The Role of Patient Payment Method in Premature Discharge from Methadone Maintenance Treatment

Proctor, Steven L.; Herschman, Philip L.; Lee, Ronnie; Kopak, Albert M.

doi:10.1080/10826084.2018.1504081

Cited by 5 publications

(9 citation statements)

References 41 publications

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“…Induced by the healthcare system: The barriers include lack of full or proper insurance coverage (e.g., in the California Medicaid program, naloxone is covered as an FFS medication, and managed care plans like capitation do not cover the drug), high costs of medications, limited number of providers/counselors resulting in a dearth of programs or long waiting lists, a low percentage of licensed physicians having a secured waiver that is required to provide MAT or the majority of counties lacking a treatment-waivered physician, insufficient education among pharmacists (this can be resolved by educational materials through improved FDA-approved formulations), the short-term period of opioid substitution programs, and bureaucratic requirements for program entry/enrollment [ 73 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ].…”

Section: Resultsmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

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Section: Resultsmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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“…15 One potential explanation is that privately-funded sites have more patients paying in cash, and a previous study found that patients paying in cash are less likely to be discharged for noncompliance, possibly because they are more invested in treatment. 9 The most common discharge reason in OTPs was lost contact, with approximately three times as many patients across OTPs (the gap was more severe in privately-funded OTPs) discharged due to lost contact as compared to for completion of care. Qualitative research is needed to better understand patient perspectives on reasons for ceasing contact with an OTP.…”

Section: Discussionmentioning

confidence: 99%

“…Different reasons for involuntary discharge may require different prevention approaches. For example, prevention of discharge for noncompliance may require early and regular reinforcement of program rules, 9 or a lower-barrier approach to treatment (e.g., not discharging patients due to polysubstance usage; having more flexible hours). 14,32 Given the serious risks associated with discharge, OTPs should follow up with discharged patients and, when appropriate, seek to reengage patients in MT.…”

Section: Discussionmentioning

confidence: 99%

“…In Florida OTPs, staff can select only one of the following discharge reasons in the Central Database: (1) arrested/jail/prison, (2) completed care, (3) died, (4) inability to pay/lost insurance/funding, (5) lost contact, (6) medical reasons/hospitalized, (7) no reason, (8) noncompliant, (9) patient did not complete admission process, (10) patient self-terminated treatment/left against medical advice, (11) presumed dead, (12) transferred to another program, and (13) work-related/job transfer.…”

Section: Discharge Measuresmentioning

confidence: 99%

“…Another study examined the relationship between patient payment method (i.e., cash vs. insurance) and discharge reason, finding that patients paying with cash were more likely to be voluntarily discharged against medical advice and involuntarily discharged due to inability to pay. 9 Publicly-funded OTPs may receive government funding through a variety of mechanisms, including the following: Medicaid (insurance for low-income individuals), Medicare (for the disabled or people over age 65), from state agencies that distribute state/federal funding for treatment purposes (e.g., via "block" grants), or from federal/state government grants. 16,17 Depending on the type of funding utilized, patients at publicly-funded OTPs might obtain BT or MT at low cost or no cost.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comprehensive analysis of discharge reasons from methadone outpatient treatment programs

2022

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Background and Objectives Methadone treatment (MT) for opioid use disorder is only available in opioid treatment programs (OTPs) in the United States, with retention predictive of positive health outcomes. OTP discharge reason information is needed to develop interventions for facilitating MT retention. We sought to identify discharge reason frequencies and associations between discharge reasons and facility/county‐level characteristics. Methods We examined annual OTP discharge reasons for all Florida OTPs from 2014 to 2017 (n = 44,774 discharges). We used multinomial logistic regression analysis to examine associations between patients’ discharge reasons and (1) facility‐level characteristics (e.g., size, funding type) and (2) county‐level characteristics (e.g., race/ethnicity, overdose rates). Results Lost contact was the most common discharge reason (29%). Only 11% of patients were discharged for treatment completion, with the proportion one‐third as low in privately versus publicly‐funded OTPs (p < .001). Privately‐funded OTPs had a patient share self‐terminating treatment against medical advice about 3.5 times higher than publicly‐funded OTPs. Inability to pay accounted for 7% of OTP discharges. Noncompliant discharges represented 6% and were more common in counties with larger proportions of Black residents (p < .01). Counties with higher drug overdose rates had significantly more discharges for noncompliance or self‐terminating against medical advice (p < .01 and p < .05). Discussion and Conclusions Statewide differences in discharge reasons exist between publicly and privately‐funded OTPs, possibly reflecting differences in funding incentives and state oversight. State agencies should develop consistent approaches for collecting/reporting discharge reasons. Scientific Significance Our study is the first to examine the relationship between OTP funding type and discharge reasons.

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