Ten Connecticut prescribers, including a Derby nurse practitioner who is under investigation by the state, were responsible for more than 22 percent of the state’s Medicare spending on potent narcotics in 2013, new federal data show. More than 4,300 Connecticut clinicians, mostly physicians, wrote Medicare prescriptions for oxycodone, morphine and other Schedule II drugs, which have a high potential for abuse and addiction, at a total cost of $40 million. But a handful of those providers accounted for the largest share of those prescriptions, an analysis of the data show. Topping the list, in both the number of prescriptions and cost, was Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, who wrote out 8,523 prescriptions, at a cost of $2.7 million. Statewide, the average number of prescriptions per clinician was 104, and no other prescriber had more than 5,000 Schedule II claims. The average cost per prescriber was $9,138; the next closest individual cost was $1.8 million.
Lawmakers this session approved bills that put in place new initiatives to stem substance abuse and opioid overdoses, change the way restraints and seclusion are used in Connecticut schools and limit the use of shackles on juveniles in court. Those were just some of the legislature’s health and safety measures reported on by C-HIT during the year. The session, which ended last week, was largely dominated by budget and transportation issues. Under the bills approved:
• Any prescriber supplying more than a 72-hour supply of a controlled substance must first review the patient’s record in a statewide database. In addition, practitioners must review the patient’s record at least every 90 days if prescribing for prolonged treatment.
A Derby nurse practitioner was among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 – an anomaly in a state where Medicare records show nurse practitioners rarely prescribe such drugs, which have a high potential for abuse. Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, wrote out 8,705 prescriptions for opioids and other Schedule II drugs in 2012 – the most prolific prescriber among all Connecticut practitioners, including pain specialists and other physicians, according to Medicare data compiled by ProPublica. She wrote out more prescriptions for the opioid Exalgo than any other Medicare provider in the country, and was the seventh highest prescriber nationally of Oxycontin, writing out more than twice as many prescriptions for that narcotic as the next highest prescriber in Connecticut. She also was the 10th highest prescriber nationally of Avinza, a morphine product. There is no indication that Alfonso’s unusual prescribing frequency drew scrutiny from state or federal officials.
The state and the recently formed union representing family child care providers in the Connecticut Care 4 Kids program announced an agreement Thursday that will provide for professional development and wage increases. The agreement came after nine months of negotiations between the two parties. Family child care providers who provide in-home care will undergo a four-hour orientation program that will include specialized trainings and information on the quality-enhancement programs offered by the Office of Early Childhood, the governor’s office said. Also, the state will offer incentives for license-exempt providers who seek state licensure, through a one-time, $500 bonus for maintaining their license status. The state now has hundreds of unlicensed family day care providers.