Prior to COVID-19, we were facing one of the biggest public health crises of our generation: opioid addiction. Roughly 130 Americans were dying every day from an opioid overdose, but as a nation we were making headway in combating this epidemic. One of the most important milestones was the passage of the SUPPORT Act, which requires Medicare and Medicaid to cover opioid treatment program (OTP) services beginning January and October of this year, respectively, expanding access to care for thousands of people living with addiction. With COVID-19 now gripping the world, we’re at risk of these advancements being overwhelmed and consumed by the pandemic. As Dr. Nora Volkow, director of the National Institute on Drug Abuse, recently stated, “under no circumstances can we forget or marginalize persons with [substance use disorder] during this new public health crisis.”
Deemed an essential health service by the Department of Health and Human Services, opioid treatment providers are on the frontlines of this pandemic. At Behavioral Health Group (BHG), an opioid treatment center network where I’ve served as CEO for over six years, we’ve worked closely with federal and state regulators to ensure we can remain open and continue safely serving our patients during COVID-19. Unlike hospitals and other health care providers, however, where patients have many different options for where they can receive care, BHG has the additional challenge of being a sole community provider of OTP and often the only option for patients with opioid use disorder (OUD). If we are forced to shutter our business, patients are left with no alternatives to manage their condition.
While federal and state regulators have loosened requirements for OTPs in response to social distancing orders, allowing providers to send patients home with more medication and conduct counseling via telehealth, OTPs are facing unprecedented challenges that are threatening their ability to continue caring for patients. As more and more people lose their jobs, those in recovery can no longer afford health coverage or treatment.
Nationally, 32 percent of patients receiving treatment for OUD are uninsured and pay out-of-pocket for care. To help address this, the government has issued grants to states over the past few years to help cover the cost of treatment for the uninsured. Unfortunately, these short-term grant programs are quickly depleting as the number of people who need financial assistance continues to grow. In fact, 25 percent of our patients have reported losing employment since the start of COVID-19 and have indicated they will not be able to afford treatment. And with Medicaid not mandated to cover OTP services until October, many patients are left with virtually no options. As more patients are forgoing treatment because they lost their jobs — where hours were limited and health coverage of OTP services were rare as it is — not only is the ability for OTPs to keep their doors open at risk, patients’ lives are at risk.
Abrupt disruption in treatment means patients will relapse at high rates. This will result in increased overdoses, straining our already overtaxed emergency rooms and putting patients at increased risk of COVID-19 exposure and even death.
The operational burdens that have resulted from the pandemic are also threatening the ability of OTPs to stay open. The costs of higher absences of employees who are affected by COVID-19, as well as the costs for securing and retaining qualified employees to take their place, are taking a toll. Efforts to minimize patient visits to centers are leading to reduced revenue from payors, who typically reimburse for individual patient interactions that are a crucial part of medication-assisted treatment. At BHG, we’ve seen a 50 percent reduction in daily patient visits, which has led to reduced billing to payors, ultimately threatening our ability to continue caring for patients.
During these trying times and social distancing requirements, OTPs have done their part in continuing to safely treat patients, but we need Congress to step in and provide federal support to ensure the lives of those with opioid addiction are not further disrupted as the COVID-19 pandemic continues.
Specifically, accredited OTPs and others in the behavioral health industry need a robust federal funding stream. This funding should be provided directly to providers, as opposed to being funneled through states, which will only delay patient and provider access. With the help of Congress, countless lives can be saved from opioid overdose deaths. Just a fraction of the emergency funding that has been provided to other industries hit hard by the pandemic can help OTPs like BHG continue caring for the most vulnerable patients in this extraordinarily difficult period of time. We urge Congress to take action and ensure that OTPs can continue providing care — our patients’ lives depend on it.
Jay Higham is the CEO of Behavioral Health Group, a network of opioid treatment and recovery centers that provide daily, lifesaving treatment to roughly 20,000 patients suffering from opioid use disorder.
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