Research Reveals Gaps in Tracking Opioid Use Among Older Adults in Medicare Post-Acute Care
Medicare data may miss the majority of opioid use after hospital discharge in skilled nursing facilities, raising concerns for patient safety and care.
A new research letter published in JAMA Health Forum highlights major gaps in how opioid use is tracked among older adults receiving post-acute care under Medicare. Researchers found that Medicare Part D claims significantly underreport opioid dispensing for patients admitted to skilled nursing facilities after hospitalization — a shortcoming that may hinder effective pain management, patient safety monitoring, and health policy decisions.
The analysis, titled “Opioid Exposure Measurement in Postacute Care Under Medicare Consolidated Payments,” compared Medicare Part D prescription claims with records from long-term care pharmacies serving skilled nursing facilities. The researchers found that among 52,586 opioid-naive Medicare beneficiaries admitted to SNFs after a hip fracture, 71.4 % received an opioid within 100 days of admission. At 31 days post-admission, 86.5% of patients were still receiving opioids per pharmacy data, versus only 19.4% reflected in Part D. Within 100 days of SNF admission, 65% of patients who received opioids in SNFs were not captured in Medicare claims, suggesting that current data sources may overlook most opioid use during this critical transition from hospital to nursing care.
Older adults recovering from surgery, fractures, or illness often rely on opioids for short-term pain relief while in SNFs. These facilities are key points of care transition, when patients are particularly vulnerable to medication errors, side effects, and overuse. Because Medicare data drives national opioid surveillance and reimbursement policies, undercounting opioid prescriptions may give a false sense of progress in reducing opioid use — and limit the ability to identify patients at risk of misuse or prolonged dependency.
“Accurate data on medication use are essential to protecting patients,” said Sarah Berry, MD, MPH, senior scientist at the Hinda and Arthur Marcus Institute for Aging Research. “If we underestimate how often opioids are prescribed in skilled nursing facilities, we risk missing opportunities to monitor safety and efficacy, prevent dependency, and guide policy. Our findings show that important blind spots remain in how opioid exposure is measured for older hospitalized adults.”
The authors suggest that incorporating data from long-term care pharmacies could improve measurement of medication use in post-acute care and enhance the accuracy of opioid-related research and policy.
In addition to Dr. Berry, the Research Letter was authored by Kelsey L. Corcoran, DC, research scientist, Center for Gerontology & Healthcare Research, Brown University School of Public Health; Kaleen N. Hayes, PharmD, PhD, associate director of health services, Policy and Practice, Brown University School of Public Health; Richa Joshi, MBA, MS, biostatistician, Department of Epidemiology, Brown University School of Public Health; and Andrew R. Zullo, PharmD, PhD, ScM, clinical pharmacy specialist, Research, Center for Gerontology & Healthcare Research, Brown University School of Public Health.
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Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across seven campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $98 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, Threads, and LinkedIn.
About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.
