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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
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Contents
• Pill Mills
• KASPER Program Update
• Controlled Substance Prescribing in
Kentucky (House Bill 1)
• Pain Management Facilities
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Pill Mills
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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)
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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.
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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
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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.
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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
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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
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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
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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
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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
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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
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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.
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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.
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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.
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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]