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Suppression of Substance Abuse Claims Impacts Diagnoses

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

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TUESDAY, March 15, 2016 (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 in the March 15 issue of the Journal of the American Medical Association.

Kathryn Rough Sc.M., 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 six 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).

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 percent for hepatitis C, 51.3 percent for tobacco use, 48.9 percent for cirrhosis, 38.4 percent for depression, 26.6 percent for anxiety, and 24.0 percent 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 write.

Two authors disclosed financial ties to the pharmaceutical industry.

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