Official NTOCC Comments

Review the official comments, letters and responses from the National Transitions of Care Coalition (NTOCC).

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Posted on 2/19/2019 by NTOCC ® in Transitions of Care NTOCC IMPACT NEWSLETTER TOC

FEB 2019 NTOCC IMPACT Newsletter-

                   IMPACT NEWSLETTER                     

NTOCC Executive Director's Corner

News and updates from the NTOCC Executive Director’s desk.


Dear NTOCC Community

As I write the first Executive Director report for 2019, I am struck with the question “What will this year bring not only personally and professionally but what changes will we see in healthcare?  I spent some time looking at the various predictions from Forbes, Healthcare Global and others.   Many of the 2019 predictions are focused on continued development and expansion in the use of telehealth, mobile technology, health wearables, artificial intelligence, greater vertical integration and an increased focus on value and outcomes-based models of care.  Most which should not be a surprise to us in the field. 

On December 21, 2018 CMS issued its final rule that dramatically redesigns and sets a new direction for Medicare Accountable Care Organizations (ACOs).  This new program “Pathways to Success” is a step towards quality healthcare at a lower cost through competition and beneficiary engagement.  Pathways to Success expands access to high-quality telehealth services that are convenient for patients, including telehealth services provided at a patient’s place of residence.  This support from Medicare moves certain ACOs to providing clinical care at a distance, increasing accessibility and reducing potential delays in diagnosis and intervention.  The rule moves ACOs to take on real risk while offering them incentives and flexibility they need to coordinate care and be innovative in its delivery.  The “Pathways to Success” focuses the payment process on advancing the transition to value and outcome-based care.  For further information on the final rule and implementation of “Pathways of Success” go to the CMS Newsroom.

These types of programs will offer patients and their family caregivers, especially in rural areas and other locations where face to face resources or clinical specialties are limited, greater access to care options.  But as we all know not everyone is able to use technology, whether patient portals, remote monitoring, mobile technology or other advancements, as easily as others.  Therefore, I believe continued focus on care coordination and especially at the point of transitions of care will be essential in 2019.  These wonderful new advancements in technology still need to meet the patient where they are in their specific life environment including their social determinants of health.  If our patients and family caregivers are struggling to understand written transition care plans and medication lists, follow-up care instructions, how will they maneuver this new world of digital and telehealth communication among their care teams and PCP?  

I believe the focus on transitions and care coordination becomes even more important to the success of programs like “Pathways to Success” and to patient and family caregiver engagement and satisfaction.  The work of NTOCC is focused on ensuring providers, patients and family caregivers together will achieve greater access to care, mutually agreed upon treatment care plans which will provide support for both clinical, behavioral and medication management and ensure that transitions and care coordination not only supports the patient’s preference but allows patients and family caregivers to make informed decisions about their care with their providers.  My prediction in 2019 is that transitions and care coordination will continue to be a major focus using interdisciplinary care teams which will contribute to the success of programs like “Pathways for Success”.  NTOCC will continue to focus on building tools and resources that support medication management and coordination, patient and family engagement, transition planning, information transfer, follow up care, healthcare provider engagement and shared accountability.  


Best regards,

Cheri Lattimer

NTOCC, Executive Director

Allied Against Opioid Abuse Explains How Education Can Help Prevent Prescription Opioid Abuse
by AAOA Staff

Every day, there is a new headline about the opioid abuse epidemic — a life lost too young, a community looking for solutions to the crisis, or a new study highlighting how the epidemic has grown and evolved. These stories remind us that the opioid epidemic is a complex public health crisis and there is not a silver bullet to solving it. We all have a role to play, and it starts with being educated and informed.


Founded in 2018, Allied Against Opioid Abuse (AAOA) brings together leading healthcare organizations to prevent the misuse and abuse of prescription opioids through education. Working with national and local partners, including the National Transitions of Care Coalition, AAOA is raising awareness about prescription opioid safety and providing resources on the safe use, storage and disposal of these medicines.


Properly safeguarding these medicines is critical, as too often the misuse and abuse of prescription opioids starts in the home. According to the most recent Substance Abuse and Mental Health Services Administration (SAMHSA) survey on drug use and health, more than half (53 percent) of those who misused prescription pain relievers in the past year received the medicine from a friend or relative.

Research commissioned by AAOA highlights how a lack of awareness helps drive the crisis and reinforces the need for education on how to properly safeguard prescription opioids. The report found that among those surveyed:

  • Nearly 70 percent said they would be more likely to safely store and properly dispose of prescription opioids if they were given information on how to do so;
  • Approximately 36 percent said they did not know they needed to dispose of leftover prescription opioids;
  • Nearly 30 percent did not know how to dispose of opioids safely; and,
  • Nearly 90 percent said keeping their leftover prescription opioids for future use was the leading factor in why they didn’t dispose of them.

AAOA is taking on this issue directly by serving as a centralized information resource and connecting healthcare providers, pharmacists and the public to educational resources about the rights, risks and responsibilities associated with prescription opioids. Educating patients and their caregivers about the “3 Rs” facilitates a dialogue about pain management and ultimately helps limit the number of prescription opioids in the home that could end up in the wrong hands.

  • Rights: Every patient has the right to know the full scope of the pain relief options available to them, including non-opioid treatments. Patients should talk with their healthcare provider to understand how their opioid prescription is dispensed and be aware of partial-fill options, which limit the number of pills patients take home initially.
  • Risks: Prescription opioids carry a serious risk of dependence, addiction and overdose, especially with prolonged use. Patients should talk to their healthcare provider and pharmacist to make sure they understand the risks and potential side effects associated with the medication they are prescribed.
  • Responsibilities: When an opioid prescription is taken home, patients can help prevent misuse and abuse by properly storing the medicine in a secure place and safely disposing of any unused or expired pills as soon as possible. Patients can check with their local pharmacy or law enforcement agency about prescription take-back initiatives and disposal drop-offs in their community.

These resources are a start, but we need your help in spreading the word; educate yourself and then share this information with your family, friends, neighbors and colleagues.


If you are a provider, take the time to talk to your patients about prescription opioids and make sure they not only know the risks and alternative treatment options but also understand the importance of storing and disposing of these medicines properly.



AAOA has many resources available to help with these conversations. Check out our website ( and follow us on Twitter (@AAOA_Tweets) to learn more.


Additional AAOA Educational Resources: 

  • Disposal location database

  • What You Can Do video

  • Rights, Risks and Responsibilities fact sheet

  • Surgical patient video of pain management featuring Dr. Marty Makary and physicians from Johns Hopkins Hospital

  • Pharmacy Toolkit web portal 





News, Policy & Advocacy Corner                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Please take a moment to read through the research, news, updates regarding legislation, regulations & policy that we post in this section each Quarter.  Please do not hesitate to reach out to your members of Congress and express your opinion in regards to these issues as well.   If you have any questions we can help with or information you would like for us to consider adding to our list please send them to me at

                                                                                                                                                                                                                                                                                    Kindest Regards, 
                                                                                                                                                                                                                                                                                    Val Emmons

                                    NTOCC, Communications & Government Affairs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               


U.S. Government Funding Bill Update
The Senate overwhelmingly passed the government funding package on Thursday, February 14, 2019 by a vote of 83-16.  The bill passed the House Thursday with a tally of 300-128, and President Trump signed the bill Friday February 15, 2019 in order to avert a government shutdown.

William Barr Confirmed As United States Attorney General

On February 14th the Senate voted to approve William Barr as attorney general, giving the Justice Department its first confirmed chief since President Trump ousted Jeff Sessions last fall.

More than 50 senators voted for Barr's nomination, giving him enough support to be confirmed. The vote caps off a relatively low drama fight over Trump's second nominee for the post. Barr was largely on a glide path after he cleared the Judiciary Committee and a procedural vote without any missteps that threatened GOP support for his nomination.

Sen. Rand Paul (Ky.) appeared to be the only Republican who would vote against Barr on Thursday, while Democratic Sens. Joe Manchin (W.Va.), Doug Jones (Ala.) and Kyrsten Sinema (Ariz.) broke with their party and supported him.

Democrats have 47 seats in the Senate. With Manchin, Jones and Sinema voting earlier in the week to advance Barr's nomination, Democrats would have needed to flip six Republicans in addition to Paul to sink his nomination.

HHS launches innovative payment model with new treatment and transport options to more appropriately and effectively meet beneficiaries’ emergency needs

Supporting ambulance triage options aims to allow beneficiaries to receive care at the right time and place

On February 14, 2019, the U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (Innovation Center), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model for emergency ambulance services that aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place with the potential for lower out-of-pocket costs. 

“This model will create a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment in whatever setting makes sense for them,” said HHS Secretary Alex Azar. “Today’s announcement shows that we can radically rethink the incentives around care delivery even in one of the trickiest parts of our system. A value-based healthcare system will help deliver each patient the right care, at the right price, in the right setting, from the right provider.”

The new model, the Emergency Triage, Treat and Transport (ET3) model, will make it possible for participating ambulance suppliers and providers to partner with qualified health care practitioners to deliver treatment in place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services. In doing so, the model seeks to engage health care providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. Additionally, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will have a five-year performance period, with an anticipated start date in early 2020.

“The ET3 model is yet another way CMS is transforming America’s healthcare system to deliver better value and results for patients through innovation,” said CMS Administrator Seema Verma. “This model will help make how we pay for care more patient-centric by supporting care in more appropriate settings while saving emergency medical services providers precious time and resources to respond to more serious cases.”

Currently, Medicare primarily pays for unscheduled, emergency ground ambulance services when beneficiaries are transported to a hospital emergency department (ED), creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate.  To counter this incentive, the ET3 model will test two new ambulance payments, while continuing to pay for emergency transport for a Medicare beneficiary to a hospital ED or other destination covered under current regulations:

  • payment for treatment in place with a qualified health care practitioner, either on-the-scene or connected using telehealth; and
  • payment for unscheduled, emergency transport of Medicare beneficiaries to alternative destinations (such as 24-hour care clinics) other than destinations covered under current regulations (such as hospital EDs).

The ET3 model encourages high-quality provision of care by enabling participating ambulance suppliers and providers to earn up to a 5% payment adjustment in later years of the model based on their achievement of key quality measures.  The quality measurement strategy will aim to avoid adding more burden to participants, including minimizing any new reporting requirements.  Qualified health care practitioners or alternative destination sites that partner with participating ambulance suppliers and providers would receive payment as usual under Medicare for any services rendered. 

The model will use a phased approach through multiple application rounds to maximize participation in regions across the country.   In an effort to ensure access to model interventions across all individuals in a region, CMS will encourage ET3 model participants to partner with other payers, including state Medicaid agencies.

CMS anticipates releasing a Request for Applications in Summer 2019 to solicit Medicare-enrolled ambulance suppliers and providers.  In Fall 2019, to implement the triage lines for low-acuity 911 calls, CMS anticipates issuing a Notice of Funding Opportunity for a limited number of two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate. 

For more information, please visit:

CMS proposes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage

On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) released proposed changes that will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.

“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” said CMS Administrator Seema Verma. “Medicare Advantage enrollment is at an all-time high as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”

The proposed changes will expand opportunities for seniors to choose Medicare Advantage plans that for the first time are providing new supplemental benefits in 2019. Beginning with the 2019 plan year, Medicare Advantage plans can provide certain enrollees with access to different benefits and services. For the 2020 plan year and beyond, under statutory changes and the proposed guidance on which we are soliciting comment in today’s release, Medicare Advantage plans will have greater flexibility to offer chronically ill patients a broader range of supplemental benefits that are tailored to their specific needs, such as providing home-delivered meals or transportation for non-medical needs.

The agency is also proposing new action to combat the nation’s opioid crisis. CMS is encouraging Medicare Advantage plans to take advantage of new flexibilities to offer targeted benefits and cost sharing reductions for patients with chronic pain or undergoing addiction treatment, and encouraging Part D plans to provide lower cost sharing for opioid-reversal agents. CMS’ overutilization policies have resulted in a 14 percent decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).

Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. Average Medicare Advantage and Part D premiums are at their lowest in three years and plan choices have increased. Today’s proposals build in additional flexibilities to continue to increase choice and competition among Medicare health and drug plans.

For a fact sheet on the 2020 Advance Notices (Part I and Part II) and the Draft Call Letter, please visit: CMS released Part I of the Advance Notice on December 20, 2018.

The 2020 Advance Notices (Part I and Part II) and Draft Call Letter may be viewed by going to: and selecting “2020 Advance Notices.”

All comments on the Advance Notices – including Part I – and Draft Call Letter must be submitted by March 1, 2019. The final 2020 Rate Announcement will be published by Monday, April 1, 2019.


CMS Final Rule Creates Pathways to Success for the Medicare Shared Savings Program

On December 21,2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that dramatically redesigns and sets a new direction for the Medicare Accountable Care Organizations or “ACOs.” ACOs are groups of healthcare providers that take responsibility for the total cost and quality of care for their patients, and in exchange they can receive a portion of the savings they achieve. To ensure the ACO program delivers the most value, Pathways to Success is designed to advance five goals: Accountability, Competition, Engagement, Integrity, and Quality.

The Medicare Shared Savings program (MSSP) launched in 2012 and currently over 10.4 million beneficiaries in Fee-for-Service Medicare (of the 38 million total Fee-for-Service beneficiaries) receive care from providers participating in a Medicare ACO. Most Medicare ACOs currently do not face financial consequences when costs increase, but Pathways to Success will change this. Having more Accountable Care Organizations take on real risk, while offering them the incentives and flexibility they need to coordinate care and innovate, is an important step forward in how Medicare pays for value. Data on ACO performance shows that over time ACOs taking accountability for costs perform better than those that do not. As a result of today’s changes, the projected savings to Medicare total $2.9 billion over ten years.

Invitations for a national partner call will come out soon to walk through this final rule: “Pathways to Success”

For more information, please visit


AHRQ Analysis Finds Hospital-Acquired Conditions Declined By Nearly 1 Million from 2014-2017

HHS Initiatives Continue to Improve Patient Safety


Link to Infographic: Declines in Hospital-Acquired ConditionsNew data released on January 29, 2019 by the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS) show reductions in hospital-acquired conditions such as adverse drug events and healthcare-associated infections helped prevent 20,500 hospital deaths and save $7.7 billion in health care costs from 2014 to 2017.

AHRQ’s preliminary analysis (PDF, 545 KB) estimates that hospital-acquired conditions were reduced by 910,000 from 2014 to 2017. The estimated rate of hospital-acquired conditions dropped 13 percent; from 99 per 1,000 acute care discharges to 86 per 1,000 during the same timeframe.

AHRQ’s new report quantifies trends for several hospital-acquired conditions, including adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, Clostridioides difficileinfections, pressure injuries (pressure ulcers), and surgical site infections. The report showed that harms decreased in several categories, such as adverse drug events, which dropped 28 percent from 2014 to 2017. However, opportunities for improvement exist in other harm categories, such as pressure ulcers. 

“CMS is delivering on improving quality and safety at America’s hospitals,” said CMS Administrator Seema Verma.  “Our work isn’t done and we will continue our efforts to hold providers accountable for delivering results.”

AHRQ Director Gopal Khanna, MBA, added, “The updated estimates are a testament to the successes we’ve seen in continuing to reduce hospital-acquired conditions. There’s no question that challenges still remain in addressing the problem of hospital-acquired conditions, such as pressure ulcers. But the gains highlighted today were made thanks to the persistent work of many stakeholders’ ongoing efforts to improve care for all patients.”

The continued decline in hospital-acquired conditions is a signal that patient safety initiatives led by CMS are helping to make the Nation’s health care safer, Federal officials said. AHRQ, CMS, the Centers for Disease Control and Prevention, and other Federal and private partners throughout the field support ongoing improvements in health care and are establishing a growing foundation of knowledge about how to keep patients safe. AHRQ has developed a variety of patient safety tools and resources, including the Comprehensive Unit-based Safety Program, to reduce hospital-acquired conditions. CMS has sustained and accelerated the national progress and momentum toward continued harm reduction in the Medicare program.

CMS, through the Hospital Improvement Innovation Networks (HIINs), works to instill best practices in harm reduction to more than 4,000 of the Nation’s acute care hospitals. The HIINs regularly engage with hospitals, providers, and the broader caregiver community to quickly implement evidence-based practices in harm reduction to improve the quality of care for Medicare beneficiaries.  The agency further supports evidence-based harm-reduction strategies through the Quality Improvement Network-Quality Improvement Organizations (QIN-QIOs) and the End Stage Renal Disease Network Program.

CMS has set a goal of reducing hospital-acquired conditions by 20 percent between 2014 and 2019. If achieved, AHRQ projects the 20 percent reduction would result in 1.8 million fewer hospital-acquired conditions over this period, potentially resulting in 53,000 fewer deaths and saving $19.1 billion in hospital costs.

HHS agencies will continue working to build on these promising results—improving patient safety and reducing health care costs while seeking to ensure the highest quality care to patients.

To view the AHRQ report titled, AHRQ National Scorecard on Hospital-Acquired Conditions Updated Baseline Rates and Preliminary Results 2014-2017 please visit: (545 KB).

New CMS App Displays What Original Medicare Covers
Newest eMedicare Tool Provides Valuable Information to Mobile Users

On Monday January 28,2019, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to some of the most-used content on

The new “What’s Covered” app lets people with Original Medicare, caregivers and others quickly see whether Medicare covers a specific medical item or service. Consumers can now use their mobile device to more easily get accurate, consistent Original Medicare coverage information in the doctor’s office, the hospital, or anywhere else they use their mobile device. In addition to the “What’s Covered” app, through Blue Button 2.0 the agency is enabling beneficiaries to connect their claims data to applications and tools developed by innovative private-sector companies to help them understand, use, and share their health data.

“eMedicare is one of several initiatives focused on modernizing Medicare and empowering patients with information they need to get the best value from their Medicare coverage,” said CMS Administrator Seema Verma. “President Trump is delivering on his commitment to Medicare by modernizing tools that deliver health information in the most convenient way possible. This new app is the next in a suite of products designed to give consumers more access and control over their Medicare information.”

CMS created the app to meet the needs of the growing population of people with Medicare. The Medicare population is projected to increase almost 50 percent by 2030—from 54 million beneficiaries in 2015 to more than 80 million beneficiaries in 2030. As of 2016, about two-thirds of Medicare beneficiaries indicate they use the Internet daily or almost daily (65 percent). Questions about what Medicare covers are some of the most frequent inquiries that CMS receives. There are approximately 15 million page views annually for coverage-related content on and 1-800 MEDICARE receives over 3 million coverage-related calls each year.

CMS launched the eMedicare initiative in 2018 to empower beneficiaries with cost and quality information. Other tools in the eMedicare suite include:

  • Enhanced interactive online decision support to help people better understand and evaluate their Medicare coverage options and costs between Medicare and Medicare Advantage.
  • A new online service that lets people quickly see how different coverage choices will affect their estimated out-of-pocket costs.
  • New price transparency tools that let consumers compare the national average costs of certain procedures between settings, so people can see what they’ll pay for procedures done in a hospital outpatient department versus an ambulatory surgical center.
  • A new webchat option in the Medicare Plan Finder.  
  • New easy-to-use surveys across so consumers can continue to tell us what they want.

The eMedicare initiative expands and improves on current consumer service options. People with Medicare will continue to have access to paper copies of the Medicare & You handbook and Medicare Summary Notices.

The What’s Covered app is available for free in both Google Play and the Apple App Store.

The app is available in Google Play at:,
and is available in the Apple App Store at:


Audrey J. Weiss, Ph.D., Kimberly W. McDermott, Ph.D., and Kevin C. Heslin, Ph.D.

The opioid epidemic is a national crisis, but research suggests that some subgroups of the population, such as women, may be more affected than other groups. For example, compared with men, women are more likely to be prescribed painkillers and are likely to be prescribed them in higher doses and to become dependent on them more quickly.1,2 The rate of opioid-related hospitalizations3 and deaths4 has been increasing faster in recent years among women than men. Indeed, in most states in 2014, women had higher opioid-related hospitalization rates than men.5

Among women, some subgroups may be more severely affected by the opioid crisis than others. Substantial differences in opioid use exist based on characteristics of women such as age, race/ethnicity, income, payer, and geography. For example, compared with Black and Hispanic women, White women are more likely to have long-term use of prescription opioids and are likely to have higher rates of drug overdose deaths involving prescription or illegal opioids.6,7 Women aged 65 years and older have a higher prevalence of long-term prescription opioid use for noncancer pain than do women under age 65 years.8 Even within age groups, differences may exist. For instance, among women of reproductive age (15-44 years), prescription opioid use is higher among those with Medicaid than among those with private insurance.9

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents statistics on opioid-related hospitalizations among women aged 15 years and older using the 2016 National Inpatient Sample (NIS). The distribution of opioid-related stays by select patient and hospitalization characteristics is presented and contrasted with the distribution for non-opioid-related stays. The types of opioid diagnoses during hospitalization are also provided for select patient characteristics. Finally, rates of opioid-related stays are presented by patient characteristics. Differences greater than 10 percent between estimates are noted in the text.


Distribution of opioid-related inpatient stays among women by patient characteristics, 2016
Figure 1 presents characteristics of opioid-related versus nonopioid-related stays among women in 2016.

  • A higher percentage of opioid-related stays than nonopioid stays were among younger women, White women, and women with Medicaid or who were uninsured. 

    Compared with non-opioid-related stays, a higher percentage of opioid-related stays involved women aged 15-44 years (42.0 vs. 37.0 percent) and 45-64 years (34.9 vs. 23.5 percent), White women (73.3 vs. 62.8 percent), and women with stays billed to Medicaid (35.7 vs. 21.0 percent) or whose stays were not expected to be covered by insurance ("uninsured"; 5.0 vs. 3.2 percent)
  • A lower percentage of opioid-related stays than nonopioid stays were among older women, racial/ethnic minority women, women in the highest income quartile, and women with Medicare or private insurance. 

    Compared with non-opioid-related stays, a lower percentage of opioid-related stays involved women aged 65 years and older (23.1 vs. 39.5 percent). Non-White women also constituted a lower percentage of opioid-related than non-opioid-related stays (Black: 12.5 vs. 14.9 percent; Hispanic: 6.2 vs. 11.4 percent; Other race/ethnicity: 3.6 vs. 6.5 percent). A lower percentage of opioid-related than nonopioid stays were among women who resided in the highest income quartile (16.9 vs. 19.5 percent) and women who with stays billed to Medicare (38.3 vs. 43.3 percent) or private insurance (18.5 vs. 30.0 percent).

    There were no noteworthy differences by patient residence location.                                                                                   READ THIS COMPLETE STATISTICAL BRIEF HERE


Audrey J. Weiss, Ph.D., Kevin C. Heslin, Ph.D., Marguerite L. Barrett, M.S., Rwaida Izar, M.P.H., and Arlene S. Bierman, M.D., M.S.


Opioid misuse in older adults is an underappreciated and growing problem. Although opioid misuse overall is lower among older than among younger Americans, the rate of opioid misuse among older adults nearly doubled between 2002 and 2014.1 In 2016, a third of the more than 40 million Americans enrolled in Medicare Part D received prescription opioids and a substantial number received higher doses than recommended for prolonged periods of time, putting them at increased risk of misuse.2 Between 2005 and 2014, the rate of opioid-related hospitalizations increased fastest among patients aged 65 years and older compared with all other age groups.3

Eighty percent of U.S. adults aged 65 years and older have multiple chronic conditions (e.g., heart disease, diabetes, arthritis, and depression) compared with less than 20 percent of adults aged 18-44 years.4 Chronic pain is common among older adults,5 and more than one-third of older Americans are living with a disability,6 making this population more likely than younger adults to receive an opioid prescription.7 In addition, complex social needs and mental health issues including depression, substance abuse, cognitive decline, and dementia often go unrecognized and/or complicate clinical management.8, 9 Compounded by the physiologic changes associated with aging, these conditions place older adults using opioid medications at increased risk for adverse events including injurious falls10 and delirium,11 which may result in ED visits or hospital admissions.

Additionally, older adults are more likely than younger adults to take prescription medications,12 which increases the likelihood of drug interactions and adverse effects associated with the use of opioids. In the period from 2011-2014, more than 90 percent of Americans aged 65 years and older reported use of a prescription drug in the past 30 days, with over 40 percent reporting use of five or more prescription drugs in the prior 30 days (compared with less than 5 percent of adults aged 18-44 years).13 This represents a substantial increase in the proportion of adults aged 65 years and older who used prescription medications compared with 20 years earlier (1988-1994: one prescription medication, 74 percent; five or more prescription medications, 14 percent).14

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents statistics on opioid-related hospital stays and ED visits among patients aged 65 years and older in fiscal year (FY) 2010 (from quarter 4 of 2009 through quarter 3 of 2010) and FY 2015 (from quarter 4 of 2014 through quarter 3 of 2015), hereinafter referred to as 2010 and 2015.15 The number and rate of opioid-related stays and ED visits in 2010 and 2015 are provided for three distinct age groups: 65-74 years, 75-84 years, and 85 years and older. The percentage of opioid-related inpatient stays and ED visits that involved a principal opioid diagnosis is provided for each of the three age groups in 2015. Characteristics of opioid-related stays and ED visits versus nonopioid-related stays and visits among adults aged 65 years and older are presented for 2015. Identification of opioid-related stays and ED visits is based on all-listed diagnoses and includes events associated with prescription opioids or illicit opioids such as heroin. Differences greater than 10 percent between estimates are noted in the text.


Distribution of opioid-related inpatient stays and ED visits among patients aged 65 years and older, 2010 and 2015
Figure 1 provides the number of opioid-related inpatient stays and ED visits among patients aged 65 years and older by patient age group in 2010 and 2015.
  • Among patients aged 65 years and older, the rate of opioid-related hospitalizations increased more than the rate of nonopioid-related hospitalizations between 2010 and 2015:
    • Inpatient stays: a 34.3 percent increase in the rate of opioid-related stays, from 199.3 to 267.6 per 100,000 population, versus a 17.4 percent decrease in the rate of nonopioid-related stays
    • Emergency department (ED) visits: a 74.2 percent increase in the rate of opioid-related ED visits, from 44.7 to 77.9 per 100,000 population, versus a 17.4 percent increase in the rate of nonopioid-related ED visits

  • Compared with nonopioid-related stays among patients aged 65 years and older in 2015, opioid-related stays involved—
    • Higher average inpatient costs and ED charges
    • A higher proportion of patients discharged against medical advice
    • A higher proportion of patients with multiple chronic conditions
    • A higher hospitalization rate among patients residing in western States relative to other regions


Figure 1. Number of opioid-related inpatient stays and ED visits among patients aged 65 years and older, by age group, 2010 versus 2015

Abbreviation: ED, emergency department
Note: Number of stays and visits were based on all-listed diagnoses and rounded to the nearest hundred.
Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), 2010 and 2015 fiscal year data from the National (Nationwide) Inpatient Sample (NIS), 2009-2010 and 2014-2015; Nationwide Emergency Department Sample (NEDS), 2009-2010 and 2014-2015

Read this complete statistical Brief Here.

Now Available from CMS: eCQM Tools, Resources, & Collaboration (InfoTRAC) Graphic and Annual Timeline on the eCQI Resource Center

The Centers for Medicare & Medicaid Services (CMS) recently updated the Electronic Clinical Quality Improvement (eCQI) Resource Center website based on user feedback. It is the one-stop shop for the most current resources to support electronic clinical quality improvement. The website serves as a centralized location for federal eCQI initiatives and includes the most current Electronic Clinical Quality Measure (eCQM) specifications, as well as links to the tools, standards, education, and materials critical to support development, testing, implementation, and reporting of eCQMs. The eCQI Resource Center is excited to offer two new resources based on stakeholder feedback.

The new eCQM Tools, Resources, & Collaboration (InfoTRAC) previously named eCQM Tools & Resources, has been revised and redeveloped based on user input. This interactive graphic provides an in-depth overview of the tools, standards, and resources used in the various stages of the eCQM lifecycle. Stakeholders will find references and links to tools and resources specific to their areas of interest.

The Annual Timeline is a new interactive tool that improves awareness of eCQM resources and timeframes for measure developers, implementers, and end users to plan and provide feedback looking from a calendar year. It is a general guide for referencing scheduled updates affecting programs that use eCQMs including eCQM specifications, tools, reporting, proposed and final rules, public comments, and more.

Tell us what you think! Visit the eCQI Resource Center to learn more. Send any suggestions for improvement, news, events, and content for posting to

For More Information in Regards to......

promoting interoperability programs
Submit specific questions regarding eCQMs, eCQM standards, and eCQM tools to the eCQI Resource Center. You can also find the most updated measure specifications and supplemental materials on the eCQI Resource Center.

           Join NTOCC in Washington D.C. this year for our Annual Transitions of Care Conference: 

"Quality Transitions: What is the Secret Sauce to Positive Outcomes"
  Mark your calendars for September 18, 2019. 
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