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Addiction Science & Clinical Practice

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01-12-2021 | Buprenorphine | Review

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

Authors: Dominic Hodgkin, Constance Horgan, Gavin Bart

Published in: Addiction Science & Clinical Practice | Issue 1/2021

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.

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Title: Financial sustainability of payment models for office-based opioid treatment in outpatient clinics
Authors: Dominic Hodgkin
Constance Horgan
Gavin Bart
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Buprenorphine
Opioids
Opioids
Climate Change
Published in: Addiction Science & Clinical Practice / Issue 1/2021
Electronic ISSN: 1940-0640
DOI: https://doi.org/10.1186/s13722-021-00253-7

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

Abstract

Background

Methods

Results

Conclusion

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Abstract

Background

Methods

Results

Conclusion

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