A Financial Model for Team-Based Opioid Use Disorder Treatment

J Am Board Fam Med. Jan-Feb 2020;33(1):124-128. doi: 10.3122/jabfm.2020.01.190228.

Abstract

Introduction: Opioid use disorder (OUD) affects 2 million Americans, yet many patients do not receive treatment. Lack of team-based care is a common barrier for office-based opioid treatment (OBOT). In 2015, we started OBOT in a family medicine practice. Based on our experiences, we developed a financial model for hiring a team member to provide nonbillable OBOT services through revenue from increased patient volume.

Methods: We completed a retrospective chart review from July 2015 to December 2016 to determine the average difference in medical visits per patient per month pre-OBOT versus post-OBOT. Secondary outcomes were the percentage of visits coded as a Level 3, Level 4, and Level 5, and the percentage of patients with Medicaid, private insurance, or self pay. With this information, we extrapolated to build a financial model to hire a team member to support OBOT.

Results: Twenty-three patients received OBOT during the study period. There was a net increase of 1.93 visits per patient per month (P < .001). Fourteen patients were insured by Medicaid, 7 had private insurance, and 2 were self pay. Twenty-three percent of OBOT visits were Level 3, 69% were Level 4, and 8% were Level 5. Assuming all visits were reimbursed by Medicaid and accounting for 20% cost of business, treating 1 existing patient for 1 year would generate $1,439. Treating 1 new patient would generate $1,677.

Conclusions: In a fee-for-service model, the revenue generated from increased medical visits can offset the cost of hiring a team member to support nonbillable OBOT services.

Keywords: Buprenorphine; Fee-for-Service Plans; Medicaid; Opioid-Related Disorders; Opioids; Retrospective Studies.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Buprenorphine / therapeutic use
  • Family Practice / economics*
  • Family Practice / organization & administration
  • Fee-for-Service Plans
  • Humans
  • Narcotic Antagonists / therapeutic use
  • Opiate Substitution Treatment / economics*
  • Opiate Substitution Treatment / methods
  • Opioid-Related Disorders / therapy*
  • Retrospective Studies

Substances

  • Narcotic Antagonists
  • Buprenorphine