Pennsylvania chose another path. In 2019, it established the first voluntary financial incentive program to improve ED treatment and follow-up for patients with OUD. The Opioid Hospital Quality Improvement Program (HQIP), developed by the Office of Medical Assistance Programs in collaboration with the Hospital and Healthsystem Association of Pennsylvania, reallocates hospital revenue assessed by the state in the form of quality initiatives.
Hospitals could earn incentive payments by implementing one or more clinical pathways for ED patients with OUD, with increasing incentives for each of these pathways:
- offer warm handoffs to community resources
- provide treatment for pregnant patients
- initiate buprenorphine in the ED
- admit patients to initiate medication treatment
A hospital attesting to having one pathway earned a base payment of $25,000; two pathways, $37,000; three pathways, $56,000, and four pathways, $75,000. Hospitals could earn up to $193,000 in 2019 from this process incentive, with additional funds distributed from a total pool of $30 million.
Did this incentive work?
We evaluated adoption of clinical pathways among hospitals in Pennsylvania in a recent publication in JAMA Network Open.
The short answer – yes, the incentive worked. Of 155 Pennsylvania hospitals, 80 percent responded by developing at least one of the four pathways. While hospitals did not have to demonstrate effectiveness, the simple existence of the pathways represents a significant – and rapid – change in practice.
Of course, there is a more nuanced answer. We found that only half of hospitals adopted all four pathways. The pathways least likely to be adopted involved the initiation of medication treatment (the most effective way to prevent future overdose). Hospitals unwilling to develop the ability to provide this treatment may be delaying care for patients who need it, when they need it most.