MHA’s Substance Use Disorder Prevention and Treatment Task Force (SUDPTTF) has issued new guidelines for prescription opioid management within hospitals hospital settings, including hospital owned/affiliated clinics or physician practices.

This is the second set of guidance materials that the MHA task force has issued to address the commonwealth’s opioid crisis; last year the task force issued opioid management guidelines for emergency departments. The new 19-page standards sent to MHA’s membership on Thursday, June 23 focus on provider-specific practices such as enhanced screening of patients, providing alternative non-opioid options, and developing comprehensive pain stewardship programs.

Some of the recommended guidance relating to hospital/organizational operations relate to closely monitoring opioid prescribing trends, developing internal policies to reduce the potential for opioid diversion, implementing Naloxone standing orders, using a common/template patient fact sheet informing patients of opioid risks, and working with residency and fellowship programs to ensure that the next generation of prescribers are well trained on limiting or finding alternatives to prescription opioids.

The SUDPTTF work group was chaired by Robert J. Roose, M.D., CMO and VP of addiction and recovery services for Sisters of Providence Health System, and John M. Connolly M.D., VP of medical management and chairman, department of anesthesia, Beth Israel Deaconess Hospital – Plymouth.

The guidelines were developed taking into account new provider requirements included in the new state opioid law (Chapter 52 of the Acts of 2016), and also integrating industry best practices. The task force also worked with provider associations – in particular the Massachusetts Medical Society – to ensure that the guidance conforms to current standards of practice.

“We’re asking every member hospital to sign a commitment document, agreeing to work with administrators, departments, and staff to identify and provide the resources necessary to implement the guidelines,” said MHA’s VP of Clinical Affairs Pat Noga, R.N.

In addition, the commitment document calls upon hospitals with residency and fellowship programs to adopt core competencies within their medical training programs for direct care specialties that prescribe opioid medications. The core competencies document was developed in coordination with the Massachusetts Medical Society, the Conference of Boston Teaching Hospitals, and the Massachusetts Department of Public Health.

“Hospitals are taking definitive, meaningful steps to combat the opioid crisis,” Noga said. “Every hospital with an ED has signed the commitment to implement our prescribing guidelines. Now we’re expanding the effort with guidance that can be applied to all hospital settings, including many clinics and affiliated physician practices. I believe that with every hospital signing the attached commitment, we will see not only improvements in the health and lives of our patients but the procurement of safer communities.” 

Emergency department (ED) boarding for patients in need of inpatient psychiatric and substance use disorder services is a problem that the state, providers, health insurers, and  patient advocates have been attempting to resolve for several years. In discussions, one issue raised as a contributing factor is the inconsistent coordination between a provider and an insurer when the insurer’s member is boarded in the ED while there is a search for available mental health or substance use disorder services.  In addition, many of the plans indicated that they are not aware when their members are being boarded and if the hospital is seeking assistance with the placement.

MHA, working closely with the Massachusetts Association of Health Plans, Blue Cross and Blue Shield of Massachusetts, and Beacon Health, developed and issued a document that contains an updated direct contact list for each of the plans operating in Massachusetts, as well as a chart showing the insurers’ notification or prior authorization requirements for inpatient admissions directly from the emergency department.

“Moving patients out of EDs efficiently requires the exchange of information between hospitals and health plans to ensure appropriate care coordination and placement of patients within inpatient or community base services, where appropriate,” said MHA’s VP of Legal and Regulatory Affairs Anuj Goel. “Our hope is that improving real-time communication between the parties will help with this continuing public health problem.” MHA will also be working with its members to track how this new process is working to determine other possible solutions. 

The Southern New England Practice Transformation Network (SNE-PTN) is one of 29 networks across the country selected and funded by Centers for Medicare and Medicaid Services (CMS) to prepare clinicians to participate in alternative payment models in the future. SNE-PTN is led by UMass Medical School and University of Connecticut School of Medicine.

The SNE-PTN is part of CMS’ Transforming Clinical Practices Initiative, which is one of the largest federal investments designed to support clinician practices through this process of practice transformation.  It is offering support to primary care, specialist and behavioral health clinicians to benefit the health of patients by improving the quality and financial health of the practice. Eligible clinicians are professionals who bill Medicare, Medicaid, or CHIP. Clinicians who receive federal funding through a Medicare ACO are excluded from participation.

A fact sheet (see below) outlines the essentials about SNE-PTN, including contact information on how providers can participate.

The killing of 49 people in Orlando, Florida and the physical injury to 53 others has brought attention – once again – to guns in American society. In Massachusetts, which has some of the nation’s more restrictive gun laws, hospitals still see gunshot incidents. All hospital emergency departments are required to report patients treated for gunshot wounds and assault-related sharp instrument wounds to the state’s Weapon Related Injury Surveillance System (WRISS).

According to WRISS, in 2013, Massachusetts hospital EDs reported a total of 1,765 gunshot and stabbing incidents. Gunshot wounds accounted for 37% (652) of reports, while sharp instrument wounds accounted for 63% (1,113). While sharp instrument wounds are only reported for assault-related incidents, gunshot wounds are captured for all intents. Here is a breakdown of gunshot wounds by intent for 2013:

•        59% (386) were assault-related,

•        20% (128) were unintentional,

•        4% (26) were self-inflicted, and

•        14.5% (95) were of unknown intent.

Some notes to remember when reviewing the data: if a person dies by gunshot before first being treated in an ED that victim is not counted through WRISS. Most self-inflicted gunshots result in death and therefore the person is not transported to the ED and is not counted through WRISS.

Preliminary total counts (not yet vetted entirely by WRISS) for 2014 (1,635) and 2015 (1,440) are the lowest since statewide reporting began in 1994. WRISS staff says this may reflect real changes or reporting changes. Hospitals needing to order more WRISS reporting forms may contact WRISS Hospital Coordinator  Laurie Jannelli at laurie.jannelli@state.ma.us or (617) 624-5668.

THURSDAY, JULY 14; 9 A.M. - 4 P.M.
MHA CONFERENCE CENTER, BURLINGTON, MASS.

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