Association of provider opioid prescribing practices and the Centers for Medicare and Medicaid Services hierarchical condition category score: A retrospective examination of correlation between the volume of provider-prescribed opioid medications and provider panel complexity.

OBJECTIVE: Opioids are being prescribed at increasing rates in primary care practices, and among individual providers there is significant variability in opioid prescribing. Primary care practices also vary significantly in complexity of their patients, ranging from healthy patients to those with multiple comorbidities. Our objective was to examine individual primary care providers for an association between their opioid prescribing and the complexity/risk of their panel of patients (a panel of patients is a group of patients whose medical care is the responsibility of a specific healthcare provider or care team).

METHODS: We retrospectively examined 12 months of opioid prescription data from a primary care practice. We obtained counts of opioids prescribed by providers in the Mayo Clinic, Rochester, Minnesota primary care practice. For patients paneled (assigned) to family medicine and internal medicine, we used the Centers for Medicare and Medicaid Services hierarchical condition category patient risk score as a measure of patient complexity. After adjusting the opioid counts for panel patient count (to get opioid counts per patient), we used linear regression analysis to determine the correlation between the hierarchical condition category risk and the amount of opioid prescribed by individual providers.

RESULTS: Among our combined 103 primary care providers, opioid unit counts prescribed per patient were highly correlated with the providers' hierarchical condition category panel risk score (r(2) = 0.54). After excluding three outliers, r(2) was 0.74. With and without the outliers, the correlation was very significant (p < 0.0001). Subgroup analysis of panels with hierarchical condition category ⩽ 0.45 showed no correlation of opioid prescribing volume with hierarchical condition category (r(2) < 0.02; p = 0.32). Provider panels with hierarchical condition category > 0.45 showed significant correlation with hierarchical condition category (r(2) = 0.26; p = 0.001).

CONCLUSION: When examining differences in primary care providers' opioid prescribing practices, the Centers for Medicare and Medicaid Services endorsed risk score (the hierarchical condition category score) can help adjust for population differences of a provider's patients.