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de Groot K, Joyce MM, Hynes DM. VIReC VA/CMS Data for Research: Impact of the Suppression of Substance Abuse Claims in Medicare and Medicaid Data: Implications for Research on Population Health in Veterans. Paper presented at: AcademyHealth Annual Research Meeting; 2015 Jun 14; Minneapolis, MN.
Research Objective: Population health research relies on comprehensive healthcare data. Veterans enrolled in Veterans Health Administration (VHA) have also relied on Centers for Medicare and Medicaid (CMS) services to meet their healthcare needs, and therefore evaluation of impacts on healthcare use and outcomes requires review of a full complement of data. In 2014, CMS implemented policy restricting the disclosure of information on substance abuse (SA) patients without consent, due to a re-interpretation of 42 CFR Part 2 (Confidentiality of Alcohol and Drug Abuse Patient Records). CMS now suppresses an entire claim if it includes any procedure, diagnosis, or diagnosis related group (DRG) code related to SA. We studied how the suppression of SA claims might affect research on Veterans. Study Design: We obtained a list of codes used to suppress SA claims. We searched for these codes in 2009 Medicaid and 2011 Medicare claims data (received prior to suppression of SA claims) to approximate the number of suppressed claims in future years of data. We also examined inpatient claims that contained these codes to determine how many were directly related to treatment of SA. Population Studied: Veterans who are eligible for care in the VHA and had 2009 Medicaid or 2011 Medicare claims. Principal Findings: In 2009 Medicaid data, 9.87% of inpatient claims and 0.98% of non-inpatient claims contained a code for SA. In 2011 Medicare data, 3.51% of inpatient and 0.11% of non-inpatient claims contained a SA code. Review of inpatient claims show that most records that would be suppressed are due only to a diagnosis of SA (71% in Medicaid; 75% in Medicare), not a procedure or DRG related to SA. The majority of inpatient claims with SA codes (over 99% in Medicaid; 72% in Medicare) had DRGs not directly related to treatment of SA. The most common non-SA DRGs were for cirrhosis and malignancy of hepatobiliary system in Medicaid, and for psychosis in Medicare. In Medicaid claims with an SA diagnosis code, 84% of SA codes are found in high positions (1st 5 positions) on the claim. In contrast, in Medicare claims with an SA diagnosis code, only 51% of SA codes are found in high positions on the claim. Conclusions: Suppression of SA claims will markedly impact research that focuses on Veterans, especially research focused on inpatient hospitalization. Many claims with SA codes were not primarily for SA treatment, so even research focusing on non-SA issues will be affected. Implications: The VHA estimates that approximately 8% of its patients have a SA disorder. Research addressing SA in the Veteran population is especially important as SA may add to the already high comorbidity burden of veterans, and generally affect post-deployment health. Moreover, given that SA codes may appear in claims when SA is not the primary condition under treatment, the impact of claim suppression on population health research generally will be impacted by this re-interpretation of 42 CFR Part 2. Policymakers should carefully reconsider the implementation of this decision.