Nav: Home

Examination of effect of CMS policy to suppress substance abuse claims data

March 15, 2016

In a study appearing in the March 15 issue of JAMA, Kathryn Rough, Sc.M., of Brigham and Women's Hospital, Boston, and colleagues examined the association between implementation of the Centers for Medicare & Medicaid Services (CMS) suppression policy of substance abuse-related claims and rates of diagnoses for non­substance abuse conditions in Medicaid data.

In a change from longstanding practice, the CMS recently began suppressing substance abuse-related claims in the Medicare and Medicaid Research Identifiable Files to comply with a 1987 federal regulation barring third party payers from releasing information from federally funded substance abuse treatment programs without patient consent. CMS removes any claim containing a diagnostic or procedure code related to substance abuse, meaning that the entire encounter captured by the claim is deleted (including all diagnosis and procedure codes). Therefore, important diagnoses linked to substance abuse might also be suppressed.

This study included Medicaid data for 2000-2006 prior to implementation of the suppression policy (i.e., containing substance abuse codes) and data for 2007-2010 after the policy was enacted, allowing comparison of data without vs with claim suppression. The researchers calculated annual inpatient and outpatient rates of diagnoses for 6 conditions that commonly co-occur with substance abuse (hepatitis C, human immunodeficiency virus, cirrhosis, tobacco use, depression, and anxiety) and 4 conditions unrelated to substance abuse (type II diabetes, stroke, hypertension, and kidney disease).

The authors found that conditions unrelated to substance abuse appeared generally unassociated with the CMS suppression practices. However, 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.

"Underestimation of diagnoses has the potential to bias health services research studies and epidemiological analyses for which affected conditions are outcomes or confounders. In studies of health care utilization, the number of missing claims may vary in a nonrandom fashion between groups defined by demographics, disease, or locality. Comparisons between groups may lead to spurious conclusions--a hospital that regularly admits substance abusers will have artificially low rates of readmission, giving a false appearance of better performance."
(doi:10.1001/jama.2015.18417; this study is available pre-embargo at the For The Media website.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

Related Substance Abuse Articles:

Children of incarcerated parents have more substance abuse, anxiety
Children of incarcerated parents are six times more likely to develop a substance use disorder in adulthood and nearly twice as likely to have diagnosable anxiety compared to children whose parents were not incarcerated, according to new research from the Center for Child and Family Policy at Duke University.
The healing power of a smile: A link between oral care and substance abuse recovery
A new study links the benefits of comprehensive oral care to the physical and emotional recovery of patients seeking treatment for substance use disorder.
Reducing care needs of teens with substance-abuse disorders
Screenings, interventions, and referrals can help adolescent teens overcome substance abuse in the short-term.
Pain and substance abuse interact in a vicious cycle
Pain and substance use interact in a vicious cycle that can ultimately worsen and maintain both chronic pain and addiction, according to a research team including faculty at Binghamton University, State University of New York.
Gap in substance abuse data could have long-term implications, study finds
A policy of redacting Medicare claims that included diagnosis or procedure codes related to substance abuse was in effect from 2013-2017, just as the Affordable Care Act and the opioid epidemic were drastically changing the healthcare landscape.
AI tool promotes positive peer groups to tackle substance abuse
When it comes to fighting substance abuse, research suggests the company you keep can make the difference between recovery and relapse.
Investigators highlight potential of exercise in addressing substance abuse in teens
Exercise has numerous, well-documented health benefits. Could it also play a role in preventing and reducing substance misuse and abuse in adolescents?
What effect has substance abuse on outcome of schizophrenia treated with antipsychotics?
Review in the journal Current Drug Abuse Reviews: Long-term administration of antipsychotics and the influence of drug abuse on the disease outcome
Large declines seen in teen substance abuse, delinquency
Survey data indicate that in recent years, teens have become far less likely to abuse alcohol, nicotine and illicit drugs, according to researchers at Washington University School of Medicine in St.
Victimization of transgender youths linked to suicidal thoughts, substance abuse
In two peer-reviewed papers, researchers at The University of Texas at Austin have found that transgender adolescents are twice as likely to have suicidal thoughts as the general population, and they are up to four times as likely to engage in substance use.
More Substance Abuse News and Substance Abuse Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.