Substance Use Disorders Among Medicare Beneficiaries: Prevalence, Mental and Physical Comorbidities, and Treatment Barriers

Parish, William J.; Mark, Tami L.; Weber, E.; Steinberg, Deborah G.

doi:10.1016/j.amepre.2022.01.021

Cited by 16 publications

(17 citation statements)

References 23 publications

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“…The smaller number of facilities accepting Medicare as a form of payment may be a factor in the low levels of treatment in this population: only approximately 11% of Medicare beneficiaries with an SUD received treatment. 10 We also found that, by 2021, a little more than 50% of US counties had a treatment facility that accepted Medicare as a form of payment, whereas more than 65% of counties had facilities that accepted Medicaid and private insurance as a form of payment. Despite increases in the percentage of counties with access to facilities accepting various forms of payments, there remained almost a 15-percentage-point gap between the percentage of counties with at least 1 facility accepting Medicaid and those accepting Medicare.…”

Section: Discussionmentioning

confidence: 54%

“… 9 Yet, in 2018, the proportion of Medicare beneficiaries who received treatment for an identified substance use disorder (SUD) was only 11%. 10 Two of the most commonly cited reasons for not receiving care were related to access: limited affordability and limited availability of treatment. 10 , 11 For both of these aspects, there are unique challenges to treating SUD and OUD among older adults.…”

Section: Introductionmentioning

confidence: 99%

“… 10 Two of the most commonly cited reasons for not receiving care were related to access: limited affordability and limited availability of treatment. 10 , 11 For both of these aspects, there are unique challenges to treating SUD and OUD among older adults. One barrier is that not all SUD treatment facilities accept Medicare, the most common insurance coverage for those 65 years or older, as a form of payment.…”

Section: Introductionmentioning

confidence: 99%

“…12 Possible reasons included Medicare lacking a reimbursement rate for intensive outpatient services and not allowing SUD treatment to be provided as part of the home health care benefit. 10 Another barrier is that older adults may face greater access challenges given that approximately 25% of adults older than 65 years live in a small town or rural area; this rate is higher than for younger adults. 13 In general, rural areas tend to have fewer SUD treatment facilities, 14 and rural county residents have less use of medications for OUD.…”

Section: Introductionmentioning

confidence: 99%

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Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021

et al. 2022

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ImportanceThe 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresMeasures 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.ResultsA 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 RelevanceResults 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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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021

et al. 2022

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“…Moreover, only 15.9% of beneficiaries with OUD received medication for OUD (MOUD) through Medicare in 2020 [ 43 ], adding to concerns that Medicare beneficiaries face substantial barriers accessing treatment [ 44 ]. Common reasons for not receiving treatment for substance use disorders among Medicare beneficiaries include financial barriers (insurance coverage and affordability), concerns about stigma, uncertainty about treatment effectiveness, and logistical barriers such as lack of transportation and not knowing where to get help from [ 45 ]. A systematic evaluation of access to MOUD in different post-acute care settings is lacking.…”

Section: Discussionmentioning

confidence: 99%

Discharge locations after hospitalizations involving opioid use disorder among medicare beneficiaries

Moyo

Eliot

Shah

et al. 2022

Addict Sci Clin Pract

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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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Twenty-Year Trends in Drug Overdose Fatalities Among Older Adults in the US

Humphreys

Shover

2023

JAMA Psychiatry

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Substance Use Disorders Among Medicare Beneficiaries: Prevalence, Mental and Physical Comorbidities, and Treatment Barriers

Cited by 16 publications

References 23 publications

Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021

Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021

Discharge locations after hospitalizations involving opioid use disorder among medicare beneficiaries

Twenty-Year Trends in Drug Overdose Fatalities Among Older Adults in the US

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