Five-Year Comparative Analysis of Medicare Opioid Prescription Volume Among Oral and Maxillofacial Surgeons

Abstract

To examine the volume and variation in opioid prescribing practices among oral and maxillofacial surgeons (OMSs) serving Medicare beneficiaries from 2013 to 2017 and identify the practice-level features that correlate with the opioid prescription volume. The present cross-sectional study included Medicare Provider Utilization and Payment Data from 2013 to 2017. Providers were included if they were labelled as OMSs. The primary outcome variable was the opioid claim volume. The predictor variables included provider and beneficiary gender, beneficiary age, and beneficiary hierarchical condition category (HCC). The secondary outcome variables included mean opioid prescriptions per beneficiary and opioid days' supply per claim. Descriptive statistics and regression analyses were computed at an α level of 0.05. The 5-year analysis cohort included 2071 distinct providers; 605,593 total opioid prescription claims were recorded for 516,217 Medicare beneficiaries, with an average supply of 3.54days of opioids per patient. From 2013 to 2017, a significant increase had occurred in the number of mean opioid claims per provider (P<.001) and a significant decrease in both the mean opioid claims per beneficiary (P<.001) and the days' supply per opioid claim per beneficiary (P<.001). Male provider gender (P<.001), lower beneficiary age (P<.001), percentage of female beneficiaries seen by a provider (P<.001), and lower HCC risk score (P<.001) all correlated with an increased opioid claim volume. Finally, a significant difference was found in the opioid claim volume among OMSs between the states (P<.001) and between oral and maxillofacial surgery and other surgical subspecialties (P<.001). Although the total number of opioids prescribed by OMSs has increased over time, the prescribing practices have, on the aggregate, become more responsible. The extreme cases of opioid prescribing and variations in state-level opioid claim volumes warrant additional investigation.