Caring for Opioid Use Disorder Patients Costs Hospitals $95B Per Year

Caring for patients with opioid use disorders (OUDs) costs hospitals more than $95 billion per year and accounts for almost 8 percent of all hospital spending, according to data from PINC AI Applied Sciences (PAS).

PAS data scientists used the PINC AI Healthcare Database (PHD) to analyze discharges for emergency department (ED) outpatient visits and inpatient admissions that occurred between 2017 and 2022. They used OUD prevalence and cost estimates from the PHD analysis to determine the cost of care for people with OUDs.

OUD was associated with around 66 million ED outpatient visits and 760,000 inpatient admissions each year, leading to economic challenges for hospitals. On average, patients with an OUD diagnosis had a 32.5 percent higher cost per ED visit and an 8 percent higher cost per inpatient visit compared to those without an OUD diagnosis.

Patients experiencing an opioid overdose in an ED are at high risk for multiple organ failure, hospitalization, and steeper costs due to stays in the intensive care unit and unplanned readmissions after discharge.

The mean total cost of an ED outpatient visit for hospitals was $854 for a patient without OUD and $1,264 for a patient without an OUD diagnosis. The mean inpatient visit cost was $14,510 for a patient without OUD and $15,763 for a patient with OUD.

When applying these cost estimates to all hospital ED and inpatient visits in the country, the total cost of OUD to hospitals was $95.43 billion annually. This makes up 7.86 percent of all hospital expenditures. If the payer mix remained constant, $67 billion of the spending would occur within Medicare and Medicaid.

A disproportionately large share of patients with an OUD diagnosis were of lower socioeconomic status, the data revealed.

Half of ED patients had Medicaid coverage compared to 27 percent of non-OUD patients. Furthermore, over 16 percent of ED patients with OUD were uninsured compared to 13 percent of patients without OUD.

Among patients admitted to inpatient settings, 40 percent had Medicaid coverage compared to 17 percent without OUD, and 8 percent were uninsured compared to 3.9 percent of non-OUD patients.

Medicaid reimbursement is typically lower than other payers and care for uninsured patients often goes without reimbursement. When this happens, the costs associated with OUD visits fall on the health systems.

Patients with an OUD diagnosis were more likely to be homeless, accounting for 4 percent of ED visits and 6 percent of inpatient admissions.

Patients with an OUD were also more likely to be discharged to nursing, long-term care, rehabilitation, or law enforcement facilities, creating an additional strain on finances, resources, and the continuum of patient care.

“Solving for the opioid epidemic is not only the right thing to do for patients’ health and for families and society – but it also helps prevent a downward drag on provider finances, allowing them to drive high-quality, cost-effective healthcare for the patients and communities they serve,” the press release stated.

Shifting from fee-for-service to value-based care payment models can help improve access to care for patients with OUD while reducing costs. Better data access could also help hospitals minimize the cost of OUD care.