The U.S. is experiencing an epidemic of opioid misuse and mortality, and although effective treatments are available, they are greatly underused due to a variety of barriers. In response, some U.S. hospitals have established programs to identify emergency department patients with opioid use disorders (OUD) and begin treatment with medications for OUD.
“We had been hearing that some hospitals were creating these programs, and we were curious how they were making things work financially. That matters for an idea like this to spread,” said lead author Dominic Hodgkin, a professor at Brandeis University’s Heller School for Social Policy and Management.
To better understand the financial aspects of emergency department-based treatment models, including insurance billing and reimbursement, researchers at Heller recently conducted a qualitative study of 12 interviews with officials at U.S. hospitals across 10 states.
The researchers found that medication costs are often billable to insurers, but costs of key para-professional staff like peer navigators are not, requiring the hospital to absorb their salaries. Even some billable costs are reimbursed at low rates which challenge sustainability. Additionally, to fund non-billable components, hospitals typically rely on time-limited grant funding, including the federal 340B drug rebate program. Several interviewees also noted anticipated cost savings to their hospitals from reduced use of emergency department services by patients who had no (or low-paying) insurance.
These findings indicate that some hospitals are able to sustain emergency department-based induction of medications for OUD using time-limited grant funding. However, wider dissemination of this model will likely require more stable funding streams, such as Medicaid reimbursement, paying adequate rates and coverage of personnel.
"This research could help show more hospitals that it is possible to sustain these important programs, although that would become easier if insurers started covering them more fully," said co-author Constance Horgan, Professor and Co-Director of the Schneider Institutes for Health Policy and Research at Heller.
Brandeis researchers Dominic Hodgkin, Margot Davis, PhD'08, Cindy Thomas, PhD'00, Jennifer Wicks and Constance Horgan served as co-authors for the research article published in Academic Emergency Medicine, along with Shelly Greenfield (Harvard) and Zachary Meisel (University of Pennsylvania).