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Wide Variation Across Nation in Opioid Abuse and Dependence Treatment

Robin Gelburd, JD, is the president of FAIR Health, a national, independent, nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 28 billion claim records contributed by payers and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. CMS as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.
Whether treatment for opioid abuse and dependence most commonly emphasized methadone administration, naltrexone injection, group psychotherapy, or another procedure in 2017 depended on the state or region where the patient received care, according to a new white paper and state-by-state infographics from FAIR Health. Which procedures made up the largest share of total expenditures for opioid abuse and dependence also varied by region and state.

Analyzing 2017 data from our database of more than 26 billion privately billed healthcare claim records dating back to 2002, we identified the top 10 procedure codes for specific treatments and services associated with opioid abuse and dependence diagnoses by utilization and aggregate cost in each US Census region (Northeast, Midwest, South, West) and also reported the top 5 codes by utilization and aggregate cost in each state and the District of Columbia. Procedures include therapeutic procedures and other services, such as drug tests and visits to doctor’s offices or emergency departments (EDs).

Among the regional differences the study revealed were that:
  • Methadone administration (H0020) was 1 of the 10 most common procedures by utilization in every region, but it was among the top 10 by cost in only 1 region, the Northeast.
  • Naltrexone injection (J2315) was in the top 10 list by cost in only 1 region, the Midwest.
  • Group psychotherapy (CPT 90853) was 1 of the 10 most common procedures by utilization in every region except the South.
  • The top 10 procedures by utilization in the South included 7 drug tests or test-related procedures, more than in any other region.
  • The top 10 procedures by cost in the West included 6 therapeutic procedures, more than in any other region.
  • Two outpatient rehabilitative services were found in the top 10 lists by utilization or cost only in the South and West: intensive outpatient treatment (H0015) and partial hospitalization (S0201).
  • Two inpatient treatments, sub-acute detoxification (H0010) and short-term residential (H0018), were included among the top 10 procedures by cost in 1 region, the West.
  • ED visits were found in the top 10 lists by cost only in the Northeast and Midwest.
Across states, the study found these differences, among others:
  • Only New York had group counseling (H0005) as 1 of its 5 most common procedures by utilization and cost.
  • Only 5 states—Delaware, Nebraska, North Dakota, South Dakota and Wisconsin—included psychotherapy, 45 minutes (CPT 90834), as 1 of their 5 most common procedures by utilization.
  • Only California had intensive outpatient treatment in its top 5 list by utilization.
  • Subacute detoxification appeared in the top 5 lists of only 2 states, Mississippi and Tennessee, and there only by cost.
  • Only Wyoming included among its top 5 procedures by cost an ED visit, high severity, immediate significant threat to life or physiologic function (CPT 99285).
Dr Martin A. Makary, Johns Hopkins Professor of Health Policy, said: “FAIR Health has issued an excellent study of an important aspect of the opioid crisis. Treatment of opioid abuse and dependence should be driven by science. This report represents a step in that direction.”

Our study unveils a tapestry of variation by region and state in the procedures most commonly associated with opioid abuse and dependence. The findings transform the states into living laboratories, offering opportunities to research the outcomes linked to the different treatment strategies.

This is the fourth in a series of white papers released by FAIR Health on the opioid epidemic. The first white paper examined national trends in the epidemic; the second, the impact of the epidemic on the healthcare system; and the third, geographic variations in the epidemic.

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