Substance use disorder treatment centers and facility ownership changes

项目摘要 据估计，2020年有4030万成年人和青少年需要治疗药物使用障碍。还没有 在需要治疗的人中，只有6.5%的人得到了治疗。获得高质量的医疗服务仍然是一项重大挑战。 在过去的十年里，私募股权公司获得了大量的物质使用障碍(SUD)治疗 设施，尽管关于这些收购范围的证据很少。SUD治疗中心很有吸引力 私募股权收购的目标，因为对SUD治疗的需求增加，医疗保险增加 覆盖范围扩大，以及SUD治疗覆盖面的扩大，所有这些都增加了治疗需求。 由于市场的碎片化性质和以下方面的法规变化而带来的提高效率的机会 丁丙诺啡处方有增加利润的潜力。评论人士表示，人们担心一个 对短期利润的关注可能会导致私人股本收购的设施质量下降。类似的收购 在卫生保健的其他领域，这导致了质量下降和死亡率上升。在这项提案中，我们 将首次对私募股权收购SUD设施进行全面编目和描述 2010-2022年的投资者。我们将在差异研究设计中使用准实验差异 利用所有权变更的时间差异来研究提供护理和患者的变化 结果。我们的跨学科团队由耶鲁大学医学院、管理学、 公共卫生是唯一适合研究这一问题的方法和实质性专业知识 评估复杂的治疗和政策影响。我们的具体目标是：(1)编目和描述 私募股权对SUD治疗设施所有权的变化(2010-2022年)及其预测因素 变化；(2)确定私募股权收购是否与组织的变化有关 水平，包括提供的治疗的变化(更多的机构为阿片类药物使用障碍提供药物 (Moud)治疗；提供初级保健服务的设施较少或对复杂患者有吸引力的服务)和 接受的保险类型的变化；(3)确定私募股权收购是否与 随着收购设施中Moud的使用、质量和患者保险类型的变化。增加经济增长的压力 由于报销比例明显较高，商业保险患者的数量可能会导致 减少接受医疗补助的患者数量；(4)确定私募股权收购是否 与以下社区的OUD治疗质量和阿片类药物相关不良事件的变化相关 收购。归根结底，SUD治疗设施的一个目标是改善健康结果。使用商业广告 保险数据，我们将检查治疗质量和健康结果的变化(OUD相关紧急情况 部门访问)。据我们所知，目前还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有记载。

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.