EDs: Addressing Boarding & Opioid Use

Hospital EDs Get New Tool in Tracking Risk for Opioid Misuse

The fight against opioid use disorder (OUD) is about to get a new tool that will make it easier for physicians in hospitals to review risky controlled substances history of patients presenting in the emergency department.
MHA, through its Substance Use Disorder Prevention and Treatment Task Force, partnered with Collective Medical in 2017 to bring hospitals and other providers onto the Collective EDie platform (formerly known as PreManage ED). Through Collective EDie, when a patient arrives at a hospital ED, their past prescription history along with other data such as recent hospital utilization may trigger an alert that will show up on the emergency department’s tracking board.
This alert is triggered based on pre-set risk criteria such as frequency of prescriptions or prescribers, and would pull fill data directly from the state’s prescription monitoring system (PMP) that shows where and how often a patient has been getting prescriptions. Some patients, of course, require painkillers and other opioids; but other patients with OUD “shop” for the drugs through visits to multiple hospital EDs. In the past, a physician could check the PMP but there would not be an automatic alert from Collective EDie providing detailed data to the physician for those patients where risk could be occurring.
Nearly all hospitals in the commonwealth are in the Collective EDie network and can use it as part of the tools they employ in providing care. When a patient registers in any participating ED, Collective EDie is alerted and queries data repositories to identify in real time whether the patient meets any pre-defined criteria. If risk is identified, Collective EDie will automatically push a notification to the ED. These notifications are designed to give the ED provider a quick-to-read, easy-to-digest, integrated clinical snapshot of the presenting patient, including a summary of identified risks (e.g., security, opioid), critical clinical information (e.g., recent ED or inpatient encounters, existence of ED care recommendations from other providers), and important care coordination information (e.g., other members of the patient’s care team, existence of an existing pain contract for the patient). The new drug-tracking alert system is expected to go live by year’s end. DPH is encouraging hospitals to complete an application to begin the integration process soon, selecting “CMT (Collective Medical Technologies)” as their Primary Software Vendor under Technical Information. Note that only hospitals that have fully integrated Collective EDie into their EMRs will be able to use this functionality.

State Unveils Coordinated Plan to Ease ED Boarding

Last Thursday, after about a year of discussion and focus groups, several agencies in the Executive Office of Health and Human Services released their updated policy to help move psychiatric patients waiting in emergency departments – which is known as “boarding” – to inpatient admission. Boarding occurs for a variety of reasons, including lack of appropriate beds, the inability to locate a psychiatric bed in a unit close to the patient, and communication and authorization breakdowns between providers, insurers, and state government. 
The new Expedited Psychiatric Inpatient Admissions Policy, or EPIA 2.0, builds on the original EPIA that was released in February 2018. A major change is that the “escalation process” – that is, the clear steps and responsibilities that trigger involvement by senior clinical leadership at acute care hospitals, health insurance companies, and inpatient psychiatric units and facilities– will now begin after 24 hours of a patient not being admitted, rather than 48 hours. A point person for each shift must be identified and all stakeholders will have to use a standard bed search protocol, which is still in development. On the payment side, additional reimbursement that may be necessary to ensure admission to an inpatient unit/facility – known as “specialing” for single rooms, additional staff, etc. – must be offered by the health plan, and that authorization must be documented.
Further changes to payer and provider responsibilities are also outlined in the new EPIA 2.0, which goes into effect immediately.

House Takes Bold Step to Outlaw Flavored Tobacco

The Massachusetts House last week passed a landmark bill that imposes a tax on vaping products and outlaws flavored tobaccos. The legislation is scheduled to be debated Wednesday in the Massachusetts Senate.
MHA is a member of the Tobacco Free Mass. coalition that strongly supports the House bill banning flavored tobacco products, including mint, wintergreen, and menthol flavors. In addition to being a flavor, menthol is also a numbing agent, allowing the smoker to inhale more deeply and become more addicted. According to recent data, 54% of high school students that smoke use menthol cigarettes, and more than 90% of tobacco-using African American youth smoke menthol cigarettes.
The House bill (H 4183) imposes an excise tax on vaping products at 75% of the wholesale price. Thirty percent of that tax revenue would go to a trust fund that communities can use for substance use disorder prevention. The bill additionally: requires private insurers, the Group Insurance Commission, and MassHealth to provide coverage for tobacco use cessation counseling and all generic FDA-approved tobacco cessation products with at least one product available with no out of pocket costs; restricts the sale of vapes/e-cigarettes with specified nicotine levels to adult-only retail tobacco stores and smoking bars; increases the retailer fine for sales to minors from $100, $200, and $300 for first, second and third violations, respectively, to $1,000, $2,000 and $5,000.
The effective date for the flavored vape/e-cigarette ban, increased retailer fines for sales to minors, and insurance mandates is immediately upon passage. The effective date for the flavored tobacco ban is June 1, 2020.
As reported in the State House New Service, Cambridge Democrat Marjorie Decker said on the House floor, "Today, we are clearly communicating to big tobacco companies that while you stole the health and well-being of our parents and grandparents, you cannot have our children.”
Massachusetts hospitals have been on the frontlines in combatting tobacco use, which is the leading cause of preventable death in the U.S. Most hospitals have banned use of all tobacco products anywhere on the hospital campus.

MHQP Debuts New Engagement Site for Patients

To receive good care, it helps if patients are actively engaged with their caregivers. But since medical care is complex and sometimes a cause for anxiety, it’s hard for patients to know what questions to ask and what they should expect when seeing a medical professional.
Last week, the Massachusetts Health Quality Partners (MHQP) unveiled a new portion of its website titled Resources for Empowered Patients: Actions to Help You Manage Your Care. MHQP’s Consumer Health Council worked for two years to assemble the site, which provides tools, guidelines and information related to patient engagement.
MHQP says its new site was developed primarily to target patients who would most benefit from being more engaged in their care, “such as those with chronic and/or high cost conditions, and those with a new diagnosis who may be unfamiliar with navigating a new part of the healthcare system.”
Patients can also learn a wealth of information about their care – including information about the staffing on each unit of every hospital in Massachusetts – by visiting MHA’s PatientCareLink website.

Germs Can Kill

Antibiotic-resistant germs kill 35,000 people in the U.S. each year, according to the latest Antibiotic Resistance Threat Report from the CDC. Countering that frightening news is that prevention efforts have reduced deaths from antibiotic-resistant infections by 18% overall and by nearly 30% in hospitals since 2013. The CDC warns, however, “Without continued vigilance, germs will continue to spread, cause infections, and harm and kill people.”

WEBINAR: Essentials of Facility Reimbursement for ED and Observation Services

Thursday, December 5; 1 - 2 p.m. (EST)

Successful Emergency Department financial performance requires identifying key opportunities and avoiding common pitfalls. Join us and position your ED for optimized performance by taking a focused look at the critical areas of ED documentation, revenue capture, and compliance. Learn about the most important and hot-off-the-presses 2020 OPPS changes affecting ED facility reimbursement and the evolving Observation Comprehensive APC. Topics covered will include correct E/M level assignment, procedure charge capture and observation services. Learn more about the topics to be covered, faculty, and registration details by clicking here.

John LoDico, Editor