Substance use disorder treatment centers and facility ownership changes

药物滥用障碍治疗中心和设施所有权变更

基本信息

批准号：
10680862
负责人：
Susan H Busch
金额：
$ 78.72万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10680862
关键词：
Adolescent Adult Adverse event Area Authorization documentation Buprenorphine Catalogs Communities Complex Data Databases Directories Emergency department visit Equity Faculty Future Goals Health Health Insurance Health Services Accessibility Healthcare Healthcare Systems Individual Industry Insurance Insurance Coverage Marketing Medicaid Medicine Methadone Methodology Nature Newsletter Nurses Nursing Homes Opioid Outcome Ownership Patient-Focused Outcomes Patients Peer Review Pharmacy facility Physicians Policies Policy Analysis Positioning Attribute Privatization Public Health Quality of Care Quasi-experiment Regulation Reporting Research Research Design Review Literature Services Source Structure Substance Use Disorder Time Work addiction authority care delivery care outcomes follow-up health care quality improved medical schools medical specialties medication for opioid use disorder member mortality novel opioid use disorder policy implication pressure primary care services substance use treatment treatment center

项目摘要

Project Summary An estimated 40.3 million adults and adolescents needed treatment for substance use disorders in 2020. Yet only 6.5% of those needing treatment received it. Access to high-quality care remains a significant challenge. In the past decade, private equity (PE) firms have acquired numerous substance use disorder (SUD) treatment facilities, although evidence on the extent of these acquisitions is scarce. SUD treatment centers are attractive targets for private equity acquisition due to increased need for SUD treatment, increased health insurance coverage, and expansions in coverage of SUD treatments, all of which increase demand for treatment. Opportunities for efficiencies due to the fragmented nature of the market and changes to regulations regarding buprenorphine prescribing have the potential to increase profits. Commentators have raised concerns that a focus on short term profits may lead to quality declines in private equity-acquired facilities. Similar acquisitions in other areas of health care have resulted in declines in quality and increases in mortality. In this proposal, we will, for the first time, comprehensively catalog and describe SUD facility acquisitions by private equity investors from 2010-2022. We will we use a quasi-experimental difference in differences research design that leverages differences in the timing of ownership changes to study changes in the delivery of care and patient outcomes. Our interdisciplinary team consisting of faculty from the Yale Schools of Medicine, Management, and Public Health is uniquely suited to study this issue with the methodological and substantive expertise to assess the complex treatment and policy implications. Our specific aims are: (1) To catalog and describe changes in private equity ownership of SUD treatment facilities (2010-2022) and the predictors of such changes; (2) To determine whether private equity acquisition is associated with changes at the organization level including changes in treatments offered (more facilities offering medication for opioid use disorder (MOUD) treatment; fewer facilities offering primary care services or services attractive to complex patients) and changes in the types of insurance accepted; (3) To determine whether private equity acquisition is associated with changes in MOUD use, quality and patient insurance type in acquired facilities. Pressure to increase the volume of commercially insured patients given the significantly higher reimbursement rates may lead to reductions in the number of Medicaid patients treated; (4) To determine whether private equity acquisition is associated with changes in OUD treatment quality and opioid-related adverse events in communities with acquisitions. Ultimately, a goal of an SUD treatment facility is to improve health outcomes. Using commercial insurance data, we will examine changes in treatment quality and health outcomes (OUD-related emergency department visits). To our knowledge no information about the extent and impacts of this change have been documented in the peer-reviewed literature.

项目概要据估计，2020 年将有 4030 万成年人和青少年需要治疗药物滥用障碍。然而只有 6.5% 的需要治疗的人接受了治疗。获得高质量护理仍然是一项重大挑战。在过去的十年中，私募股权 (PE) 公司获得了大量药物使用障碍 (SUD) 治疗药物设施，尽管有关这些收购规模的证据很少。 SUD 治疗中心很有吸引力由于 SUD 治疗需求增加、健康保险增加而成为私募股权收购的目标覆盖范围以及 SUD 治疗覆盖范围的扩大，所有这些都增加了治疗需求。由于市场的分散性和相关法规的变化而带来了提高效率的机会丁丙诺啡处方有可能增加利润。评论家们担心，注重短期利润可能会导致私募股权收购设施的质量下降。类似收购其他卫生保健领域的情况导致质量下降和死亡率上升。在这个提案中，我们将首次对私募股权收购 SUD 设施进行全面分类和描述 2010年至2022年的投资者。我们将使用准实验差异研究设计利用所有权变更时间的差异来研究护理和患者提供的变化结果。我们的跨学科团队由来自耶鲁大学医学院、管理学院、公共卫生部门特别适合通过方法论和实质性专业知识来研究这个问题评估复杂的治疗和政策影响。我们的具体目标是： (1) 编目和描述 SUD处理设施私募股权的变化（2010-2022年）及其预测变化； (2) 判断私募股权收购是否与组织变革相关水平，包括所提供治疗的变化（更多设施提供阿片类药物使用障碍药物（MOUD）治疗；提供初级保健服务或对复杂患者有吸引力的服务的设施较少）以及接受的保险类型发生变化；（3）判断私募股权收购是否存在关联关系随着收购设施中 MOUD 使用、质量和患者保险类型的变化。增加压力鉴于报销率显着提高，商业保险患者数量可能会导致接受医疗补助的患者人数减少；（4）判断私募股权收购是否成立与 OUD 治疗质量的变化和社区中阿片类药物相关的不良事件有关收购。 SUD 治疗机构的最终目标是改善健康结果。使用商业保险数据，我们将检查治疗质量和健康结果的变化（OUD 相关的紧急情况）部门访问）。据我们所知，目前还没有关于这一变化的程度和影响的信息。记录在同行评审的文献中。