An Update on Kentucky All Schedule Prescription Electronic ......• KBML responsible for licensure...

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An Update on Kentucky All Schedule Prescription Electronic

Reporting (KASPER)

Mary Reinle BegleyInspector GeneralKentucky Cabinet for Health and Family Services

David R. HopkinsKASPER Program ManagerOffice of Inspector General

Health Care Compliance AssociationNovember 9, 2012

Cabinet for Health and Family Services

Contents

• Pill Mills

• KASPER Program Update

• Controlled Substance Prescribing in

Kentucky (House Bill 1)

• Pain Management Facilities

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Pill Mills


Jeff and Chris George

Photos from Palm Beach Post

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Dr. Paul H. Volkman

Story: Bill Estep, Lexington Herald-Leader, February 14, 2012. AP Photo released by U.S. Marshals Service (undated)


Care More Pain Management Clinic

Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012

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Care More Pain Management Clinic

Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012

KASPER Program Update

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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.


KASPER Operation

• KASPER tracks most Schedule II – V substances dispensed in KY.

– Over 11 million controlled substance prescriptions reported to the system each year.

• KASPER data is 1 to 7 days old.– Dispensers have 7 days to report.– Health Information Designs processes & provides data

once per day.• Reports available to authorized individuals.

– Available via web typically within 15 seconds (92% of requests).

– Available 24/7 from any PC with Web access.

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Status of Prescription Drug Monitoring Programs (PDMPs)

Research is current as of February 1, 2012

AK

AL

AR

CACO

ID

IL INIA

MN

MO

MT

NENV

ND

OH

OK

OR

TN

UT

WA

AZ

SD

NM

VA

WYMI

GA

KS

HI

TX

ME

MS

WINY

PA

LA

KYNC

SC

FL

NHMARICTNJDEMD

DC

VT

WV

Operational PDMPs

Enacted PDMP legislation, but program not yet operational

Legislation pending

GU

2011 KASPER Reports Requested


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2011 KASPER Reports Requested


122 186274

362418

533

708

811

2004 2005 2006 2007 2008 2009 2010 2011

Nu

mb

er o

f R

epo

rts

in T

ho

usa

nd

s


Top Prescribed Controlled Substances byTherapeutic Category by Doses - 2011

Hydrocodone 42.8%LortabLorcetVicodin

Alprazolam 13.3%Xanax

Clonazepam 6.9%Klonopin

Oxycodone 15.5%OxyContinPercodanPercocet

Diazepam 4.9%Valium

Lorazepam 4.2%Ativan

Amphetamine 2.7%Adderall

Pregabalin 2.8%Lyrica

Tramadol 3.1%Ultram

Zolpidem 3.8%Ambien

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KASPER Stakeholders• Licensing Boards – to investigate potential inappropriate

prescribing by a licensee. • Practitioners and Pharmacists – to review a current

patient’s controlled substance prescription history for medical and/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.


KASPER Usage December 31, 2011

Law Enforcement = 1.5%(13% of KY LE have

accounts)

Prescribers = 94.9%(32% of KY prescribers have accounts)

Pharmacists = 3.5%(26% of KY

pharmacists have accounts)

Judges, Other= .1%

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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

– Decrease the number of doses dispensed

Controlled Substance Prescribingin Kentucky

House Bill 1

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eKASPER Reporting

• Schedule II controlled substances and Schedule III controlled substances that contain hydrocodone administered to a patient– Beginning July 1, 2013

• Controlled substance administration or dispensing must be reported within seven days through June 30, 2013– Must be reported within one day of

administration or dispensing on or after July 1, 2013


eKASPER Accounts

• eKASPER registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans.

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eKASPER Master Accounts

12/31/2011 04/24/2012 07/20/2012 10/24/2012

Doctor* 5,470 5,680 11,923 15,988

APRN 690 781 1,523 1,771

Pharmacist 1,385 1,450 3,602 4,683

Total 7,545 7,911 17,048 22,442

*Includes physicians, dentists, optometrists and podiatrists


eKASPER Provider Usage – KRS 218A.172 (HB1)

• 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

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eKASPER Provider Usage - Regulations

Expanded by Licensure Boards to include all Schedule III controlled substances and the following Schedule IV controlled substances:

AmbienAnorexicsAtivanKlonopinLibriumNubainOxazepamPhentermine

SomaStadolStadol NSTramadolValiumVersedXanax


CS Prescribing Regulations – Licensure Boards

• 201 KAR 5:130– Kentucky Board of Optometric Examiners KASPER

requirements

• 201 KAR 8:532– Kentucky Board of Dentistry KASPER requirements

• 201 KAR 9:230, 201 KAR 9:260– Kentucky Board of Medical Licensure KASPER

requirements

• 201 KAR 20:057– Kentucky Board of Nursing KASPER requirements

• 201 KAR 25:090– Kentucky Board of Podiatry KASPER requirements.

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KASPER Reports

• 2011 weekday average: 2,888

• Current weekday average: 18,722


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

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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


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

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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


eKASPER Planned Enhancements

• Hospital or facility accounts• Improved KASPER data quality• Improved prescription record data

matching• Improved report processing speeds

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Pain Management Facilities

HB 1 – Ownership Requirements

• Physician ownership requirement on all pain management facilities (PMF)

• Exception for those health facilities operating as a PMF on April 24, 2012

• No sanctions or convictions imposed on facility or employees


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Oversight

• KBML responsible for licensure standards for physician-owned pain management facilities.

• OIG, Division of Health Care is responsible for licensure standards for existing pain management facilities that qualify for the physician-ownership exemption of HB 1.


Inspections/Complaint Investigations

• The OIG began inspecting PMFs for compliance with 902 KAR 20:420E on July 23, 2012.

• PMFs will be subject to an unannounced initial inspection and at least one unannounced inspection annually.

• The OIG will investigate credible, relevant complaints or allegations against the facility. Complaint investigations will be unannounced.


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Determining Whether a Facility is a PMF

• The majority of patients of practitioners are provided treatment for pain that includes the use of controlled substances.

• To determine majority, the OIG will calculate the majority of patients based upon the number of unduplicated patients treated in a one month time period and may use data from KASPER.


Professional Standards for Prescribing and Dispensing Controlled Substances

All licensed prescribers in a PMF must comply with the professional standards relating to the prescribing and dispensing of controlled substances established by their professional licensing boards.


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Referral to Licensing Boards and Law Enforcement

The Cabinet will refer a physician or practitioner to the appropriate professional licensure board and law enforcement agency if a surveyor has probable cause to believe that the facility’s prescriber is engaged in the improper, inappropriate, or illegal prescribing or dispensing of controlled substances.


Adverse Action and Appeals

• The Cabinet will deny, revoke, or issue an emergency suspension for violations identified in 902 KAR 20:420E.

• Facilities may file a written request for a hearing with the Cabinet upon receipt of notice to deny, revoke, or suspense the facility’s license on an emergency basis.


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Mary Reinle BegleyKentucky Cabinet for Health and Family Services

275 East Main Street, 5EDFrankfort, KY 40621

502-564-2888 [email protected]

David R. Hopkins502-564-2815 extension 3333

Dave [email protected]

An Update on Kentucky All Schedule Prescription Electronic ......• KBML responsible for licensure...

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