Substance use disorder treatment centers and facility ownership changes

项目摘要 2020年，估计有4030万成年人和青少年需要接受药物使用障碍治疗。然而 只有6.5%的需要治疗的人得到了治疗，获得高质量的护理仍然是一个重大挑战。 在过去的十年中，私募股权（PE）公司已经获得了许多物质使用障碍（SUD）治疗 设施，虽然这些收购的程度证据是稀缺的。SUD治疗中心具有吸引力 由于SUD治疗需求增加，医疗保险增加，私募股权收购目标 覆盖率，以及扩大SUD治疗的覆盖率，所有这些都增加了对治疗的需求。 由于市场的分散性和有关法规的变化， 丁丙诺啡处方有可能增加利润。有论者关注到， 专注于短期利润可能会导致私人股本获得的设施质量下降。类似收购 在其他保健领域，保健服务质量下降，死亡率上升。在本提案中，我们 将首次对私募股权收购的SUD设施进行全面分类和描述 2010-2022年投资者。我们将使用一种准实验性的差异研究设计， 利用所有权变更时间的差异来研究护理和患者交付的变化， 结果。我们的跨学科团队由来自耶鲁大学医学院，管理学院， 和公共卫生是唯一适合研究这个问题的方法和实质性的专业知识， 评估复杂的治疗和政策影响。我们的具体目标是：（1）分类和描述 SUD处理设施的私募股权所有权的变化（2010-2022年）及其预测因素 变更;（2）确定私募股权收购是否与组织的变更相关 水平，包括所提供治疗的变化（更多的设施提供阿片类药物使用障碍的药物治疗） （MOUD）治疗;提供初级保健服务或对复杂患者有吸引力的服务的设施较少）， 接受的保险类型的变化;（3）确定私募股权收购是否与 随着MOUD使用、质量和所收购设施中患者保险类型的变化。压力增加 鉴于报销率明显较高，商业保险患者的数量可能导致 减少医疗补助患者的数量;（4）确定私募股权收购是否是 与OUD治疗质量和阿片类药物相关不良事件的变化相关， 收购。最终，SUD治疗设施的目标是改善健康结果。使用商业 保险数据，我们将检查治疗质量和健康结果（OUD相关紧急情况）的变化 部门访问）。据我们所知，没有关于这一变化的程度和影响的信息。 在同行评议的文献中记录。

Project Summary An estimated 40.3 million adults and adolescents needed treatment for substance use disorders in 2020. Yet only 6.5% of those needing treatment received it. Access to high-quality care remains a significant challenge. In the past decade, private equity (PE) firms have acquired numerous substance use disorder (SUD) treatment facilities, although evidence on the extent of these acquisitions is scarce. SUD treatment centers are attractive targets for private equity acquisition due to increased need for SUD treatment, increased health insurance coverage, and expansions in coverage of SUD treatments, all of which increase demand for treatment. Opportunities for efficiencies due to the fragmented nature of the market and changes to regulations regarding buprenorphine prescribing have the potential to increase profits. Commentators have raised concerns that a focus on short term profits may lead to quality declines in private equity-acquired facilities. Similar acquisitions in other areas of health care have resulted in declines in quality and increases in mortality. In this proposal, we will, for the first time, comprehensively catalog and describe SUD facility acquisitions by private equity investors from 2010-2022. We will we use a quasi-experimental difference in differences research design that leverages differences in the timing of ownership changes to study changes in the delivery of care and patient outcomes. Our interdisciplinary team consisting of faculty from the Yale Schools of Medicine, Management, and Public Health is uniquely suited to study this issue with the methodological and substantive expertise to assess the complex treatment and policy implications. Our specific aims are: (1) To catalog and describe changes in private equity ownership of SUD treatment facilities (2010-2022) and the predictors of such changes; (2) To determine whether private equity acquisition is associated with changes at the organization level including changes in treatments offered (more facilities offering medication for opioid use disorder (MOUD) treatment; fewer facilities offering primary care services or services attractive to complex patients) and changes in the types of insurance accepted; (3) To determine whether private equity acquisition is associated with changes in MOUD use, quality and patient insurance type in acquired facilities. Pressure to increase the volume of commercially insured patients given the significantly higher reimbursement rates may lead to reductions in the number of Medicaid patients treated; (4) To determine whether private equity acquisition is associated with changes in OUD treatment quality and opioid-related adverse events in communities with acquisitions. Ultimately, a goal of an SUD treatment facility is to improve health outcomes. Using commercial insurance data, we will examine changes in treatment quality and health outcomes (OUD-related emergency department visits). To our knowledge no information about the extent and impacts of this change have been documented in the peer-reviewed literature.