Strengthening the link between the ED and treatment offers an opportunity to combat the opioid epidemic.
Hospital emergency departments not only care for patients with overdose and other complications from opioid use, but they also serve as vital touch points to encourage patients into longer-term treatment. After an overdose, patients are at risk for repeat overdose and death.
Pennsylvania is unique in establishing a voluntary incentive program to improve the rate at which patients with opioid use disorder receive follow-up treatment after emergency department care. Evaluations of the program show that financial incentives are effective in producing rapid treatment innovations for opioid use disorder.
In a new study, researchers at the Perelman School of Medicine at the University of Pennsylvania found that Pennsylvania’s financial incentive policy encouraged hospitals to enact rapid system and practice changes to support treatment for opioid use disorder for patients visiting the ED.
The study, published in Psychiatric Services, evaluates the efficacy of the Opioid Hospital Quality Improvement Program (O-HQIP), which Pennsylvania pioneered in 2019. The program seeks to increase the rate of follow-up treatment for Medicaid patients within seven days of an ED encounter for opioid-related illness by offering financial compensation to hospitals who participate in the program.
WHAT’S THE IMPACT?
Strengthening the link between the ED and treatment offers an opportunity to combat the opioid epidemic, and the financial incentives have shown momentum for the efforts to improve treatment access.
The program identified four distinct treatment pathways: initiation of buprenorphine treatment during the ED encounter, warm handoff to outpatient treatment, referral to treatment for pregnant patients and inpatient initiation of methadone or buprenorphine treatment.
An initial incentive for participation was paid to hospitals in 2019, contingent on participation in all four pathways, with lesser payments for partial participation. In future years, hospitals can earn additional incentives for improvements in performance.
To evaluate the degree of the program’s success, researchers conducted 20 semistructured interviews with leaders from a diverse sample of hospitals and health systems across Pennsylvania. The interviews revealed that the incentives oriented institutional priorities toward expanding opioid treatment access.
Hospitals were often on the cusp of change and responded to this nudge to prioritize opioid treatment access. But most hospitals – specifically, smaller or independent hospitals with lower volumes of patients with opioid use disorder – were unable to justify investing in these resources internally. Some hospitals noted resources as a barrier to participation, despite the incentive payments.
While initiating buprenorphine in the ED is proven to improve patients’ health outcomes and retention in treatment, many hospitals found implementing a pathway for buprenorphine difficult and time-consuming, and all partially participating hospitals chose to forgo this pathway.
Future work will focus on overcoming barriers to implementing buprenorphine treatment.
THE LARGER TREND
In 2019, buprenorphine was found by Mayo Clinic Proceedings to be one of three FDA-approved drugs that are underused in helping patients combat opioid addiction. Patient compliance with buprenorphine, that analysis found, is relatively high and associated with improved rates of sobriety and a reduction in accidental overdoses.
The opioid epidemic has long been a challenging issue both for Americans and the healthcare system that treats them, and the mortality statistics are significant. The American Academy of Family Physicians published research in 2019 showing that, if there’s no change in the annual incidence of prescription opioid misuse, annual opioid deaths could hit 82,000 by 2025.
From finding new, more cost-effective care delivery models to establishing outpatient addiction treatment programs, there’s an opportunity for investors to pump some much needed cash into the efforts to curb opioid misuse. If done correctly, the investors can see a healthy ROI, while also helping patients with addiction issues and easing the burden on the healthcare system.
HENRY KOTULA 