Study: Opioid-Related Health Spending Jumped More than 1,300% in Four Years

ER visits and lab tests account for much of the surge

The nation’s ongoing opioid problem comes with significant physical and emotional costs to patients and families, but the dollar cost to the health system has been harder to determine. Now a new report shows a more than 1,300% rise in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse, according to Kaiser Health News.

From 2011 to 2015, insurers’ payments to hospitals, laboratories, treatment centers, and other medical providers for these patients grew from $32 million to $446 million––a 1,375% increase. While that’s a small portion of the overall spending on medical care in the United States, the rapid rise is cause for concern, Robin Gelburd, president of Fair Health, told Kaiser. Fair Health is a nonprofit databank that provides cost information to the health industry and consumers.

The Fair Health study found a sharp difference in how much insurers spend on patients diagnosed with opioid dependence or abuse. On average, insurers spend $3,435 a year on an individual patient, but for those with a diagnosis of opioid dependence or abuse, that amount jumps to $19,333. Those numbers reflect what insurers actually paid. The report also includes data on what providers charged.

The study, released on September 13, builds on a report that Fair Health issued in early August, which found a 3,000% increase in the volume of insurance claims related to opioid-dependence diagnoses between 2007 and 2014.

The latest study—part of a series—offers amounts associated with claims billed by providers and paid by insurers for the types of medical services used.

Both studies used claims data from insurers representing more than 150 million insured Americans who either have insurance through work or buy coverage on their own.

The surge in spending on patients with opioid diagnoses is likely a combination of factors, the report notes. As media attention focuses on drug dependency, more people may be seeking treatment. At the same time, prescription and illegal use of narcotics may also be increasing.

The study found that emergency room visits and laboratory tests accounted for much of the spending.

Based on claims volume, the fastest-growing set of services in terms of utilization were for alcohol or drug therapy. Laboratory tests, including checks for barbiturate or opioid use, were not far behind.

The researchers did not use 2015 data for lab test costs, noting that a change in billing codes increased the number of categories—and, in some cases, appeared to generate higher payments by insurers. It is too early to estimate the long-term effects of this change, Gelburd said.

The report gives some examples of the changes. For example, one billing code for a test on opiate use commonly brought in a $31 payment from insurers before the change. The two billing codes that replaced it now are commonly paid at $78 and $156.

According to Gelburd, some observers speculate that the rapid increase in lab spending might reflect that, with more patients in therapy, the tests are being used to ensure they are taking their proper medications and not abusing narcotics. But the spending might also reflect a growing use of very expensive urine and blood tests when less-expensive ones would be sufficient.

Source: Kaiser Health News; September 12, 2016; and Fair Health; September 2016.