The team, led by Sanjay Basu, MD, PhD, a Harvard primary care physician and epidemiologist and Jonathan E. Fried, MD, MPH, an internal medicine resident at Brigham and Women’s Hospital, interviewed practice managers and identified four common approaches to delivering buprenorphine-based treatment in primary care practices. The approaches differed based on who in the clinic delivered the majority of face-to-face care, the presence of nurse care managers, and whether care was delivered in traditional one-on-one or group settings.
The research team then used microsimulation modeling to identify the cost and financial benefit of delivering buprenorphine-based treatment in a variety of primary care settings, including Federally Qualified Health Centers (FQHC), non-FQHCs in both rural and urban high poverty areas,, and practices outside of high poverty areas. They found that all four approaches to care produced positive net revenue after the first year in a variety of practice settings, and net revenues were consistently highest for rural practices.
Physician-led treatment and shared medical visits, both of which relied on nurse care managers, consistently produced the greatest net revenue gains, generating from $29,000 to $70,000 per full-time physician per year across the practice types.
Additionally, net revenues were positive for all primary care practices that had at least nine patients in buprenorphine treatment per provider at any given time and no-show rates less than 34 percent. The findings suggest that in the current fee-for-service–dominated environment, offering office-based therapy for opioid addiction with buprenorphine can be a financially sustainable choice for cash-strapped primary care practices, despite hurdles.
Jonathan E. Fried, et al
Center for Primary Care, Harvard Medical School, Boston, Massachusetts
SOURCE Annals of Family Medicine