{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:50:44Z","timestamp":1791899444814,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["P30 DA035772"],"award-info":[{"award-number":["P30 DA035772"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The US is experiencing an epidemic of opioid misuse and mortality. Effective treatments are available, including medications for opioid use disorders (MOUD), but they are greatly underused due to a variety of barriers. In response, some US hospitals have established programs to identify emergency department (ED) patients with opioid use disorders (OUD) and begin treatment with MOUD (\u201cED induction\u201d). For this model to be widely adopted, financial sustainability for hospitals is critical. Little is known about the financial aspects of ED\u2010based treatment models, including insurance billing and reimbursement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Our study addressed the following questions about ED\u2010based induction of OUD treatment: (1) Which components of this model are billable to insurers? (2) How do hospitals fund the components that are not billable? (3) Does ED\u2010based induction generate savings that could help fund that service?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative study, involving semi\u2010structured interviews with officials at selected US hospitals. Potential interviewees were identified using a snowball sampling approach. We conducted 12 interviews across 10 states, mostly with urban teaching hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key findings include, (1) medication costs are often billable to insurers, but costs of key para\u2010professional staff like peer navigators are not, requiring the hospital to absorb their salaries. Even some billable costs are reimbursed at low rates which challenge sustainability. (2) To fund non\u2010billable components, hospitals typically rely on time\u2010limited grant funding, including the federal 340B drug rebate program. (3) Several interviewees anticipated cost savings to their hospitals from reduced use of ED services by patients who had no (or low\u2010paying) insurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings indicate that some hospitals are able to sustain ED\u2010based induction of MOUD using time\u2010limited grant funding. However, wider dissemination of this model will likely require more stable funding streams, such as Medicaid reimbursement, paying adequate rates, and coverage of personnel.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70185","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T04:19:25Z","timestamp":1762402765000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Financial Sustainability of Programs to Initiate Medications for Opioid Use Disorder in Emergency Department Settings"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4494-9176","authenticated-orcid":false,"given":"Dominic","family":"Hodgkin","sequence":"first","affiliation":[{"name":"Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5855-1196","authenticated-orcid":false,"given":"Cindy Parks","family":"Thomas","sequence":"additional","affiliation":[{"name":"Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot T.","family":"Davis","sequence":"additional","affiliation":[{"name":"Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0887-8611","authenticated-orcid":false,"given":"Jennifer J.","family":"Wicks","sequence":"additional","affiliation":[{"name":"Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly F.","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Harvard Medical School and McLean Hospital  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary F.","family":"Meisel","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania and the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance M.","family":"Horgan","sequence":"additional","affiliation":[{"name":"Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"National Center for Health Statistics \u201cU.S. Overdose Deaths Decrease Almost 27% in 2024 \u201d(2025)."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000555"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108568"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108479"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2022.108837"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109497"},{"key":"e_1_2_9_8_1","unstructured":"National Council for Mental Wellbeing \u201cAddressing Opioid Use Disorder in Emergency Departments: Expert Panel Findings \u201d(2021) https:\/\/www.thenationalcouncil.org\/resources\/addressing\u2010opioid\u2010use\u2010disorder\u2010in\u2010emergency\u2010departments\u2010expert\u2010panel\u2010findings\/."},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.3474"},{"key":"e_1_2_9_10_1","first-page":"e214","article-title":"Buprenorphine in the Emergency Department: Randomized Clinical Controlled Trial of Clonidine Versus Buprenorphine for the Treatment of Opioid Withdrawal","volume":"65","author":"Srivastava A.","year":"2019","journal-title":"Canadian Family Physician"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14054"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.13900"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.04.023"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-022-00324-3"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2022.2.52978"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2024.209540"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108410"},{"key":"e_1_2_9_18_1","unstructured":"California Health Care Foundation \u201cProtocols for Emergency Department Medication\u2010Assisted Treatment of Opioid Addiction \u201d(2016) https:\/\/www.chcf.org\/wp\u2010content\/uploads\/2017\/12\/PDF\u2010EDMATOpioidProtocols.pdf."},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-021-00253-7"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-017-4077-z"},{"key":"e_1_2_9_22_1","unstructured":"Commonwealth Fund \u201cThe Federal 340B Drug Pricing Program: What It Is and Why It's Facing Legal Challenges \u201d(2022) 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