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.

项目摘要估计有4030万成人和青少年在2020年需要治疗药物使用障碍。需要治疗的人中只有6.5％接受了治疗。获得高质量护理仍然是一个重大挑战。在过去的十年中，私募股权（PE）公司获得了许多药物使用障碍（SUD）治疗设施，尽管这些收购范围的证据很少。 SUD治疗中心很有吸引力由于增加了SUD治疗，健康保险的增加而导致私募股权获得的目标覆盖范围和覆盖范围的SUD治疗范围，所有这些都会增加对治疗的需求。由于市场性质分散的效率机会以及有关法规的变化丁丙诺啡处方有可能增加利润。评论员提出了担心专注于短期利润可能会导致私募股权获得的设施的质量下降。类似的收购在其他医疗保健领域，导致质量和死亡率的提高。在这个建议中，我们将首次全面编目并通过私募股权来描述SUD设施的收购 2010 - 2022年的投资者。我们将在研究设计中使用准实验差异，所有权时机的利用差异是研究护理和患者提供变化的变化结果。我们的跨学科团队由耶鲁大学医学院，管理学院组成，公共卫生非常适合研究这个问题，并具有方法论和实质性专业知识评估复杂的待遇和政策影响。我们的具体目的是：（1）分类并描述 SUD治疗设施的私人股权所有权的变化（2010-2022）和此类预测因素变化；（2）确定私募股权获取是否与组织的变更相关联级别包括提供的治疗变化（更多的设施为阿片类药物使用障碍提供药物（MOUD）治疗；提供对复杂患者有吸引力的初级保健服务或服务的设施更少）和接受的保险类型的变化；（3）确定私募股权收购是否关联随着MOUD使用，质量和患者保险类型的变化，在获得的设施中。增加鉴于报销率明显更高的商业保险患者的数量可能导致接受治疗的医疗补助患者人数减少；（4）确定私募股权是否获得与OUD治疗质量的变化和与阿片类药物相关的不良事件有关收购。最终，SUD治疗设施的目标是改善健康状况。使用商业保险数据，我们将检查治疗质量和健康成果的变化（与Oud相关的紧急情况部门访问）。据我们所知，没有关于这一变化的程度和影响的信息在同行评审的文献中记录。