Financial sustainability of payment models for office-based opioid treatment in outpatient clinics

Abstract

Background Office-Based Opioid Treatment (OBOT) is a delivery model which seeks to make medications for opioid use disorder (MOUD), particularly buprenorphine, widely available in general medical clinics and offices. Despite evidence supporting its effectiveness and cost-effectiveness, uptake of the OBOT model has been relatively slow. One important barrier to faster diffusion of OBOT may be the financial challenges facing clinics that could adopt it. Methods We review key features and variants of the OBOT model, then discuss different approaches that have been used to fund it, and the findings from previous economic analyses of OBOT’s impact on organizational finances. We conclude by discussing the implications of these analyses for the financial sustainability of the OBOT delivery model. Results Like other novel services, OBOT poses challenges for providers due to its reliance on services which are ‘non-billable’ in a fee-for-service environment. A variety of approaches exist for covering the non-billable costs, but which approaches are feasible depends on local payer policies. The scale of the challenges varies with clinic size, organizational affiliations and the policies of the state where the clinic operates. Small clinics in a purely fee-for-service environment may be particularly challenged in pursuing OBOT, given the need to fund a dedicated staff and extra administrative work. The current pandemic may pose both opportunities and challenges for the sustainability of OBOT, with expanded access to telemedicine, but also uncertainty about the durability of the expansion. Conclusion The reimbursement environment for OBOT delivery varies widely around the US, and is evolving as Medicare (and possibly other payers) introduce alternative payment approaches. Clinics considering adoption of OBOT are well advised to thoroughly investigate these issues as they make their decision. In addition, payers will need to rethink how they pay for OBOT to make it sustainable.

COVID-19 and practice transformation: Building an office-based opioid treatment program in a family medicine residency practice.

“…Keywords: opioid epidemic, primary health care, community health center, Office-based opioid treatment (OBOT) is a delivery model that seeks to make medications for opioid use disorder, including buprenorphine and extended-release naltrexone, available in general medical clinics and office settings (Hodgkin et al, 2021) and has been shown to improve patients' physical and mental health, provide similar treatment retention and rates of negative urine drug screens, and prevent HIV, hepatitis C, and other infectious diseases (Velander, 2018). Primary care OBOT offers whole-person care for people with substance use disorders by treating for comorbid mental health and psychiatric conditions, integrating harm reduction and recovery support, and coordinating access to the continuum of care.…”

“…Primary care OBOT offers whole-person care for people with substance use disorders by treating for comorbid mental health and psychiatric conditions, integrating harm reduction and recovery support, and coordinating access to the continuum of care. Cited barriers to providing OBOT include financial sustainability of payment models (Hodgkin et al, 2021), time, competing priorities, lack of collaborating specialists, and stigma (Louie et al, 2019; Russell et al, 2021). Additionally, primary care implementing OBOT to respond to the opioid epidemic during the COVID-19 pandemic simultaneously adapted their systems of care to the imperative public health interventions.…”

Virtual Primary Care for People with Opioid Use Disorder: A Scoping Review of Current Strategies, Benefits, and Challenges

“…Furthermore, virtual care implementation within organizations fluctuated due to staff turnover or equipment changes. Brief Report [107] [70, 75] Protocol [36] Review [108] QuADS: Quality Assessment with Diverse Studies…”

A survey of barriers and facilitators to the adoption of buprenorphine prescribing after implementation of a New Jersey-wide incentivized DATA-2000 waiver training program

“…New Jersey has numbered amongst the states with the highest opioid overdose rates with 30 deaths per 100,000 of the population [ 18 ] and in an effort to increase the number of buprenorphine providers, New Jersey has implemented a series of interventions to decrease barriers to buprenorphine prescribing. This includes eliminating medication prior authorizations for buprenorphine for all Medicaid plans as has been done in other states including Illinois and California, and implementing higher reimbursement for office-based addiction treatment as in Virginia and Massachusetts [ 19 , 20 ]. Financial incentives are often used to influence medical providers’ behaviors and a one-time incentive to obtain a DATA-2000 waiver has been piloted in Colorado, Pennsylvania and California [ 21 – 24 ].…”