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Key takeaways:
In addition to the enormous economic, physical and emotional toll on individuals, families and society, data from PINC AI™ Applied Sciences (PAS) shows that care for patients with opioid use disorders (OUDs) in the hospital setting resulted in billions in annual hospital costs nationwide – the majority of which were not reimbursable or were paid for by public payers.
OUD is associated with approximately 66 million emergency department (ED) outpatient visits and 760,000 inpatient visits each year in the U.S. during 2017-2022, creating substantial economic burden for affected hospitals.
According to the new analysis, patients with an OUD diagnosis average 32.5 percent higher cost per ED visit and 8 percent higher cost per inpatient visit than those without an OUD diagnosis. Opioid overdose patients that present to the ED are at a high risk for multiple organ failure, hospitalization, increased costs due to ICU stays and unplanned readmissions following discharge.
By applying these cost estimates to all hospital ED and inpatient visits in the nation, PAS estimates the total costs of OUD to U.S. hospitals are $95.43 billion annually, or 7.86 percent of all hospital expenditures (although OUD only accounted for 0.56 percent of total ED outpatient visits and 2.28 percent of inpatient admissions). If the payer mix remained constant, $67 billion of the expense would be borne by the Medicare and Medicaid programs.
PINC AI™ data shows a disproportionately large share of OUD-diagnosed patients are of lower socioeconomic status. Fifty percent of ED patients were insured by Medicaid (versus 27 percent in non-OUD group) and more than 16 percent were uninsured (versus 13 percent in non-OUD group).
Similarly, in the inpatient setting, 40 percent were insured by Medicaid and 8 percent were uninsured (versus 17 and 3.9 percent, respectively among non-OUD patients). OUD-diagnosed patients were also more likely to be homeless, accounting for 4 percent of ED admissions and 6 percent of inpatient admissions.
Additionally, the analysis indicates that patients with an OUD diagnosis were more likely to be discharged to nursing, long-term care, rehabilitation or law enforcement facilities than those with no OUD – representing additional strain on finances, resources and the continuum of patient care.
The PINC AI™ data makes clear the vital need to address OUD – to improve health, outcomes and to support stronger hospital finances at a time when many are struggling to stay afloat. For instance, Medicaid reimbursement is widely known to be the lowest of all payers, and care for the uninsured is often completely unreimbursed. In these cases, costs associated with OUD visits are largely borne by health systems.
Solving for the opioid epidemic is not only the right thing to do for patients’ health and for families and society – but it also helps prevent a downward drag on provider finances, allowing them to drive high-quality, cost-effective healthcare for the patients and communities they serve.
Beyond the financial impact, far too many have lost a friend, colleague or loved one to OUD. Overdose deaths involving opioids, including prescription and synthetic opioids, have increased by more than eight times since 1999 – killing nearly 69,000 people in 2020. 82 percent of those deaths involved synthetic opioids.
The devastating effect of OUD on individuals, family, society and the healthcare system is simply something we cannot accept – the time for action to help stem the tide of opioid addiction in our communities is now.
Together, Premier, PINC AI™ Applied Sciences and leading health systems across the nation are answering the call.
Leveraging one of the largest hospital discharge databases in the United States, the PINC AI ™ Healthcare Database (PHD), PAS data scientists analyzed all discharges for ED outpatient visits and inpatient admissions occurred during Q1 of 2017 and Q1 of 2022. OUD was defined as having a principal or secondary discharge diagnosis of opioid abuse (ICD-10 diagnosis codes: F11.2 percent), opioid dependence (ICD-10 diagnosis codes: F11.2 percent), or unspecified opioid use (ICD-10 diagnosis codes: F11.9 percent) disorder. Prevalence of OUD was estimated for ED outpatient visits and inpatient admissions separately. Mean total cost of care was also reported for ED outpatient visits and inpatient admissions separately by OUD status. National estimates were created by leveraging prevalence and cost estimates from the PHD analysis and the total number of ED outpatient visits reported from the 2018 National Hospital Ambulatory Medical Care Survey and the total number of inpatient visits from the 2020 American Hospital Association Annual Survey.