warning letters to doctors if signs indicate a patient may be going to different doctors to feed a drug habit.

Former CMS administrator Mark McClellan said Medicare should at least be able to stop paying for prescriptions written by doctors facing fraud charges.

"That's the kind of thing that seems like you ought to be able to find a way to deal with," he said.

In some cases, after years of inaction by Medicare and others, high prescribers were accused of harming patients.

Gerson Sternstein, 61, a Connecticut psychiatrist, consistently ranked among Medicare's most prolific OxyContin prescribers from 2007 to 2010. (OxyContin was reformulated in late 2010 to make it less prone to abuse.)

Since 2009, at least five malpractice lawsuits have been filed in Connecticut accusing him of questionable prescribing. A state medical board investigation found that his count of painkillers and other controlled substances - for the 12 months beginning July 2008 - exceeded that of Yale-New Haven Hospital.

In revoking Sternstein's license in 2011, the board cited 10 cases in which he had given out painkillers inappropriately, including two in which patients died - one from opiate toxicity, the other from a heart condition that can be associated with drug overdose.

In an e-mail, Sternstein said he was a specialist in treating patients whose pain could not be managed by anyone else. "I considered it my responsibility to try and help these individuals in their suffering," he said, noting that he faced no criminal action.

In defending himself to the medical board, documents show, one of the doctor's arguments was that Medicare allowed him to prescribe as he chose.

"Dr. Sternstein believes Medicare [Part] D allows wide latitude in off label use of medications," the board report states.
 
Ducttape said:
that is because you are either a pure interventional pain specialist (in which case, ugh:thumbdown:) or you do not take medicare (in which case, congrats!:thumbup:)
Click to expand...

Neither whatsoever. Some days being a block jock seems attractive, the amount of time/hassle involved sometimes with opioid rx'ing and the assoc BS can be frustrating some days
 
I'm not in the database so I sent an e-mail asking why. Here is the response I got back:

Dr. XXXXXX:

Thank you for your message.

You do not show up in our Prescriber Checkup app because you do not have at least 50 claims for one or more drugs for Medicare participants 2010.
We used that cutoff because experts suggested that would eliminate claims that were lingering refills.

The most claims Medicare shows for any drug for you is 37 for Gabapentin.

Best,

Jennifer XXXXXXX
ProPublica

Maybe I am guilty of under-utilization?
 
so how do you rectify this conundrum?


say you are seeing 2500 patients a year, and 50% medicare, say 50% of those have medicare part D, that would mean you wrote 37 scripts for over 750 patients - 1 in 20 patients.


if you prescribe, and arent only doing PT/Bmed/injection therapy, then there must be a problem with the data.....
 
Ducttape said:
so how do you rectify this conundrum?


say you are seeing 2500 patients a year, and 50% medicare, say 50% of those have medicare part D, that would mean you wrote 37 scripts for over 750 patients - 1 in 20 patients.


if you prescribe, and arent only doing PT/Bmed/injection therapy, then there must be a problem with the data.....
Click to expand...

In 2010 I was working - in part - on an inpatient rehab unit. I suspect that the majority of my
Medicare opioid scripts were written there, post stroke, THA, CVA, etc. My sense is that somehow those data did not get counted.
 
101N said:
I'm not in the database so I sent an e-mail asking why. Here is the response I got back:

Dr. XXXXXX:

Thank you for your message.

You do not show up in our Prescriber Checkup app because you do not have at least 50 claims for one or more drugs for Medicare participants 2010.
We used that cutoff because experts suggested that would eliminate claims that were lingering refills.

The most claims Medicare shows for any drug for you is 37 for Gabapentin.

Best,

Jennifer XXXXXXX
ProPublica

Maybe I am guilty of under-utilization?
Click to expand...


You lack compassion. LOL. JK.
 
I just received a self-referral from an out-of-state patient who recently migrated. Looked him up on the PDMP and found that he's getting opioids from a PMD in CA. Looked up the PMD in this database and discovered - surprise, surprise - that he's a yahoo. Top three drugs prescribed are Fentanyl, Oxycodone, and Hydrocodone. Specialty: Internal Medicine.

This data is useful.
 
I do wish there was a comprehensive database but in my state the PMP is not set up to generate such reports. The data is all there, but the drugs are entered by NDC codes. There are hundreds of them just for hydrocodone alone. The computer analyst running that section of the program told me it is currently impossible to determine prescribing by drug or who the top prescribers are in our state. The propublica is an interesting piece of data, albeit incomplete.
 
One interesting aspect of the data set is the distinction between Interventional Pain Medicine and Pain Medicine. I'm not sure what that distinction is based upon because in my state there are interventionists in both. Moreover, at least in this data set the amout of opioid prescribed seems to be the same regarless of the title.

Interventional Pain Medicine:http://projects.propublica.org/chec...ies/208vp0014x?utf8=✓&sort=narcotics_patients

Pain Medicine: http://projects.propublica.org/chec...ies/2081p2900x?utf8=✓&sort=narcotics_patients

PA's: http://projects.propublica.org/chec...ies/363a00000x?utf8=✓&sort=narcotics_patients

If there is such a thing as a 'signature' for a drugs for injections practice I think it involves PA's who appear up high in the narcotic prescribing who are supervised by an injectionist. There are several of these in my area.
 
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It may be based on the Medicare provider designation. Some used pain medicine when it first became available (before the interventional pain designation) and never changed.

We also have PAs being supervised to do injections, but these are supervised by internal medicine doctors with zero training in pain and supervised at a distance (not in the same building). We also have NPs doing the same, supervised by chiropractors.
 
Not Medicare but related NY Times article. You can opt out of being listed by clicking link to AMA Opt-out program:



Drug Marketers Use Social Network Diagrams to Help Locate Influential Doctors


The information allows drug makers to know which drugs a doctor is prescribing and how that compares to a colleague across town. They know whether patients are filling their prescriptions — and refilling them on time. They know details of patients’ medical conditions and lab tests, and sometimes even their age, income and ethnic backgrounds.

The result, said one marketing consultant, is what would happen if Arthur Miller’s Willy Loman met up with the data whizzes of Michael Lewis’s “Moneyball.” “There’s a group of geeks, if you will, who are running the numbers and helping the sales guys be much more efficient,” said Chris Wright, managing director of ZS Associates, which conducts such analyses for pharmaceutical companies.

Drug makers say they are putting the information to good use, by helping a doctor improve the chances that their patients take their medications as prescribed, or making sure they are prescribing the right drug to the right patients.

Some doctors, however, expressed discomfort with the idea of sensitive data being used to sell drugs, even though federal law requires that any personally identifiable information be removed. “I think the doctors tend not to be aware of the depths to which they are being analyzed and studied by people trying to sell them drugs and other medical products,” said Dr. Jerry Avorn, a professor of medicine at Harvard Medical School and a pioneer of programs for doctors aimed at counteracting the marketing efforts of drug makers. “Almost by definition, a lot of this stuff happens under the radar — there may be a sales pitch, but the doctor may not know that sales pitch is being informed by their own prescribing patterns.”

The research firm IMS Health has tracked information about which drugs doctors prescribe since the 1990s, and over the last decade, the list of available information has expanded to include insurance claims data, which yields a trove of intelligence about patients’ medical diagnoses and insurance coverage. Additional details about patients, including income, education and ethnicity, can also be available.

One company, SDI Health, promises to provide clients with “actionable analysis” by tracking people — on an anonymous basis — as they move through the “patient experience.” That includes, according to their Web site, filling prescriptions at a pharmacy, visiting a doctor, being admitted to the hospital and undergoing lab tests.

“Through our unique and proprietary patient-linking technology, we connect all aspects of a patient’s behavior,” the company’s Web site states. IMS Health acquired SDI in 2011.

“The sales representative theoretically has the ability to understand not only the doctor’s behavior, and which other physicians are key opinion leaders that the doctor listens to, but also the behavior of that doctor’s patients,” said Jerry Maynor, the director of marketing for North America at Cegedim Strategic Data, one of the companies that performs data analyses.

Some said that tracking physicians’ behavior was no different from techniques other industries use to sell products, including following a consumer’s Internet activity. But David Orentlicher, a law professor at Indiana University who writes on medical ethics issues, said the pharmaceutical companies’ use of data has become more invasive. “A lot of the information comes out of the doctor-patient encounter,” he said.

Privacy advocates also pointed to research showing that people in anonymous databases can sometimes be re-identified. “It just seems like it skirts the edge of the laws that do exist,” said Adriane Fugh-Berman, an associate professor at Georgetown University Medical Center who is a critic of pharmaceutical marketing tactics.

Doctors who object to the use of their prescribing data by pharmaceutical companies can opt out through a program set up by the American Medical Association in 2006. But doctors cannot block the use of their insurance claims and other data, and some doctors complain that few know the program exists. About 31,650 of the nation’s more than 767,000 practicing physicians, roughly 4 percent, have enrolled in the opt-out program since it was created, according to the A.M.A., which also sells information about doctors to companies like IMS.

Drug makers and their consultants say their techniques can help doctors by providing information that is customized to their needs. To sell the respiratory drug Spiriva, for instance, the German drug maker Boehringer Ingelheim uses insurance and prescribing data to focus on doctors with patients who have chronic obstructive pulmonary disease but who are not frequently prescribing long-acting drugs like Spiriva, which have been shown to reduce sudden attacks of severe complications in people with the disease, compared to shorter-acting drugs.

“You start analyzing what they’re doing and you can find out if, through a combination of factors, you can intervene,” said Paul Fonteyne, the president and chief executive of Boehringer Ingelheim USA.

Some pharmaceutical companies and consultants said the industry mainly used the data to market to big decision-makers like insurers, by demonstrating that their drugs are more cost-effective or show better outcomes for patients. Boehringer Ingelheim and the insurance company Humana, for example, recently announced a partnership aimed at improving the health and reducing costs for people with C.O.P.D. and other chronic diseases.

“At the end of the day, calling on doctors in terms of a personal selling model is a lot less important to selling your drug,” said Andrew Kress, a senior vice president at IMS. “You can read a dark side to any of this, but the reality is that most manufacturers that IMS does research for are really trying to engage in a much more productive dialogue with the health care providers.”

Companies are refining their pitches to doctors in part because it is getting harder to market to them. Studies show physicians are less willing to speak to sales representatives, either because they are opposed to such pitches, or because they are under pressure to see more patients. At the same time, the industry has laid off thousands of sales representatives in an effort to save money as once best-selling drugs have lost their patent protection.

“The industry is now having a harder time getting direct access to physicians,” said Edward Rhoads, a managing partner and principal at the New England Consulting Group. As a result, he said, drug companies are asking, “How can we get the information into the community in a different way? There’s a big emphasis in understanding how physicians influence each other.”

This field, called influence-mapping, seeks to put a high-tech twist on the old idea that nothing sells a product better than word of mouth. One company, Activate Networks, applies technology licensed from Harvard University to draw connections between physicians with patients in common, then uses those ties to accelerate the adoption of newly introduced drugs.

“You can tell a lot about a physician’s behavior by looking at what the people they have relationship with are doing,” said Peter DeWan, the chief scientific officer at Activate Networks.

Mr. DeWan said his company assigned physicians a ranking based on how connected they were, which helped companies decide where to send a representative, or whom to invite to a talk about a drug.

But some doctors questioned whether these techniques were best for patients. Just because doctors are well connected doesn’t mean they are prescribing the right drugs, said Dr. David C. May, a cardiologist who practices in a northern suburb of Dallas and is chairman of the board of governors for the American College of Cardiology.

“We have seen, in our particular part of Dallas, situations in which the physicians were aggressively marketed to and the drugs were perhaps inappropriately used early on,” he said.

Dr. Larry Miller, the chief executive of Activate Networks, noted that the company also advised clients like insurance companies, which are using the same networks to persuade doctors to choose more inexpensive treatments. “You still have to be very careful,” Dr. Miller said. “We all know our own networks and know who we respect.”


A version of this article appeared in print on May 17, 2013, on page B1 of the New York edition with the headline: Data Trove on Doctors Guides Drug Company Pitches.
 
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