Sec. 254. Review, investigation, and report on use of opioids in treatment by Department of Veterans Affairs
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Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the Opioid Safety Initiative of the Department of Veterans Affairs and the opioid prescribing practices of health care providers of the Department. The report submitted under paragraph
(1)shall include the following: An assessment of the implementation and monitoring by the Veterans Health Administration of the Opioid Safety Initiative of the Department, including examining, as appropriate, the following: How the Department monitors the key clinical outcomes of such safety initiative (for example, the percentage of unique veterans visiting each medical center of the Department that are prescribed an opioid or an opioid and benzodiazepine concurrently) and how the Department uses that information— to improve prescribing practices; and to identify high prescribing or otherwise inappropriate prescribing practices by health care providers. How the Department monitors the use of the Opioid Therapy Risk Report tool of the Department (as developed through such safety initiative) and compliance with such tool by medical facilities and health care providers of the Department, including any findings by the Department of prescription rates or prescription practices by medical facilities or health care providers that are inappropriate. The implementation of academic detailing programs within the Veterans Integrated Service Networks of the Department and how such programs are being used to improve opioid prescribing practices. Information with respect to known deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider of the Department. Information made available under the Opioid Therapy Risk Report tool of the Department with respect to the following: Overall prescription rates and, if available, indications used by health care providers for prescribing chronic opioid therapy to treat noncancer, non-palliative care, and non-hospice care patients. The prescription rates and indications used by health care providers of the Department for prescribing benzodiazepines and chronic opioid therapy concurrently. The practice by health care providers of the Department of prescribing opioids to treat patients without any known pain, including to treat patients with mental health disorders other than an opioid use disorder. An evaluation of processes of the Department to oversee opioid use among veterans, including processes to identify and remedy potential overprescribing of opioids by health care providers of the Department, and an evaluation of the use and effectiveness of such processes. An evaluation of processes of the Department to oversee and ensure the implementation by medical centers of the Department of the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy, as updated under section 251(a), including any figures or approaches used by the Department to assess implementation and compliance with such guideline by medical centers and whether any medical centers are operating action plans to improve compliance with such guideline. An assessment of the data that the Department has developed to review the opioid prescribing practices of health care providers of the Department, as required by this subtitle, including a review of how the Department identifies the practices of individual health care providers that warrant further review based on— prescribing levels; health conditions for which the health care provider is prescribing opioids or opioids and benzodiazepines concurrently; or other practices of the health care provider. Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter, the Secretary of Veterans Affairs shall, with respect to each medical facility of the Department of Veterans Affairs, collect and review information on opioids prescribed by health care providers at the facility to treat noncancer, non-palliative care, and non-hospice care patients, including information on— the prescription rate at which each health care provider at the facility prescribed opioids, and benzodiazepines and opioids concurrently, to such patients and the aggregate of such prescription rates for all health care providers at the facility; the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which benzodiazepines or opioids are not a recommended treatment and the aggregate of such prescription rates for all health care providers at the facility; the prescription rate at which each health care provider at the facility prescribed or dispensed mail-order prescriptions of opioids to such patients while such patients were being treated with opioids on an inpatient-basis and the aggregate of such prescription rates for all health care providers at the facility; and the prescription rate at which each health care provider at the facility prescribed opioids to such patients who were also concurrently prescribed opioids by a health care provider who is not a health care provider of the Department and the aggregate of such prescription rates for all health care providers at the facility. If the Secretary determines that a prescription rate described in subsection
(b)with respect to a health care provider or medical facility of the Department conflicts with or is otherwise inconsistent with the standards of appropriate and safe care, the Secretary shall— through the Office of the Medical Inspector of the Veterans Health Administration, conduct a full investigation of the health care provider or medical facility, as the case may be; immediately notify the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and each Member of the Senate and the House of Representatives who represents the area in which the health care provider or medical facility, as the case may be, is located; and include information relating to such determination, prescription rate, and health care provider or medical facility, as the case may be, in the report required under subsection (d). Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter through 2026, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report that contains, for the one-year period preceding the submittal of the report, the following: The number of patients and the percentage of the patient population of the Department of Veterans Affairs who were prescribed opioids, and benzodiazepines and opioids concurrently, by a health care provider of the Department. The number of patients and the percentage of the patient population of the Department without any documented pain who were prescribed opioids by a health care provider of the Department, including those who were prescribed benzodiazepines and opioids concurrently. The number of noncancer, non-palliative care, and non-hospice care patients and the percentage of such patients who were treated with opioids by a health care provider of the Department on an inpatient-basis and who were also sent prescription opioids by mail by the Department while being treated on an inpatient-basis. The number of noncancer, non-palliative care, and non-hospice care patients and the percentage of such patients who were prescribed opioids concurrently by a health care provider of the Department and a health care provider who is not a health care provider of the Department. With respect to each medical facility of the Department, the number of times a pharmacist at the facility overrode a critical drug interaction warning with respect to an interaction between opioids and another medication before dispensing such other medication to a veteran. The results of the review conducted under subsection
(b)(including a summary of such review at the Veterans Integrated Service Network level) and the investigation conducted under subsection
(c)(including information described in subsection (c)(3)), compiled in such a manner as the Secretary determines appropriate to ensure that the information is easily accessible. Each report submitted under paragraph
(1)after the date that is two years after the date of the enactment of this Act shall include an assessment of the compliance of the Department with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any update to such guideline. In this section, the term prescription rate means, with respect to a health care provider or medical facility of the Department, each of the following: The number of patients treated with opioids by the health care provider or at the medical facility, as the case may be, divided by the total number of pharmacy users of that health care provider or medical facility. The average number of morphine equivalents per day prescribed by the health care provider or at the medical facility, as the case may be, to patients being treated with opioids. Of the patients being treated with opioids by the health care provider or at the medical facility, as the case may be, the average number of prescriptions of opioids per patient.