Comparing Medicare Opioid Prescription Trends among Oral and Maxillofacial Surgeons Practicing in Rural versus Urban Settings from 2014-2018

Tim T. Wang

Wang, Tim T., Hersh, Elliot, Panchal, Neeraj
University of Pennsylvania School of Dental Medicine, Department of Oral & Maxillofacial Surgery/Pharmacology


The opioid misuse crisis is a major public health challenge. There are many differences in the access to and delivery of oral and maxillofacial services in urban, as compared to rural, settings. In other areas of medicine, such as primary care, opioids are more often prescribed in rural settings. This study aimed to compare opioid analgesic prescription patterns among OMSs practicing in urban and rural settings.


This cross-sectional study used Medicare Provider Utilization and Payment Data from 2014 to 2018, focusing on providers labeled as OMS. Rural-Urban Commuting Area Codes (RUCA) were used to categorize each OMS as urban or rural. The outcome variables included Total Claims of Opioids (Including Refills), Mean Opioid Prescriptions Per Beneficiary, and Number of Days Supply of Opioids Per Claim. Descriptive statistics were summarized, and Wilcoxon rank-sum tests were employed to compare continuous variable means with statistical significance at p-value <0.05.


The study sample, from 2014-2018, consisted of mostly urban and male OMSs. The mean number of beneficiaries per OMS varied widely, and the mean age of beneficiaries was around 70 years. The mean hierarchical condition category (HCC), used as a proxy for patient complexity, were similar between rural versus urban OMSs across all years. The mean opioid claims per provider was higher among rural OMSs across all years, with large standard deviations among both rural and urban OMSs. However, there were no statistically significant differences in the mean opioid prescriptions per beneficiary (about 1.1-1.2). While in some years there were statistically significant differences between urban and rural OMSs in the number of days’ supply per claim, the magnitude of difference was small (all periods had about 3-4 days).


While rural OMSs prescribed a higher mean volume of opioid analgesics than their urban counterparts, there were no differences in mean amount of opioids prescriptions written per beneficiary. These results suggest similar opioid prescription behaviors among the majority OMSs practicing in both rural and urban settings. However, the large standard deviation in the mean opioid claims per provider affirms previous work that have found extreme cases of opioid prescription volume among a subset of Medicare OMSs. Limitations of this study includes the relatively small number of rural OMSs in the dataset and its limited generalizability to prescription behaviors towards the non-elderly population.