TY - JOUR
KW - buprenorphine
KW - Financial sustainability
KW - Medicaid
KW - Medication treatment of opioid use disorder
KW - Office-based opioid treatment
KW - Payment models
KW - Reimbursement
AU - D. Hodgkin
AU - C. Horgan
AU - G. Bart
A1 - 
AB - 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.
AD - Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, United States. hodgkin@brandeis.edu.; Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, United States.; Department of Medicine, University of Minnesota Medical School and Division of Addiction Medicine, Hennepin Healthcare, Minneapolis, United States.
BT - Addiction science & clinical practice
C5 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
CP - 1
DO - 10.1186/s13722-021-00253-7
IS - 1
JF - Addiction science & clinical practice
LA - eng
M1 - Journal Article
N2 - 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.
PY - 2021
SN - 1940-0640; 1940-0632; 1940-0632
SP - 021
EP - 7
EP - 45+
T1 - Financial sustainability of payment models for office-based opioid treatment in outpatient clinics
T2 - Addiction science & clinical practice
TI - Financial sustainability of payment models for office-based opioid treatment in outpatient clinics
U1 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
U2 - 34225785
U3 - 10.1186/s13722-021-00253-7
VL - 16
VO - 1940-0640; 1940-0632; 1940-0632
Y1 - 2021
Y2 - Jul 5
ER -