Does Suppression of Substance Abuse Claims Impact Diagnoses?

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CMS suppression of claims linked to immediate decline in inpatient rates of related comorbidities.
CMS suppression of claims linked to immediate decline in inpatient rates of related comorbidities.

HealthDay News -- Implementation of a Centers for Medicare & Medicaid Services (CMS) policy suppressing substance abuse-related claims in the Medicare and Medicaid Research Identifiable Files correlated with an immediate reduction in inpatient diagnoses for conditions commonly co-occurring with substance abuse, according to a research letter published the Journal of the American Medical Association.

Kathryn Rough ScM, from Brigham and Women's Hospital in Boston, and colleagues examined the correlation between implementation of the CMS suppression policy and the rate of diagnoses for non-substance abuse conditions. The annual inpatient and outpatient rates of diagnoses for 6 conditions that commonly occur with substance abuse and four unrelated conditions were calculated for 2000 to 2006 (pre-implementation) and 2007 to 2010 (post-implementation).

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The researchers observed a significant negative level change for conditions commonly occurring with substance abuse after implementation of the policy. In 2007 there were immediate reductions of 56.7% for hepatitis C, 51.3% for tobacco use, 48.9% for cirrhosis, 38.4% for depression, 26.6% for anxiety, and 24.0%for HIV rates, relative to rates observed in 2006. Less pronounced reductions were seen in outpatient diagnosis rates; the decrease was only significant for anxiety.

"Implementation of the policy coincided with sudden and substantial decreases in the rates of inpatient diagnoses for conditions commonly co-occurring with substance abuse, and anxiety showed significant reductions in outpatient diagnosis rates," the authors wrote.

Two authors disclosed financial ties to the pharmaceutical industry.

Reference

Rough K, Bateman B, Patorno E, et al. Suppression of Substance Abuse Claims in Medicaid Data and Rates of Diagnoses for Non–Substance Abuse Conditions. JAMA. 2016;315(11):1164. doi:10.1001/jama.2015.18417.

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