Abstract
The US is experiencing an epidemic of opioid misuse and mortality. Effective treatments are available, including medications for opioid use disorders (MOUD), but they are greatly underused due to a variety of barriers. In response, some US hospitals have established programs to identify emergency department (ED) patients with opioid use disorders (OUD) and begin treatment with MOUD ("ED induction"). For this model to be widely adopted, financial sustainability for hospitals is critical. Little is known about the financial aspects of ED-based treatment models, including insurance billing and reimbursement.
Our study addressed the following questions about ED-based induction of OUD treatment: (1) Which components of this model are billable to insurers? (2) How do hospitals fund the components that are not billable? (3) Does ED-based induction generate savings that could help fund that service?
We conducted a qualitative study, involving semi-structured interviews with officials at selected US hospitals. Potential interviewees were identified using a snowball sampling approach. We conducted 12 interviews across 10 states, mostly with urban teaching hospitals.
Key findings include, (1) 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. (2) To fund non-billable components, hospitals typically rely on time-limited grant funding, including the federal 340B drug rebate program. (3) Several interviewees anticipated cost savings to their hospitals from reduced use of ED services by patients who had no (or low-paying) insurance.
These findings indicate that some hospitals are able to sustain ED-based induction of MOUD 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.