Opioid treatment program weaves in hepatitis C care, despite payment obstacles

For patients receiving methadone treatment at CODAC, Inc.'s service locations in Rhode Island, motivation to addiction recovery can be enhanced if they believe their general health challenges can be successfully addressed. Atop the list of health concerns for a substantial number of these patients is the hepatitis C virus (HCV).

With today's medication treatments for hepatitis C able to achieve much more than earlier-generation options, the Rhode Island opioid treatment program (OTP) operator has established an on-site HCV clinic that an outside physician staffs one to two days a week. CODAC has had to engage in some creative financing options to pull this off; its bundled public payments for services aren't structured with the flexibility to allow reimbursement for these services.

But the value of having patients receive HCV care at the treatment site they visit daily is immeasurable, CODAC's president and CEO indicates. “They feel safe here, and respected,” Linda Hurley says.

Hurley co-presented a workshop session on integrating hepatitis C care into an OTP at last week's national conference of the American Association for the Treatment of Opioid Dependence (AATOD) in Baltimore. She credits the determined efforts of one of her co-presenters, hepatitis C and HIV specialist Lynn Taylor, MD, for much of what the initiative has been able to accomplish so far.

“She is an unending source of energy for ending HCV in Rhode Island, and the world,” Hurley says of Taylor, who directs the HIV/Viral Hepatitis Co-Infection Program at The Miriam Hospital in Providence.

Promise of new drugs

One of the obstacles that this initiative has had to overcome lies in the notion that a patient with opioid dependence might not be a good candidate for HCV medication treatment because of possible drug interactions. Hurley says this is based largely on earlier medication treatments for hep C, and that Taylor has emphasized that neither opioid nor alcohol use present a contraindication with the newer medications.

Hurley says that one of the several newer drugs for HCV is available to patients in the clinic program. “These meds cure,” she says of the new-generation options. “Finding out that they can be cured from hep C is the very thing that can move [our patients] forward. It changes their look,” offering them the real promise of a better future.

The initiative has grown out of a collaborative relationship among CODAC, The Miriam Hospital and the Warren Alpert Medical School of Brown University, where Taylor is an assistant professor. Hurley says it involved taking baby steps at various opportunities, leading up to the establishment of the on-site service where Taylor provides direct care to patients with HCV. “It's really a program with heart,” says Hurley.

Taylor's time is billed not by CODAC but by the hospital, in part because this service lies outside the OTP's Medicaid bundled rate. CODAC's service contribution to the effort, consisting of nursing and phlebotomy services, is unfunded care, not presently reimbursable through either public or private insurance. But the organization considers these services essential to saving lives.

CODAC is currently applying for an ambulatory care license from the state Department of Health; this would change the payment scenario. “All we want to do is get paid for the services we're already providing,” says Hurley.

She adds that in general, OTPs need to forge more collaborative relationships in the community. “As OTPs it is critical that we stop self-stigmatizing and keeping low profiles in the community,” she says. “When we do this, we're not seen as the experts on medication-assisted treatment.”