User login
The American Society of Addiction Medicine and the American Medical Association jointly released a framework for the Patient-Centered Opioid Addiction Treatment (P-COAT) alternative payment model (APM) and are seeking comments to refine the system.
“There are many barriers to this and many reasons why ... medication-assisted treatment, is underutilized,” Patrice Harris, MD, immediate past chair of the AMA board of trustees, said in an interview. “Certainly, one of the key barriers is the current payment system. The current payment system for physicians and clinicians is generally insufficient to identify, diagnose, and treat opioid use disorder. Prior authorization also is a barrier for physicians and patients getting timely, effective treatment. Telemedicine is a critical piece of treatment because we know that in certain areas, there are not addiction specialists and there really also are not physicians qualified to prescribe medication-assisted treatment.”
Physicians participating in P-COAT would be eligible for two types of payments. The first is a one-time payment “where a physician would get paid for doing the diagnosis and the treatment planning in the beginning,” said Dr. Harris, who practices psychiatry in Atlanta. “We call that treatment induction. That might be a one-time payment for all of those services. That is the initiation of the treatment.”
The second payment is a “monthly payment for maintenance of the medical, the psychological, and the social treatments,” she said.
The payment could work in both an integrated system where all the treatment services are offered in a single setting, or via a care coordination setting where doctors may not be part of the same integrated system, she added.
“We wanted to drive coordinated care to bio-psychosocial treatment,” ASAM President Shawn Ryan, MD, said in an interview. “We want to make sure that the patient is getting medication-assisted treatment, which is standard of care for opioid use disorder. We also want to support appropriate psychosocial interventions, whether they be integrated in one site [or] if it’s a coordinated effort between a medical provider and a psychosocial intervention provider.”
As with all APMs, P-COAT would be what is called a “ two-sided risk model” where physicians would have to meet certain quality measures to qualify for bonus payments and would be penalized if they did not. Selection of appropriate measures still is being worked out and is something on which the organizations are seeking comment.
“Unfortunately, we do not have a strong set of known quality outcomes that have been appropriately vetted across the past 10 years,” said Dr. Ryan, president and chief medical officer of BrightView, an outpatient addiction medicine practice in Cincinnati. “ASAM is working on those quality outcomes parameters. As those become more codified, we put them into the model.”
At press time, there was no timeline for when P-COAT might be implemented, but ASAM is pushing to move this into practice sooner rather than later.
“I will be disappointed if we wrote a philosophy paper,” Dr. Ryan said. “That was not my goal. It is my hope that this will result in an increase of quality and quantity of delivery for opioid use disorder and providers better reimbursement to providers and more access for the payers and the members and the patients.”
AMA and ASAM are working with private payers to find an organization to pilot the alternative payment model. ASAM also said that it was in talks with the Centers for Medicare & Medicaid Services to see how to include it in federal health care programs.
The American Society of Addiction Medicine and the American Medical Association jointly released a framework for the Patient-Centered Opioid Addiction Treatment (P-COAT) alternative payment model (APM) and are seeking comments to refine the system.
“There are many barriers to this and many reasons why ... medication-assisted treatment, is underutilized,” Patrice Harris, MD, immediate past chair of the AMA board of trustees, said in an interview. “Certainly, one of the key barriers is the current payment system. The current payment system for physicians and clinicians is generally insufficient to identify, diagnose, and treat opioid use disorder. Prior authorization also is a barrier for physicians and patients getting timely, effective treatment. Telemedicine is a critical piece of treatment because we know that in certain areas, there are not addiction specialists and there really also are not physicians qualified to prescribe medication-assisted treatment.”
Physicians participating in P-COAT would be eligible for two types of payments. The first is a one-time payment “where a physician would get paid for doing the diagnosis and the treatment planning in the beginning,” said Dr. Harris, who practices psychiatry in Atlanta. “We call that treatment induction. That might be a one-time payment for all of those services. That is the initiation of the treatment.”
The second payment is a “monthly payment for maintenance of the medical, the psychological, and the social treatments,” she said.
The payment could work in both an integrated system where all the treatment services are offered in a single setting, or via a care coordination setting where doctors may not be part of the same integrated system, she added.
“We wanted to drive coordinated care to bio-psychosocial treatment,” ASAM President Shawn Ryan, MD, said in an interview. “We want to make sure that the patient is getting medication-assisted treatment, which is standard of care for opioid use disorder. We also want to support appropriate psychosocial interventions, whether they be integrated in one site [or] if it’s a coordinated effort between a medical provider and a psychosocial intervention provider.”
As with all APMs, P-COAT would be what is called a “ two-sided risk model” where physicians would have to meet certain quality measures to qualify for bonus payments and would be penalized if they did not. Selection of appropriate measures still is being worked out and is something on which the organizations are seeking comment.
“Unfortunately, we do not have a strong set of known quality outcomes that have been appropriately vetted across the past 10 years,” said Dr. Ryan, president and chief medical officer of BrightView, an outpatient addiction medicine practice in Cincinnati. “ASAM is working on those quality outcomes parameters. As those become more codified, we put them into the model.”
At press time, there was no timeline for when P-COAT might be implemented, but ASAM is pushing to move this into practice sooner rather than later.
“I will be disappointed if we wrote a philosophy paper,” Dr. Ryan said. “That was not my goal. It is my hope that this will result in an increase of quality and quantity of delivery for opioid use disorder and providers better reimbursement to providers and more access for the payers and the members and the patients.”
AMA and ASAM are working with private payers to find an organization to pilot the alternative payment model. ASAM also said that it was in talks with the Centers for Medicare & Medicaid Services to see how to include it in federal health care programs.
The American Society of Addiction Medicine and the American Medical Association jointly released a framework for the Patient-Centered Opioid Addiction Treatment (P-COAT) alternative payment model (APM) and are seeking comments to refine the system.
“There are many barriers to this and many reasons why ... medication-assisted treatment, is underutilized,” Patrice Harris, MD, immediate past chair of the AMA board of trustees, said in an interview. “Certainly, one of the key barriers is the current payment system. The current payment system for physicians and clinicians is generally insufficient to identify, diagnose, and treat opioid use disorder. Prior authorization also is a barrier for physicians and patients getting timely, effective treatment. Telemedicine is a critical piece of treatment because we know that in certain areas, there are not addiction specialists and there really also are not physicians qualified to prescribe medication-assisted treatment.”
Physicians participating in P-COAT would be eligible for two types of payments. The first is a one-time payment “where a physician would get paid for doing the diagnosis and the treatment planning in the beginning,” said Dr. Harris, who practices psychiatry in Atlanta. “We call that treatment induction. That might be a one-time payment for all of those services. That is the initiation of the treatment.”
The second payment is a “monthly payment for maintenance of the medical, the psychological, and the social treatments,” she said.
The payment could work in both an integrated system where all the treatment services are offered in a single setting, or via a care coordination setting where doctors may not be part of the same integrated system, she added.
“We wanted to drive coordinated care to bio-psychosocial treatment,” ASAM President Shawn Ryan, MD, said in an interview. “We want to make sure that the patient is getting medication-assisted treatment, which is standard of care for opioid use disorder. We also want to support appropriate psychosocial interventions, whether they be integrated in one site [or] if it’s a coordinated effort between a medical provider and a psychosocial intervention provider.”
As with all APMs, P-COAT would be what is called a “ two-sided risk model” where physicians would have to meet certain quality measures to qualify for bonus payments and would be penalized if they did not. Selection of appropriate measures still is being worked out and is something on which the organizations are seeking comment.
“Unfortunately, we do not have a strong set of known quality outcomes that have been appropriately vetted across the past 10 years,” said Dr. Ryan, president and chief medical officer of BrightView, an outpatient addiction medicine practice in Cincinnati. “ASAM is working on those quality outcomes parameters. As those become more codified, we put them into the model.”
At press time, there was no timeline for when P-COAT might be implemented, but ASAM is pushing to move this into practice sooner rather than later.
“I will be disappointed if we wrote a philosophy paper,” Dr. Ryan said. “That was not my goal. It is my hope that this will result in an increase of quality and quantity of delivery for opioid use disorder and providers better reimbursement to providers and more access for the payers and the members and the patients.”
AMA and ASAM are working with private payers to find an organization to pilot the alternative payment model. ASAM also said that it was in talks with the Centers for Medicare & Medicaid Services to see how to include it in federal health care programs.