A financial incentive program for emergency rooms to start medication-assisted treatment (MAT) for opioid-use disorder (OUD) translated into increased rates of continuing treatment.
However, the increases were a slight improvement in an already low rate of continuing care. Before the incentive program, hospitals saw a rate of 5% of OUD ER patients filling a buprenorphine prescription. After hospitals implemented the program, that rate increased by 2.6 percentage points, according to a study.
“[Emergency room] encounters present a crucial opportunity to engage patients with OUD treatment,” the study states. “Given high mortality rates immediately after ED discharge, treatment linkage should be timely and prioritize connection to facilities and clinicians able to initiate or continue medication treatment, the most effective modality for treating OUD.”
The study reviewed the impact of the Opioid Hospital Quality Improvement Program (O-HQIP), developed by the Pennsylvania Department of Human Services to increase engagement in OUD treatment after an emergency room visit.
O-HQIP participants must have one or more of the following in their emergency rooms: buprenorphine initiation, “warm handoff” agreements with community partners, protocols for pregnant OUD patients and/or hospitalizations to start OUD treatment with MAT medications.
Starting in 2020, the O-HQIP pays participating Pennsylvania hospitals based on annual improvements to the share of Medicaid enrollees that get substance use disorder (SUD) treatment within a week of discharge from the emergency room.
For comparison, Pennsylvania hospitals that didn’t participate in the O-HQIP had similar rates of buprenorphine prescriptions filed after an OUD-ER visit to non-participating hospitals.
The study, published in JAMA Health Forum, was conducted by researchers from Howard University, Johns Hopkins University, the University of Pittsburgh, the University of Pennsylvania, the company Vital Strategies and Atrium Health Carolinas Medical Center.
Behavioral health stakeholders have a significant interest in improving outcomes around emergency rooms. In recent years, mental health diagnoses in the ER spiked pre-pandemic and worsened after the onset of the pandemic. And with the increased interest in value-based care, payers’ expectations of improved care outcomes based on paying for a treatment often consider reducing ER visits. This pushes some behavioral health providers to create more encompassing services and consolidates smaller providers.
The elimination of the X waiver, which previously restricted buprenorphine prescribing, could encourage more providers in any physical health care setting to consider starting patients with OUD on buprenorphine.
Citing previous research, the study states that starting MAT in the emergency room leads to significant reductions in treatment dropouts and lower rates of opioid abuse compared to referrals only.
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