Prescriber Checkup: Are You Listed?

I can’t remember exactly how I stumbled upon ProPublica’s “Prescriber Checkup” site.  All I remember is my astonishment that right there, on my computer screen, was my name next to a wealth of information about my prescribing habits and Medicare billing figures.  I had no idea this information was out in the open.

Don’t get me wrong- I was not alarmed by my numbers and they don’t signal any serious deficiencies in my practice, I simply wasn’t aware of the Provider Checkup tool.

Two years ago, ProPublica lobbied the Centers for Medicare and Medicaid Services (CMS) to release information about the prescribing habits of more than 1 million healthcare providers.  Never before had this information been released to the public.  After months of deliberation, CMS agreed to release the information under the authority of the Freedom of Information Act.

ProPublica’s stance is that the public has the right to know about provider’s prescribing habits.  Many physicians, NPs and PAs prescribe too many narcotic pain medications and antipsychotic medications, both of which can be risky drugs, especially for seniors.  Some providers treat their patients in a more costly manner than others, prescribing brand name medications when generic alternatives may be equally effective.  ProPublica’s mission is to get this information out to Medicare patients and their families helping them choose the right provider for their needs.

How dose Prescriber Checkup work?  The program analyzes claims information and medications prescribed for Medicare Part D patients.  Only prescriptions that are actually filled enter the system.  The program includes only information for Medicare Part D beneficiaries and does not contain information for patients treated under any other insurance plans.  Only providers who wrote 50 or more prescriptions for at least one drug are included in the database so it’s possible your name may not be present in the database.  In order to protect privacy, patient information is not disclosed in the process.

Below are snapshots of my personal profile in the Prescriber Checkup system.

ProPublica hopes this free flowing information in Prescriber Checkup will change the patient-provider relationship.  Patients can now compare the prescribing habits of their own provider with others in similar specialties.  Rightly, ProPublica cautions patients that outliers in a particular provider’s prescribing habits are not necessarily a bad thing.  For example, one provider may work in a nursing home rather than a private clinic where certain drugs are more frequently prescribed for good reason.  ProPublica recommends patients discuss concerns about released information with their provider directly.

It was a bit unsettling for me to have my prescribing information out in the open.  Prescriber Checkup, after all, does not have a “comments” section where I can defend any outliers in my personal habits.  I worry that patients may make misdirected conclusions about how I practice.  For example, the percentage of narcotic medications I prescribe to Medicare Part D beneficiaries is higher than average.  I don’t consider myself one to dole out narcotics unnecessarily and suspect this is because the database has me listed as a “primary care specialty”.  Prescriber Checkup is comparing my narcotic prescribing habits to other primary care providers. While I am certified in primary care, I practice in emergency medicine frequently treating acute pain.  I believe this accounts for my higher than average narcotic prescription writing.

Although it can be a wake up call to see your billing and prescribing habits aired publicly, especially without a forum to account for any misgivings, I support the free-flow of this type of information.  Currently, our nation is in a bit of a healthcare crisis in part created by too many hidden agendas and lack of public information.  Just like we have seen payments to prescribers from pharmaceutical companies released to the public, a positive for patients, further release of prescribing information helps protect patients and holds providers accountable for their actions.  ProPublica’s program gives patients a forum for comparing their personal providers to others in the area and opens the door to honest patient-provider conversation.

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