Healthcare Inspection - Alleged Inappropriate Opioid Prescribing Practices, Rutherford County Community Based Outpatient Clinic, Rutherfordton, North Carolina

OIG conducted an inspection in response to complaints about inappropriate opioid prescribing practices.at the Rutherford County Community Based Outpatient Clinic (CBOC), Rutherfordton, NC, associated with the Asheville VA Medical Center, Asheville, NC. We did not substantiate that community based outpatient clinic primary care physicians were being forced to write prescriptions for opioids. However, during our review, we noted the clinical and administrative environment in which community based outpatient clinic providers prescribed opioids and managed the pain-related needs of their patients and found several processes that negatively impacted the delivery of quality patient care. We recommended that the Facility Director ensure that: (1) primary care physicians are able to assess, treat, monitor, and reassess patients on chronic opioid therapy within the appropriate timeframe; (2) the Veterans’ Integrated Pain Management Clinic meets non-opioid pain management needs of patients as evidenced by timely consultation completions; (3) clinical and administrative demands of chronic opioid therapy care are considered when determining appropriateness of primary care physician staffing and that staffing plans are in place for planned and unplanned provider vacancies and absences; (4) benzodiazepine appropriateness evaluations are completed as required for chronic opioid therapy patients with post-traumatic stress disorder (PTSD); (5) primary care and mental health providers communicate and coordinate care for PTSD patients receiving both opioids and benzodiazepines; and (6) regular communication occurs between facility leadership and community based outpatient clinic leadership to support consistent high quality care.