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Raver E, Retchin SM, Li Y, Carlo AD, Xu WY. Rural-urban differences in out-of-network treatment initiation and engagement rates for substance use disorders. Health Serv Res 2024; 59:e14299. [PMID: 38456488 PMCID: PMC11366955 DOI: 10.1111/1475-6773.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To examine rural-urban disparities in substance use disorder treatment access and continuation. DATA SOURCES AND STUDY SETTING We analyzed a 2016-2018 U.S. national secondary dataset of commercial insurance claims. STUDY DESIGN This cross-sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out-of-network providers for these services, were compared between rural and urban patients. DATA COLLECTION We included individuals 18-64 years old with continuous employer-sponsored insurance. PRINCIPAL FINDINGS Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out-of-network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. CONCLUSIONS These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out-of-network.
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Affiliation(s)
- Eli Raver
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Sheldon M. Retchin
- Division of General Internal Medicine, Department of Internal Medicine, College of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Yiting Li
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Present address:
Nationwide Children's HospitalColumbusOhioUSA
| | - Andrew D. Carlo
- Meadows Mental Health Policy InstituteNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Wendy Y. Xu
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
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Savitz ST, Stevens MA, Nath B, D’Onofrio G, Melnick ER, Jeffery MM. Trends in the Prescribing of Buprenorphine for Opioid Use Disorder, 2019-2023. Mayo Clin Proc Innov Qual Outcomes 2024; 8:308-320. [PMID: 38841599 PMCID: PMC11152959 DOI: 10.1016/j.mayocpiqo.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Objective To evaluate whether access to buprenorphine to treat opioid use disorder (OUD) was associated with the coronavirus disease pandemic, the relaxation of training requirements to obtain an X-Waiver to prescribe buprenorphine (April 2021), and the removal of the X-Waiver (December 2022). Patients and Methods The OptumLabs Data Warehouse, which includes claims from Commercial and Medicare Advantage enrollees, was used to evaluate trends in prescription fills from January 1, 2019, to June 30, 2023. We compared fill patterns of buprenorphine for OUD with acamprosate to treat alcohol use disorder and naltrexone to treat alcohol use disorder or OUD. We evaluated trends in the rate ratio (RR) of overall fills; RR by days supply; distribution of fills by daily dose; and distribution of fills by prescriber type. Results Coronavirus disease (RR, 1.06; 95% CI, 1.01-1.11) was associated with a slightly increased rate of fills for Commercial enrollees but not overall or for Medicare Advantage enrollees. There were also no significant increases (P>0.05) associated with the change in training requirements or removal of the X-Waiver. Over the study period, there was an increasing share of fills for 16+ mg for Commercial enrollees, and buprenorphine prescribers were more likely to be advanced practice nurses or physician assistants. Conclusion We did not find meaningful improvement in access in response to coronavirus disease or the changes in the X-Waiver. These findings suggest that interventions beyond removing the X-Waiver may be needed to improve buprenorphine access.
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Affiliation(s)
- Samuel T. Savitz
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
| | - Maria A. Stevens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
| | - Bidisha Nath
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Edward R. Melnick
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Molly M. Jeffery
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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Stopka TJ, Estadt AT, Leichtling G, Schleicher JC, Mixson LS, Bresett J, Romo E, Dowd P, Walters SM, Young AM, Zule W, Friedmann PD, Go VF, Baker R, Fredericksen RJ. Barriers to opioid use disorder treatment among people who use drugs in the rural United States: A qualitative, multi-site study. Soc Sci Med 2024; 346:116660. [PMID: 38484417 PMCID: PMC10997882 DOI: 10.1016/j.socscimed.2024.116660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/26/2023] [Accepted: 02/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In 2020, 2.8 million people required substance use disorder (SUD) treatment in nonmetropolitan or 'rural' areas in the U.S. Among this population, only 10% received SUD treatment from a specialty facility, and 1 in 500 received medication for opioid use disorder (MOUD). We explored the context surrounding barriers to SUD treatment in the rural United States. METHODS We conducted semi-structured, in-depth interviews from 2018 to 2019 to assess barriers to SUD treatment among people who use drugs (PWUD) across seven rural U.S. study sites. Using the social-ecological model (SEM), we examined individual, interpersonal, organizational, community, and policy factors contributing to perceived barriers to SUD treatment. We employed deductive and inductive coding and analytical approaches to identify themes. We also calculated descriptive statistics for participant characteristics and salient themes. RESULTS Among 304 participants (55% male, mean age 36 years), we identified barriers to SUD treatment in rural areas across SEM levels. At the individual/interpersonal level, relevant themes included: fear of withdrawal, the need to "get things in order" before entering treatment, close-knit communities and limited confidentiality, networks and settings that perpetuated drug use, and stigma. Organizational-level barriers included: strict facility rules, treatment programs managed like corrections facilities, lack of gender-specific treatment programs, and concerns about jeopardizing employment. Community-level barriers included: limited availability of treatment in local rural communities, long distances and limited transportation, waitlists, and a lack of information about treatment options. Policy-level themes included insurance challenges and system-imposed barriers such as arrest and incarceration. CONCLUSION Our findings highlight multi-level barriers to SUD treatment in rural U.S. communities. Salient barriers included the need to travel long distances to treatment, challenges to confidentiality due to small, close-knit communities where people are highly familiar with one another, and high-threshold treatment program practices. Our findings point to the need to facilitate the elimination of treatment barriers at each level of the SEM in rural America.
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Affiliation(s)
- T J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - A T Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | - J C Schleicher
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - L S Mixson
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J Bresett
- Southern Illinois University at Carbondale, Dept of Public Health, Carbondale, IL, USA
| | - E Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - P Dowd
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - S M Walters
- New York University's Grossman School of Medicine, New York, NY, USA
| | - A M Young
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - W Zule
- RTI International, Research Triangle, NC, USA
| | - P D Friedmann
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - V F Go
- University, of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - R Baker
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - R J Fredericksen
- University of Washington, Department of Medicine, Seattle, WA, USA
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Abraham AJ, Harris SJ, Yarbrough CR. Introduction of Medicare coverage in opioid treatment programs: Findings from the first three years. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209247. [PMID: 38072386 PMCID: PMC10947910 DOI: 10.1016/j.josat.2023.209247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Prior to January of 2020, there was no Medicare reimbursement for services delivered in opioid treatment programs (OTPs). OTPs are the only authorized providers of opioid use disorder (OUD) treatment with methadone, a critical tool to address the opioid overdose crisis. While prior research has examined the availability of MOUD other than methadone for Medicare beneficiaries, research has not identified organizational and local Medicare beneficiary characteristics associated with Medicare insurance acceptance among OTPs. OBJECTIVES This study has two objectives: 1) to determine the extent to which OTPs began accepting Medicare insurance in the first three years following the new Medicare OTP benefit; and 2) to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare. METHODS We used data from the 2021-2023 National Directory of Drug and Alcohol Abuse Treatment Facilities to examine OTP acceptance of Medicare. We used logistic regression to identify organizational characteristics and local Medicare beneficiary characteristics associated with OTP acceptance of Medicare (n = 4630 OTPs). RESULTS By 2022, about 78.7 % of OTPs accepted Medicare, compared to only 41.1 % of non-OTPs. The odds of Medicare acceptance were lower among for-profit OTPs, compared to non-profit OTPs, and higher among OTPs that accepted Medicaid and private insurance. Additionally, the odds of accepting Medicare were lower for OTPs located in the Northeast, Midwest, and South, compared to OTPs located in the West. Finally, the odds of accepting Medicare were higher for OTPs located in counties with higher percentages of Non-Hispanic White Medicare beneficiaries. CONCLUSIONS We found high rates of Medicare acceptance among OTPs in the first three years of the Medicare OTP benefit, suggesting increased access to OUD treatment via OTPs for Medicare beneficiaries. While promising, results indicate potential geographic and racial/ethnic disparities in access to OTPs.
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Affiliation(s)
- Amanda J Abraham
- University of Georgia, School of Public and International Affairs, Department of Public Administration and Policy, United States of America.
| | - Samantha J Harris
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, United States of America
| | - Courtney R Yarbrough
- Emory University, Rollins School of Public Health, Department of Health Policy and Management, United States of America
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Kapinos KA, DeYoreo M, Gracner T, Stein BD, Cantor J. Trends in Geographic Proximity to Substance Use Disorder Treatment. Am J Prev Med 2023; 65:618-626. [PMID: 37037326 PMCID: PMC10524906 DOI: 10.1016/j.amepre.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION This study aims to assess the trends in the number and characteristics of substance use disorder (SUD) treatment facilities within the county of residence of adults aged 50+ years over time. METHODS Using retrospective longitudinal data from the 1992-2018 Health and Retirement Study merged with the county-level data on all licensed treatment facilities in the country, linear mixed models were estimated to calculate geographic accessibility to SUD treatment, adjusted for person-level demographics, state-level controls, and calendar year-fixed effects. Analysis was conducted in 2022. RESULTS Overall, older adults experienced a decline in the average number of SUD treatment facilities within their counties of residence from 4.80 per 100,000 residents (95% CI=4.69, 4.92) in 1992 to 4.50 (95% CI=4.35, 4.64) in 2018. However, the number accepting Medicare increased from 0.26 (95% CI=0.21, 0.30) in 1992 to 1.88 (95% CI=1.80, 1.96) facilities per 100,000 (42% of facilities); Medicaid increased from 0.20 (95% CI=0.13, 0.26) in 1992 to 3.50 (95% CI=3.39, 3.62) facilities per 100,000 (78% of facilities) in 2018. Older adults living in more rural areas experienced the most growth in SUD treatment facilities per capita in their counties but with less significant growth in facilities offering medication for opioid use disorder than those living in more urban areas. CONCLUSIONS Despite increases in the number of SUD treatment facilities in rural areas, there has been less growth in nearby facilities offering evidence-based medication treatment for opioid use disorder.
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Affiliation(s)
- Kandice A Kapinos
- RAND Corporation, Arlington, Virginia; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas.
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Harris SJ, Yarbrough CR, Abraham AJ. Changes In County-Level Access To Medications For Opioid Use Disorder After Medicare Coverage Of Methadone Treatment Began. Health Aff (Millwood) 2023; 42:991-996. [PMID: 37406230 PMCID: PMC11332379 DOI: 10.1377/hlthaff.2023.00148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
In 2020 Medicare began reimbursing for opioid treatment program (OTP) services, including methadone maintenance treatment for opioid use disorder (OUD), for the first time. Methadone is highly effective for OUD, yet its availability is restricted to OTPs. We used 2021 data from the National Directory of Drug and Alcohol Abuse Treatment Facilities to examine county-level factors associated with OTPs accepting Medicare. In 2021, 16.3 percent of counties had at least one OTP that accepted Medicare. In 124 counties the OTP was the only specialty treatment facility offering any form of medication for opioid use disorder (MOUD). Regression results showed that the odds of a county having an OTP that accepted Medicare were lower for counties with higher versus lower percentages of rural residents and lower for counties located in the Midwest, South, and West compared with the Northeast. The new OTP benefit improved the availability of MOUD treatment for beneficiaries, although geographic gaps in access remain.
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Humphreys K, Shover CL. Twenty-Year Trends in Drug Overdose Fatalities Among Older Adults in the US. JAMA Psychiatry 2023; 80:518-520. [PMID: 36988923 PMCID: PMC10061315 DOI: 10.1001/jamapsychiatry.2022.5159] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/21/2022] [Indexed: 03/30/2023]
Abstract
This study uses data from the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to assess 20-year trends in drug overdose fatalities among older adults in the US.
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Affiliation(s)
- Keith Humphreys
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Chelsea L. Shover
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles
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Waite MR, Heslin K, Cook J, Kim A, Simpson M. Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208933. [PMID: 36805798 DOI: 10.1016/j.josat.2022.208933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel. METHODS To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses. RESULTS Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment. CONCLUSIONS Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment.
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Affiliation(s)
- Mindy R Waite
- Advocate Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Jonathan Cook
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Aengela Kim
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; Chicago Medical School, Rosalind Franklin University, 3333 Green Bay Rd, North Chicago, IL 60064, USA.
| | - Michelle Simpson
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; AAH Ed Howe Center for Health Care Transformation, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
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Mark TL, Parish WJ, Weber EM, Steinberg DG, Henretty K. The cost of opioid use disorder-related conditions in Medicare. Drug Alcohol Depend 2023; 244:109778. [PMID: 36701935 DOI: 10.1016/j.drugalcdep.2023.109778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Medicare coverage excludes some levels of substance use disorder (SUD) care, such as intensive outpatient and residential treatment. Expanding access to SUD treatment could increase Medicare spending. However, these costs could be offset if SUD treatment resulted in cost savings from reducing SUD-related medical events and SUD-related medical comorbidities. METHODS This study estimated cost savings from expanding access to SUD treatment for persons with opioid use disorders (OUD) using three methods. First, we compared total Medicare fee-for-service spending on individuals with OUD and no treatment with OUD medications (MOUD) to Medicare spending on individuals without OUD after matching on age/sex/Medicare-Medicaid eligibility status. Second, we compared Medicare spending on individuals with OUD who received MOUD to spending individuals with OUD who did not receive MOUD. Third, we determined OUD-attributable Medicare spending for comorbid physical and mental conditions with a strong association with OUD. RESULTS Beneficiaries with OUD but no MOUD totaled $15.8 billion more than beneficiaries without OUD. Beneficiaries with OUD but no MOUD totaled $12.1 billion more than individuals with OUD and MOUD. Lastly, Medicare spending on OUD-attributable comorbidities was $4.7 billion if all medical and mental health comorbidities were included and $3.0 billion with only medical comorbidities. The totals could be 1.7 times higher if Medicare Advantage enrollees were included. CONCLUSION Expanding Medicare coverage of appropriate levels of care could improve access to effective treatment and reduce the costs associated with untreated OUD. This will likely result in substantial Medicare cost savings.
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Affiliation(s)
- Tami L Mark
- RTI International, 701 13th Street NW, Suite 750, Washington, DC 20005, USA.
| | - William J Parish
- RTI International, 3040 East Cornwallis Rd, P.O. Box 12194, Research Triangle Park, NC 27709, USA.
| | - Ellen M Weber
- Legal Action Center, 810 1st Street, NE, Suite 200, Washington DC 20002, USA.
| | - Deborah G Steinberg
- Legal Action Center, 810 1st Street, NE, Suite 200, Washington DC 20002, USA.
| | - Kristen Henretty
- RTI International, 3040 East Cornwallis Rd, P.O. Box 12194, Research Triangle Park, NC 27709, USA.
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Cantor JH, DeYoreo M, Hanson R, Kofner A, Kravitz D, Salas A, Stein BD, Kapinos KA. Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021. JAMA Netw Open 2022; 5:e2241128. [PMID: 36367729 PMCID: PMC9652758 DOI: 10.1001/jamanetworkopen.2022.41128] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Importance The drug overdose crisis is a continuing public health problem and is expected to grow substantially in older adults. Understanding the geographic accessibility to a substance use disorder (SUD) treatment facility that accepts Medicare can inform efforts to address this crisis in older adults. Objective To assess whether geographic accessibility of services was limited for older adults despite the increasing need for SUD and opioid use disorder treatments in this population. Design, Setting, and Participants This longitudinal cross-sectional study obtained data on all licensed SUD treatment facilities for all US counties and Census tracts listed in the National Directory of Drug and Alcohol Abuse Treatment Programs from 2010 to 2021. Main Outcomes and Measures Measures included the national proportion of treatment facilities accepting Medicare, Medicaid, private insurance, or cash as a form of payment; the proportion of counties with a treatment facility accepting each form of payment; and the proportion of the national population with Medicare, Medicaid, private insurance, or cash payment residing within a 15-, 30-, or 60-minute driving time from an SUD treatment facility accepting their form of payment in 2021. Results A total of 11 709 SUD treatment facilities operated across the US per year between 2010 and 2021 (140 507 facility-year observations). Cash was the most commonly accepted form of payment (increasing slightly from 91.0% in 2010 to 91.6% by 2021), followed by private insurance (increasing from 63.5% to 75.3%), Medicaid (increasing from 54.0% to 71.8%), and Medicare (increasing from 32.1% to 41.9%). The proportion of counties with a treatment facility that accepted Medicare as a form of payment also increased over the same study period from 41.2% to 53.8%, whereas the proportion of counties with a facility that accepted Medicaid as a form of payment increased from 53.5% to 67.1%. The proportion of Medicare beneficiaries with a treatment facility that accepted Medicare as a form of payment within a 15-minute driving time increased from 53.3% to 57.0%. The proportion of individuals with a treatment facility within a 15-minute driving time that accepted their respective form of payment was 73.2% for those with Medicaid, 69.8% for those with private insurance, and 71.4% for those with cash payment in 2021. Conclusions and Relevance Results of this study suggest that Medicare beneficiaries have less geographic accessibility to SUD treatment facilities given that acceptance of Medicare is low compared with other forms of payment. Policy makers need to consider increasing reimbursement rates and using additional incentives to encourage the acceptance of Medicare.
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Affiliation(s)
| | | | | | | | | | | | | | - Kandice A. Kapinos
- RAND Corporation, Arlington, Virginia
- Peter J. O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas
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11
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Moyo P, Eliot M, Shah A, Goodyear K, Jutkowitz E, Thomas K, Zullo AR. Discharge locations after hospitalizations involving opioid use disorder among medicare beneficiaries. Addict Sci Clin Pract 2022; 17:57. [PMID: 36209151 PMCID: PMC9548174 DOI: 10.1186/s13722-022-00338-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospitalizations involving opioid use disorder (OUD) have been increasing among Medicare beneficiaries of all ages. With rising OUD-related acute care use comes the need to understand where post-acute care is provided and the capacities for OUD treatment in those settings. Our objective was to describe hospitalized Medicare beneficiaries with OUD, their post-acute care locations, and all-cause mortality and readmissions stratified by post-acute care location. METHODS We conducted a retrospective cohort study of acute hospitalizations using 2016-2018 Medicare Provider Analysis and Review (MedPAR) files linked to Medicare enrollment data and the Residential History File (RHF) for 100% of Medicare fee-for-service beneficiaries. The RHF which provides a person-level chronological history of health service utilization and locations of care was used to identify hospital discharge locations. We used ICD-10 codes for opioid dependence or "abuse" to identify OUD diagnoses from the MedPAR file. We conducted logistic regression to identify factors associated with discharge to an institutional setting versus home adjusting for demographics, comorbidities, and hospital stay characteristics. RESULTS Our analysis included 459,763 hospitalized patients with OUD. Of these, patients aged < 65 years and those dually enrolled in Medicaid comprised the majority (59.1%). OUD and opioid overdose were primary diagnoses in 14.3% and 6.2% of analyzed hospitalizations, respectively. We found that 70.3% of hospitalized patients with OUD were discharged home, 15.8% to a skilled nursing facility (SNF), 9.6% to a non-SNF institutional facility, 2.5% home with home health services, and 1.8% died in-hospital. Within 30 days of hospital discharge, rates of readmissions and mortality were 29.7% and 3.9%; respectively, with wide variation across post-acute locations. Factors associated with greater odds of discharge to institutional settings were older age, female sex, non-Hispanic White race and ethnicity, dual enrollment, longer hospital stay, more comorbidities, intensive care use, surgery, and primary diagnoses including opioid or other drug overdoses, fractures, and septicemia. CONCLUSIONS More than one-quarter (25.8%) of hospitalized Medicare beneficiaries with OUD received post-acute care in a setting other than home. High rates and wide variation in all-cause readmissions and mortality within 30 days post-discharge emphasize the need for improved post-acute care for people with OUD.
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Affiliation(s)
- Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-6, Providence, RI, 02912, USA. .,Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Melissa Eliot
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
| | - Asghar Shah
- grid.40263.330000 0004 1936 9094Brown University, Providence, RI USA
| | - Kimberly Goodyear
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Brown University, Providence, RI USA ,grid.40263.330000 0004 1936 9094Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
| | - Eric Jutkowitz
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-6, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA ,grid.413904.b0000 0004 0420 4094Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, Providence, RI USA
| | - Kali Thomas
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-6, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA ,grid.413904.b0000 0004 0420 4094Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, Providence, RI USA
| | - Andrew R. Zullo
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-6, Providence, RI 02912 USA ,grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI USA ,grid.413904.b0000 0004 0420 4094Providence VA Medical Center, Center of Innovation in Long Term Services and Supports, Providence, RI USA
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