In September 2022, the American Journal of Managed Care published findings related to physicians’ response to suboxone telemedicine after the widespread telehealth adoption required by COVID-19. The New Haven Public School of Health commissioned the study to examine physicians’ perceptions and practices related to telehealth opioid treatment. It surveyed 1141 physicians from various settings, including private or solo group practices, clinic/urgent care centers, hospital-based outpatient departments, and five smaller settings offering telemedicine opioid treatment. Medicaid was the most frequently received reimbursement, followed by cash, Veterans Health Administration, commercial insurance, Medicare, and others.
The researchers supported their interest in this issue by citing sources estimating that 75% to 90% of people with OUD in the United States receive no treatment, and only a third of those on treatment receive medication. Delays in receiving medication results can result in devastating withdrawal symptoms. They also mentioned that there are not enough OUD facilities in the US, with 40% of our counties having no trained OUD clinicians. Most people seeking treatment for OUD come from impoverished communities; many live in rural areas, so access to treatment is limited. Telemedicine opioid treatment will offer underserved communities greater access to treatment, and research supports this argument.
More Than Half of the Respondents Prefer Telehealth Opioid Treatments
COVID-19 encouraged more physicians to use telemedicine opioid treatment and changed their perceptions about its effectiveness. Only 29% of the physicians who participated in the study had used telehealth before the pandemic. That telehealth usage figure rose to 66% during COVID-19.
The researcher found that:
- 54% of the respondents found telehealth opioid treatment more effective than in-person treatment
- 16% said that suboxone telemedicine was less effective
- 85% of the respondents favored the permanent extension of the telemedicine opioid treatment flexibility
- 77% said they would continue to use suboxone telemedicine if the regulations were extended.
Most physicians who participated in the study expressed their support for legislation to reduce limitations on telehealth opioid treatment permanently.
Pre-COVID Barriers to Telehealth Opioid Treatment
Before COVID, legislation required an in-person visit before the prescriber could order medications for OUD. During the pandemic, this requirement was lifted, and suboxone telemedicine without an in-person visit was allowed. At this point, research suggests that clinicians support reduced limitations on telemedicine opioid treatment to deal with the opioid national emergency declared in 2018.
The Efficacy of Suboxone Telemedicine
The In August 2022, JAMA Psychiatry published the results of an investigation of 175,778 patients undergoing telehealth opioid treatment. The study reported that telehealth opioid treatment during COVID-19 resulted in increased use of medications and lowered the chance of an opioid overdose. It concluded then that suboxone telemedicine is effective. This study is used by proponents of opioid telemedicine to support that lifting existing licensing and other jurisdictional limitations on telehealth opioid treatment by the Drug Enforcement Agency will broaden the scope of trained physicians to treat patients with OUD. It also will address healthcare disparities by offering treatment to underserved communities.
Research Conclusions on Telehealth Opioid Treatment
In their takeaways, the researchers who conducted the New Haven School of Health survey offer the following insights into telemedicine opioid treatment:
- Limited access to suboxone telemedicine led to inadequate services for OUD before the temporary lifting of the restrictions.
- The lack of needed suboxone telemedicine services was based on inadequate information before the pandemic.
- Encouraged by the lifting of telehealth opioid treatment during the pandemic, many physicians used telehealth for the first time and found it more helpful than expected.
- Most surveyed physicians support the lifting of telemedicine opioid treatment to continue permanently.
- Physicians see suboxone telemedicine as a viable treatment method for patients with OUD. Decision-makers will access more information following the increased use of telehealth opioid treatment.
Reimbursement for Suboxone Telemedicine
Based on studies before the one reported above, Congress proposed permanently lifting some telehealth restrictions through several actions, most notably the proposed 2023 Physician Fee Schedule (PFS). To be finalized in the next few weeks, the PFS will take effect on January 1st, 2023. It proposes several changes of relevance to OUD treatment:
- Permanently expansion of Medicare benefits for all behavioral health coverage of telephone and video telehealth.
- Extend Medicare coverage for services to be delivered by marriage and family therapists as well as counselors.
- New CPT codes include some of particular interest to clinicians working with substance use disorder, such as home visits, group therapy, remote patient monitoring, and psychological testing.
- A revised pricing plan, with bundled payments for opioid treatment programs and an add-on code for take-home supplies of methadone.
Sign the Letter of Support to the DEA
The American Association of Child and Adolescent Psychiatry, the American Psychiatric Association, the American Telemedicine Association, and ATA Action are co-leading an updated stakeholder letter urging the DEA to act and outline multiple short-term actions the DEA could take immediately to ensure patients are able to continue receiving treatment where and when they need it once the PHE ends and until the promulgation of the Special Registration for Telemedicine Rules.
If you plan to offer telehealth OUD services, please describe your program and let the TBHI community know how you will use the information above to advance your mission.
Introduction to Telehealth Theory & Practice
Enjoy a fast-moving overview of telebehavioral and telemental health. Understand the key points related to telehealth clinical, legal, ethical, technology, reimbursement, social media and other pivotal issues.