Kelsey C. Priest

All Publications

• Are observation codes underused for emergency psychiatric patients with an extended length of stay? A retrospective commercial claims analysis from 2016 to 2022. General hospital psychiatry Priest, K. C., Havlik, J., Wilson, M. P., Jo, B., Humphreys, K. 2025; 97: 209-217

  Abstract

  To compare observation billing patterns among psychiatric vs. non-psychiatric patients presenting to emergency departments (ED) with extended lengths of stay (LOS).Analysis of commercially insured claims and encounters from the Merative™ Marketscan® Commercial Database (2016 - 2022). The cohort included patients ages 18 to 64 with an ED claim, service dates occurring on two calendar dates, and a non-null billing code. Analytic methods included descriptive/inferential statistics with effect size estimation. The primary outcome was observation code frequency. Claims and encounters were compared within psychiatric and non-psychiatric patient groups.There were 40,441 psychiatric and 1,133,496 non-psychiatric encounters. Fifteen percent of psychiatric encounters had an observation billing code as compared to 32% of all non-psychiatric encounters (18%). When analyzed by specific LOS category, larger differences were observed between the two groups for LOS 2 (36%), LOS 3 (36%), LOS 4 (35%), and LOS 5 (29%), as compared to LOS 1 (14%).In this study of commercially insured patients with extended ED LOS, we observed a difference between the frequency of psychiatric and non-psychiatric observation encounters, which increased in magnitude when analyzing encounters with longer LOS. Our findings may suggest underbilling for extended stay psychiatric patients.

  View details for DOI 10.1016/j.genhosppsych.2025.10.015

  View details for PubMedID 41176923

• Trends in Psychiatrist-Led Care for Medicare Part B Enrollees. JAMA network open Havlik, J. L., Wahid, S., Priest, K. C., Ososanya, L., Igunbor, M., Humphreys, K. 2025; 8 (2): e2458160

  Abstract

  Importance: The rising incidence of mental illness in the US underscores the need for timely access to psychiatric care, especially for vulnerable populations such as older adults and individuals with mental and physical disabilities who receive Medicare.Objective: To assess changes in the number and proportion of active psychiatrists providing professional services to traditional Medicare Part B enrollees from 2014 to 2022.Design, Setting, and Participants: This repeated cross-sectional study of Medicare Part B enrollees used publicly available data (for January 1, 2014, through December 31, 2022) from the Centers for Medicare & Medicaid Services and the Kaiser Family Foundation. Data from all traditional Medicare Part B enrollees in all 50 states and the District of Columbia were analyzed.Main Outcomes and Measures: Primary outcomes included changes in (1) the proportion of active psychiatrists billing traditional Medicare and (2) the number of psychiatrists providing care relative to the number of Medicare Part B enrollees nationally, regionally, and by state.Results: The study population comprised 291 748 472 Medicare Part B enrollee-years (33 042 936 in 2014: 5 800 903 [17.6%] eligible due to disability alone and 27 242 030 [82.4%] eligible due to age). From 2014 to 2022, the number of Medicare Part B enrollees decreased by 3 497 942 enrollee-years (10.6%), while the number of psychiatrists submitting more than 10 claims to Medicare Part B decreased by 3772 (16.8%). The nationwide proportion of professionally active psychiatrists submitting claims to Medicare Part B for professional services during this period declined from 22 409 of 50 416 (44.4%) in 2014 to 18 637 of 56 492 (33.0%) in 2022 (P<.001 on univariable regression). From 2014 to 2022, state-level changes in Medicare Part B-serving psychiatrists per enrollee ranged from a 31.7% increase in Alabama (from 36.5 to 48.1 psychiatrists per 100 000 enrollees) to a 67.8% decrease in Wyoming (from 42.9 to 13.8 psychiatrists per 100 000 enrollees). Every state and district assessed saw a decrease in the percentage of active psychiatrists who billed Medicare Part B for professional services over the study period.Conclusions and Relevance: In this study of Medicare Part B acceptance among active US psychiatrists, declining acceptance of Medicare Part B for professional services among psychiatrists was observed nationally and across all states. During a time of psychiatrist workforce growth, the number of psychiatrists accepting traditional Medicare decreased, indicating potential challenges in providing equitable access to psychiatric care.

  View details for DOI 10.1001/jamanetworkopen.2024.58160

  View details for PubMedID 39913135

• A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery. Journal of general internal medicine Priest, K. C., Merlin, J. S., Lai, J., Sorbero, M., Taylor, E. A., Dick, A. W., Stein, B. D. 2024

  Abstract

  States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients.To examine trends in the perioperative opioid dispensing rates for fee-for-service Medicare beneficiaries and the effects of select state policies.A retrospective cohort study using 2006 to 2018 Medicare claims data for individuals undergoing surgical procedures for which opioid analgesic treatment is common.State policies mandating prescription drug monitoring program (PDMP; PDMP policies) use, initial opioid prescription duration limit (duration limit policies), and mandated continuing medical education (CME; CME pain policies) on pain management.Opioid dispensing rates, days' supply, and the daily morphine milligram equivalent dose (MMED).The percentage of Medicare beneficiaries dispensed opioids in the perioperative period increased from 2007 to 2018; MMED and days' supply decreased over the same period, with significant variation by age, sex, and race. None of the three state policies affected the likelihood of Medicare beneficiaries being dispensed perioperative opioids. However, CME pain policies and duration limit policies were associated with decreased days' supply and decreased MMED in the several years following implementation, respectively.While we observed a slight increase in the rate of Medicare beneficiaries dispensed opioids perioperatively and a substantial decrease in MMED and days' supply for those receiving opioids, state policies examined had relatively modest effects on the main measures. Our findings suggest that these state policies may have a limited impact on opioid dispensing for a patient population that is commonly dispensed opioid analgesics to help control surgical pain, and as a result may have little direct effect on clinical outcomes for this population. Changes in opioid dispensing for this population may be the result of broader societal trends than such state policies.

  View details for DOI 10.1007/s11606-024-08888-3

  View details for PubMedID 39020230

  View details for PubMedCentralID 6109008

• Contextualizing the Resurgence of U.S. Housestaff Union Activity. Academic medicine : journal of the Association of American Medical Colleges Lin, G. L., Priest, K. C., Sossenheimer, P. H., Pal, R. 2024

  Abstract

  There is a growing trend of resident and fellow physician unionization in the United States, with 14 new housestaff unions formed at private employers since 2022. This resurgence of housestaff union organizing parallels the last era of housestaff activism in the 1960s. Today's housestaff organizing takes place within the context of longstanding challenges in medicine, including the burnout and systemic inequities highlighted by the COVID-19 pandemic, and an increase in national activism and labor organizing. Housestaff unions offer opportunities for residents and fellows to negotiate for improvements across multiple issues.In this Commentary, the authors focus on common bargaining topics: poor working conditions, undercompensation, and inadequate representation in an increasingly corporatized health care landscape. The authors also discuss the role of collective bargaining for improving the housestaff experience and address common concerns about unionization. Finally, the authors explore the limited evidence of the impact of unions in health care settings and outline key considerations for future scholarship.The current generation of housestaff started their medical careers with an awareness of systemic challenges to the profession and have responded through collective organizing. While the short- and long-term ramifications of housestaff organizing need further study, the authors express optimism that unionization will lead to improved working conditions and thus improved health care delivery.

  View details for DOI 10.1097/ACM.0000000000005816

  View details for PubMedID 39018433

• The Policy Landscape for Armed Personnel in Health Care Facilities: A Preliminary Scoping Review of State Policies Priest, K., Lamothe, D. ELSEVIER SCIENCE INC. 2023: S80-S81

  View details for DOI 10.1016/j.jaclp.2023.11.633

  View details for Web of Science ID 001161339100153

• Caring for Hospitalized Adults with Methamphetamine Use Disorder: A Proposed Clinical Roadmap. The American journal of medicine Priest, K. C., Balasanova, A. A., Levander, X. A., Chan, B., Blazes, C. K., Mahan, J., Brown, J., Mahoney, S., Peng, L., Mahoney, S., Lundy, T., Englander, H. 2023

  View details for DOI 10.1016/j.amjmed.2023.01.012

  View details for PubMedID 36739062

• Differences in the delivery of medications for opioid use disorder during hospitalization by racial categories: A retrospective cohort analysis SUBSTANCE ABUSE Priest, K. C., King, C. A., Englander, H., Lovejoy, T., McCarty, D. 2022; 43 (1): 1251-1259

  Abstract

  Background: As the drug-related overdose crisis and COVID-19 pandemic continue, communities need increased access to medications for opioid use disorder (MOUD) (i.e., buprenorphine and methadone). Disparities in the type of MOUD prescribed or administered by racial and ethnic categories are well described in the outpatient clinical environment. It is unknown, however, if these disparities persist when MOUD is provided in acute care hospitals. Methods: This study assessed differences in the delivery of buprenorphine versus methadone during acute medical or surgical hospitalizations for veterans with opioid use disorder (OUD) by racial categories (Black Non-Hispanic or Latino vs. White Non-Hispanic or Latino). Data were obtained retrospectively from the Veterans Health Administration (VHA) for federal fiscal year 2017. We built logistic regression models, adjusted for individual and hospital-related covariates, and calculated the predicted probabilities of MOUD delivery by racial categories. Results: The study cohort (n = 1,313 unique patients; N = 107 VHA hospitals) had a mean age of 57 (range 23 to 87 years), was predominantly male (96%), and composed entirely of Black (29%) or White (71%) patients. White patients were 11% more likely than Black patients to receive buprenorphine than methadone during hospitalization (p = 0.010; 95% CI: 2.7%, 20.0%). Among patients on MOUD prior to hospitalization, White patients were 21% more likely than Black patients to receive buprenorphine (p = 0.000; 95% CI: 9.8%, 31.5%). Among patients newly initiated on MOUD during hospitalization, there were no differences by racial categories. Conclusion: We observed disparities in the delivery of buprenorphine versus methadone during hospitalization by racial categories. The observed differences in hospital-based MOUD delivery may be influenced by MOUD received prior to hospitalization within the racialized outpatient addiction treatment system. The VHA and health systems more broadly must address all aspects of racism that contribute to inequitable MOUD access throughout all clinical contexts.

  View details for DOI 10.1080/08897077.2022.2074601

  View details for Web of Science ID 000807336500001

  View details for PubMedID 35670778

  View details for PubMedCentralID PMC10292919

• A qualitative study of patient experiences with telemedicine opioid use disorder treatment during COVID-19 SUBSTANCE ABUSE Lockard, R., Priest, K. C., Gregg, J., Buchheit, B. M. 2022; 43 (1): 1150-1157

  Abstract

  Background: The drug-related overdose crisis worsened during the COVID-19 pandemic. Recent drug policy changes to increase access to medications for opioid use disorder (MOUD) during COVID-19 shifted some outpatient MOUD treatment into virtual settings to reduce the demand for in-person care. The objective of this study was to qualitatively explore what is gained and lost in virtual patient encounters for patients with opioid use disorder at a low-threshold, addiction treatment clinic that offers buprenorphine and harm reduction services. Methods: Patients were included in this study if they received care at the Harm Reduction and BRidges to Care (HRBR) clinic and utilized virtual visits between November 2019 and March 2021. The study was conceptualized using a health care access framework and prior studies of telemedicine acceptability. Semi-structured interviews were completed between March and April 2021. Interviews were dual-coded and analyzed using directed content analysis. Results: Nineteen interviews were conducted. The sample was predominantly White (84%) and stably housed (79%) with comparable gender (male, 53%) and employment status (employed, 42%). The majority (63%) of patients preferred virtual visits compared to in-person visits (16%) or a combination of access to both (21%). Two overarching tandem domains emerged: availability-accommodation and acceptability-appropriateness. Availability-accommodation reflected participants' desires for immediate services and reduced transportation and work or caregiving scheduling barriers, which was facilitated by virtual visits. The acceptable-appropriate domain articulated how participants felt connected to their providers, whether through in-person interactions or the mutual trust experienced during virtual visits. Conclusions: Virtual visits were perceived by participants as a valuable and critical option for accessing treatment for OUD. While many participants preferred virtual visits, some favored face-to-face visits due to relational and physical interactions with providers. Participants desired flexibility and the ability to have a choice of treatment modality depending on their needs.

  View details for DOI 10.1080/08897077.2022.2060447

  View details for Web of Science ID 000789672400001

  View details for PubMedID 35499402

• Opioid treatment programs, telemedicine and COVID-19: A scoping review SUBSTANCE ABUSE Chan, B., Bougatsos, C., Priest, K. C., McCarty, D., Grusing, S., Chou, R. 2022; 43 (1): 539-546

  Abstract

  Background: Methadone and buprenorphine are effective medications for opioid use disorder (MOUD) that are highly regulated in the United States. The on-going opioid crisis, and more recently COVID-19, has prompted reconsideration of these restrictions in order to sustain and improve treatment access, with renewed interest in telemedicine. We reviewed the evidence on use of telemedicine interventions and applicability to MOUD policy changes in the post-COVID-19 treatment landscape. Methods: Ovid MEDLINE and the Cochrane Database of Systematic Reviews databases were searched from inception to April 2021 and reference lists were reviewed to identify additional studies. Studies were eligible if they examined telemedicine interventions and reported outcomes (e.g. treatment initiation, retention in care). Randomized trials and controlled observational studies were prioritized; other studies were included when stronger evidence was unavailable. One investigator abstracted key information and a second investigator verified data. We described the results qualitatively. Results: We identified nine studies: three controlled trials (two randomized), and six observational studies. Three studies evaluated patients treated with methadone and six studies with buprenorphine, including one study of pregnant women with OUD. All studies showed telemedicine approaches associated with similar outcomes (treatment retention, positive urine toxicology) compared to treatment as usual. Trials were limited by small samples sizes, lack of reporting harms, and most were conducted prior to the COVID-19 pandemic; observational studies were limited by failure to control for confounding. Conclusions: Limited evidence suggests that telemedicine may enhance access to MOUD with similar effectiveness compared with face-to-face treatment. Few studies have been published since COVID-19, and it is unclear the potential impact of these interventions on the existing racial/ethnic disparities in treatment. The COVID-19 pandemic and need for social distancing led to temporary policy changes for prescribing of MOUD that could inform additional research in this area to support comprehensive policy reforms.

  View details for DOI 10.1080/08897077.2021.1967836

  View details for Web of Science ID 000695975400001

  View details for PubMedID 34520702

• Expanding Access to Medications for Opioid Use Disorder: Program and Policy Approaches from Outside the Veterans Health Administration JOURNAL OF GENERAL INTERNAL MEDICINE Priest, K. C., McCarty, D., Lovejoy, T. 2020; 35 (SUPPL 3): 886-890

  Abstract

  To mitigate morbidity and mortality of the drug-related overdose crisis, the Veterans Health Administration (VHA) can increase access to treatments that save lives-medications for opioid use disorder (MOUD). Despite an increasing need, MOUD continues to be underutilized due to multifaceted barriers that exist within broader macro- and microenvironments. To promote MOUD utilization, policymakers and healthcare leaders should (1) identify and implement person-centered MOUD delivery systems (e.g., the Medication First Model, community-informed design); (2) recognize and address MOUD delivery gaps (e.g., the Best-Practice in Oral Opioid Agonist Collaborative); (3) broaden the definition of the MOUD delivery system (e.g., access to MOUD in non-clinical settings); and (4) expand MOUD options (e.g., injectable opioid agonist therapy). Increasing access to MOUD is not a singular fix to the overdose-related crisis. It is, however, a possible first step to mitigate harm, and save lives.

  View details for DOI 10.1007/s11606-020-06266-3

  View details for Web of Science ID 000584968600005

  View details for PubMedID 33145685

  View details for PubMedCentralID PMC7609303

• Regulatory and allocative policies inform access to opioid agonist therapy ADDICTION Priest, K. C. 2020; 115 (12): 2255-2256

  View details for DOI 10.1111/add.15190

  View details for Web of Science ID 000554863000001

  View details for PubMedID 32748483

• Comparing Canadian and United States opioid agonist therapy policies INTERNATIONAL JOURNAL OF DRUG POLICY Priest, K. C., Gorfinkel, L., Klimas, J., Jones, A. A., Fairbairn, N., McCarty, D. 2019; 74: 257-265

  Abstract

  Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)-buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.

  View details for DOI 10.1016/j.drugpo.2019.01.020

  View details for Web of Science ID 000504779500034

  View details for PubMedID 30765118

• Making the business case for an addiction medicine consult service: a qualitative analysis BMC HEALTH SERVICES RESEARCH Priest, K. C., McCarty, D. 2019; 19 (1): 822

  Abstract

  As the drug poisoning crisis worsens in North America and opioid use disorder (OUD)-related hospital admissions increase, policymakers and hospital administrators are beginning to recognize the important role of hospitals in the OUD care continuum. This study explores and describes how U.S. addiction medicine physicians created and presented business propositions to hospital administrators to support the development of addiction medicine consult (AMC) services.Fifteen qualitative interviews were completed with board-certified or board-eligible addiction medicine physicians from 14 U.S. hospitals. The interviews occurred as part of a broader mixed methods study exploring hospital service delivery for patients admitted with OUD. Using a directed content analysis, the transcribed interviews were coded, analyzed, and final themes consolidated.Semi-structured interviews completed with addiction medicine physicians from established (n = 9) and developing (n = 5) AMC services at 14 U.S. hospitals explored how clinical champions persuaded hospital administrators to support AMC service development. Four elements were foundational to making the "business case": 1) describing the prevalence of substance use disorder (SUD) or OUD in the hospital; 2) identifying the negative financial impacts of not treating SUDs during hospitalization; 3) highlighting the ongoing care quality and treatment gap for hospitalized patients with SUDs; and 4) noting the success of other institutional AMC services. Study findings informed the creation of tools to support AMC service development: 1) an AMC service business case template, and 2) an AMC service design and operations resource list.OUD-related hospital admissions are unlikely to abate. Hospital administrators should consider innovative care delivery mechanisms to improve care for persons with OUD. AMC services may be a promising delivery mechanism to achieve this aim. For clinical and administrative champions, understanding how to communicate the potential effectiveness of this intervention to hospital leaders is an essential first step to AMC service creation.

  View details for DOI 10.1186/s12913-019-4670-4

  View details for Web of Science ID 000495667100001

  View details for PubMedID 31703741

  View details for PubMedCentralID PMC6842195

• More About USMLE Step 1 Scoring In Reply ACADEMIC MEDICINE Chen, D. R., Priest, K. C. 2019; 94 (11): 1628-1629

  View details for Web of Science ID 000494272900043

  View details for PubMedID 31663950

• Considerations of a Resident Recruitment Committee on the USMLE Step 1 Examination Reply ACADEMIC MEDICINE Chen, D. R., Priest, K. C. 2019; 94 (7): 923

  View details for DOI 10.1097/ACM.0000000000002759

  View details for Web of Science ID 000474593100033

  View details for PubMedID 31241568

• Student Perspectives on the "Step 1 Climate" in Preclinical Medical Education ACADEMIC MEDICINE Chen, D. R., Priest, K. C., Batten, J. N., Fragoso, L. E., Reinfeld, B. I., Laitman, B. M. 2019; 94 (3): 302–4

  View details for DOI 10.1097/ACM.0000000000002565

  View details for Web of Science ID 000459803900008

• Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy INTERNATIONAL JOURNAL OF DRUG POLICY McEachern, J., Adye-White, L., Priest, K. C., Moss, E., Gorfinkel, L., Wood, E., Cullen, W., Klimas, J. 2019; 64: 30-33

  Abstract

  Opioid agonist therapy (OAT) is a first-line treatment for opioid use disorder (OUD); however, the efficacy and role of urine drug screening (UDS) in OAT has received little research attention. Prior evidence suggests that UDS frequency reflects philosophy and practice context rather than differences in patient characteristics or clinical need. Therefore, we reviewed the literature on the effect of and recommendations for the frequency of UDS on health outcomes for persons with OUD who receive OAT.We searched Medline and EMBASE for articles published from 1995-2017. Search results underwent double, independent review with discrepancies resolved through discussion with a third reviewer, when necessary. Additional articles were identified through snowball searching, hand searching (Google Scholar), and expert consultation. The Cochrane tool was used to assess risk of bias.Of the 60 potentially eligible articles reviewed, only one three-arm randomized open-label trial, comparing weekly and monthly UDS testing with take-home OAT doses, met our inclusion criteria.Our review identified an urgent gap in research evidence underpinning an area of clinical importance and that is routinely reported by patients as an area of concern.

  View details for DOI 10.1016/j.drugpo.2018.08.006

  View details for Web of Science ID 000460810900005

  View details for PubMedID 30551003

  View details for PubMedCentralID PMC6500449

• Student Perspectives on the "Step 1 Climate" in Preclinical Medical Education. Academic medicine : journal of the Association of American Medical Colleges Chen, D. R., Priest, K. C., Batten, J. N., Fragoso, L. E., Reinfield, B. I., Laitman, B. M. 2018

  Abstract

  The United States Medical Licensing Examination (USMLE) Step 1 was implemented in the 1990s as the most recent version of the National Board of Medical Examiners' preclinical licensing examination originally created in the late 1960s. For the purposes of state licensure, the exam is pass/fail, but the Step 1 numeric score has in recent years become central to the residency application and selection process. Consequently, a medical student's Step 1 score is increasingly viewed as a key outcome of preclinical medical education.In this Invited Commentary, students from various institutions across the country draw on their shared experiences to argue that the emphasis on Step 1 for residency selection has fundamentally altered the preclinical learning environment, creating a "Step 1 climate." The authors aim to increase awareness of the harms and unintended consequences of this phenomenon in medical education. They outline how the Step 1 climate negatively impacts education, diversity, and student well-being, and they urge a national conversation on the elimination of reporting Step 1 numeric scores.

  View details for PubMedID 30570499