The American Society of Addiction Medicine and the American Medical Association jointly released a framework for the Patient-Centered Opioid Addiction Treatment (P-COAT) alternative payment model (APM) and are seeking comments to refine the system.
“There are many barriers to this and many reasons why ... medication-assisted treatment, is underutilized,” Patrice Harris, MD, immediate past chair of the AMA board of trustees, said in an interview. “Certainly, one of the key barriers is the current payment system. The current payment system for physicians and clinicians is generally insufficient to identify, diagnose, and treat opioid use disorder. Prior authorization also is a barrier for physicians and patients getting timely, effective treatment. Telemedicine is a critical piece of treatment because we know that in certain areas, there are not addiction specialists and there really also are not physicians qualified to prescribe medication-assisted treatment.”
Dr. Patrice Harris
Physicians participating in P-COAT would be eligible for two types of payments. The first is a one-time payment “where a physician would get paid for doing the diagnosis and the treatment planning in the beginning,” said Dr. Harris, who practices psychiatry in Atlanta. “We call that treatment induction. That might be a one-time payment for all of those services. That is the initiation of the treatment.”
The second payment is a “monthly payment for maintenance of the medical, the psychological, and the social treatments,” she said.
The payment could work in both an integrated system where all the treatment services are offered in a single setting, or via a care coordination setting where doctors may not be part of the same integrated system, she added.
“We wanted to drive coordinated care to bio-psychosocial treatment,” ASAM President Shawn Ryan, MD, said in an interview. “We want to make sure that the patient is getting medication-assisted treatment, which is standard of care for opioid use disorder. We also want to support appropriate psychosocial interventions, whether they be integrated in one site [or] if it’s a coordinated effort between a medical provider and a psychosocial intervention provider.”
Dr. Shawn Ryan