A huge barrier in providing MAT services to addicts is reimbursing providers. Whether due to limited insurance coverage or a lack of MAT providers, the reimbursement of providers is an ongoing issue. However, a new MAT payment model will help meet increased demand for medication-assisted treatment services.
This new MAT payment model, called Patient-Centered Opioid Addiction Treatment, gives qualifying providers an initial, one-time payment to cover the costs of MAT treatment. This includes the evaluation, diagnosing, and treatment planning. Additionally, the payment covers one month of outpatient medication-assisted treatment.
Both the American Medical Association and the American Society of Addiction Medicine support the payment model.
New MAT Payment Model Supports Treatment as a Whole
Under the new payment model, participating providers receive two payments. As stated earlier, providers would receive a one-time initial payment for the evaluation and treatment planning. This payment, called the Initiation of Medication-Assisted Treatment (IMAT), is adequate to cover the costs of services and would be significantly higher than monthly payments for ongoing treatment.
The second payment, called the Maintenance of Medication-Assisted Treatment (MMAT), covers ongoing outpatient medication, psychological treatment, and social services to a patient who has successfully initiated treatment. MMAT payments would continue if patients are candidates for continued treatment.
Additionally, there are additional incentives for participating providers utilizing the new MAT payment model:
- higher amounts would be paid for patients with more complex needs that require more intensive supervision. These services would have to be consistent with criteria set forth by the American Society of Addiction Medicine (ASAM). Payments are also based on minimum quality standards. Additionally, payments would be adjusted according to treatment outcomes and programs quality.
- Add-on payments would be available to providers that use recognized treatment tools. These would include remote patient monitoring, counseling and the use of psychotherapy.
Reasons Why Current Payment Models Fall Short
The implementation of the Patient-Centered Opioid Addiction Treatment Model would help address current shortcomings with current pay models. First, current payment models don’t allow providers to properly identify, diagnose and treat opioid addiction. Secondly, timely treatment is affected by strict prior authorization standards put forth by insurance companies.
Additionally, there is limited reimbursement for telemedicine practices. This allows providers to evaluate, diagnose and treat patient through telecommunication technology. Other issues with current payment models include limited payment for transportation to services as well as separate billing practices for medical and behavioral services.
Goals of the Patient-Centered Opioid Addiction Treatment Model
The implementation of this new MAT payment model hopes to achieve the following goals:
- To provide the appropriate support to those providers who successfully treat opioid addiction and related issues through the use of medication-assisted treatment.
- Encourage more primary care providers to implement MAT programs as a part of their addiction treatment programs.
- Expand the implementation of the medical/social/psychological model of addiction treatment.
- Eliminate outpatient treatment services which are either ineffective or expensive.
- Reduce spending on emergency room visits and hospitalizations due to overdoses.
- Reduce the number of deaths due to opiates and prescription pain medications.
New MAT Payment Model Addresses a Desperate Need
The Patient-Centered Opioid Addiction Treatment Model of payment addresses a desperate need in regards to MAT treatment. In an article published in Modern Healthcare, author Steven Ross Johnson wrote the following:
Currently, more than 48,000 clinicians in the U.S. are certified to prescribe buprenorphine, according to SAMHSA, with the vast majority (72%) authorized to prescribe the medication to as many as 30 patients. According to those figures, if all buprenorphine prescribers recognized by the agency were to administer the drug to the maximum number of patients they are allowed, the maximum number of people allowed to get treatment would be just more than 3.1 million. By contrast, about 20.4 million adults needed substance use treatment at some time in 2014, according to SAMHSA.
In a written statement, Dr. Shawn Ryan, chair of the AMA-ASAM Alternative Payment Model Working Group, wrote the following:
The current physician reimbursement structure does not account for all the services that patients with an opioid use disorder need to progress to successful treatment and recovery…While we know that a combination of medication and psychosocial support systems is the evidence-based standard for treatment, we continue to find that patients are not able to access treatment due to limited or non-existent insurance coverage.
The article further states that patients would receive outpatient treatment using either buprenorphine or naltrexone. Additionally, they would have to undergo psychological or counseling therapy services. Also, providers would also have to set up care coordination, social support and as well as other medical services if needed.
A physician would only qualify to receive payment under the payment model if they were part of an opioid addiction treatment team where they would be contracted to deliver all three types of services.
Addressing an Ongoing Public Health Crisis
This new MAT payment model hopes to bring medication assisted treatment to those people who need services the most. Despite extraordinary measures being taken my medical and legal professionals, the ongoing opioid crisis shows no signs of decline. The following are statistics from the CDC show the seriousness of the current drug crisis:
- In 2016, there were more than 63,600 drug overdose deaths in the United States.
- The age-adjusted rate of drug overdose deaths in 2016 (19.8 per 100,000) was 21% higher than the rate in 2015 (16.3).
- Among persons aged 15 and over, adults aged 25–34, 35–44, and 45–54 had the highest rates of drug overdose deaths in 2016 at around 35 per 100,000.
- West Virginia (52.0 per 100,000), Ohio (39.1), New Hampshire (39.0), the District of Columbia (38.8), and Pennsylvania (37.9) had the highest observed age-adjusted drug overdose death rates in 2016.
- The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) doubled between 2015 and 2016, from 3.1 to 6.2 per 100,000.
Additonally, the CDC states that of the 63,600 drug overdose deaths reported in the United States, nearly two-thirds were opioid related. When broken down further, 15,469 deaths involved heroin; 14,487 deaths involved natural and semi-synthetic opioids; 3,373 deaths involved methadone; and 19,413 deaths involved synthetic opioids other than methadone include fentanyl.
In order to combat the opioid drug crisis, more resources need to be made available to those struggling with opioid addiction. With the Patient-Centered Opioid Addiction Treatment Model being advocated by leading advocacy groups, it will provide much needed resources and support to those in need.
Are You Struggling with Opioid Addiction?
If you or a loved one are struggling with opioid addiction, you may feel hopeless. You may have tried treatment before, but you can’t pull free from your substance abuse While you may feel like a lost cause, help is just a phone call away. When you call Medically Assisted Treatment toll-free today, you take the first step in your recovery journey.
Our experienced professionals work with the best MAT programs in the country. Medically Assisted Treatment will help you find the treatment programs that fit your specific needs. From your first phone call to placement, we will provide you with the resources and support you need to break the chains of substance abuse.
Call Medically Assisted Treatment today.