Across the U.S. these days, discussions about the opioid epidemic are heating up. Just last week, a bombshell report from the Washington Post, after examining data from the U.S. Drug Enforcement Agency, revealed that from 2006 to 2012 more than 76 billion opioid pain pills were sold in the United States, with three pharmaceutical manufacturing companies behind 88 percent of those sales.
However, there is also a deeper story to be told beyond looking at just the number of opioids sold—one that examines how hospital emergency departments (EDs) can collaborate with local substance use disorder (SUD) clinics to reach patients who either have relapsed or are in the ED looking for pain medication.
One instance of this type of partnership is happening in Elizabethtown, Ky., where Hardin Memorial Hospital (HMH)—about 50 miles from Louisville—has begun connecting to local SUD clinics and other community organizations, including Stepworks, a treatment and recovery center with five locations across Kentucky—a state that has been hit as hard as any by the opioid epidemic, and which also has one of the highest prescribing rates in the U.S.
Here’s an example of how the collaboration works: when a Stepworks patient with an SUD gets registered in the HMH emergency department, their care managers will receive a real-time notification that the patient is in the ED. The treatment clinic can then reach out to ED social workers and arrange to meet the patient there, before opioids are given, and to direct the patient to the best care setting.
The idea behind the care collaboration is a basic, but critical one: for SUD patients who are in recovery but have relapsed, or have ended up in the ED seeking pain medication, being able to intervene before they leave the hospital can make an immense difference in how their addiction continues going forward. In a recent week, for example, 50 Stepworks patients had ED visits, company officials noted. When the organization is able to intervene, all but a few have chosen to re-engage in treatment.
Deron Bibb, chief operating officer of Stepworks, believes that healthcare professionals generally don’t grasp the disease of addiction. This is why he feels it’s incredibly important for hospitals to partner with organizations that deal with SUD patients on a daily basis and help them on their paths to recovery. “We have been doing this for a long time, and we’re essentially the de facto experts” on substance use disorder, Bibb says. “The [key] is getting these patients who are in the ED back into treatment. They are most likely there because they had a relapse or are seeking pain medications.”
Through a collaboration with Collective Medical, a health technology company that develops care coordination software, Stepworks providers get real-time notifications when their SUD patients are admitted to the ED at Hardin Memorial Hospital. “The patients are literally sitting in the ED when our providers get that alert,” Bibb says. “And we can actually add information on the patient on our end into the system so that the ED physician knows exactly what’s going on with that person, allowing for more appropriate treatment. The sharing of that information is phenomenal,” he attests.
Bibb notes the importance of “intercepting” SUD patients before they leave the ED, as re-engaging them while they are there with the goal to get them back into treatment will minimize the time they spend outside of a recovery environment. “Instead of a hospital giving these patients a pamphlet with a phone number [for a recovery center]—as we know there’s a 99 percent chance they do not make that phone call the next day—we can re-engage right at that point. That is a statistically proven opportunity—get them before they walk out that door, because the minute they do, the probability of success falls off the table.” And that ability to re-engage within this tight window of opportunity would not be possible without the real-time alerts, Bibb contends.
As of now, eight hospitals in Kentucky, including HMH, are live on the Collective Medical system for this initiative, though Bibb says that several more patient care organizations are in the pipeline. The more hospitals that link up to the platform, the more opportunity there will be for facilities like Stepworks to intervene when SUD patients hit the ED.
“Let’s say someone does graduate from one of our [recovery] programs, or maybe we’re treating them on an outpatient basis and they relapse. They may not want to go to the local ED, so they drive to one that’s 60 miles away. But if the [further] hospital is on the Collective Medical system as well, we can still share that information. So this has a real second-tier potential, rather than dealing just with what is right in front of us in our own backyard,” Bibb explains.
Speaking to the broader point of data sharing, Bibb feels that interoperability failures in the healthcare system lead to a lack of key patient information being available at the point of care. He says that it’s fairly routine for SUD patients who are in the ED—either because they relapsed or because they have a legitimate medical issue and happen to be in recovery at the time—to be given an opioid by an “unsuspecting provider,” says Bibb. “Oftentimes, that’s no one’s fault. The provider probably didn’t have good enough information on the patient, and if the patient is in recovery, he or she might be embarrassed to tell the doctor that. It’s a stigma issue. But what we are doing with [HMH] is what EHRs should have been doing all along. If you think about it, we’re now sharing that patient,” he says.
To this end, another piece of Stepworks’ continuum of services is what it calls “an addiction medical home,” which involves medication-assisted therapy with provider encounters, behavioral health counseling and medication management. As many SUD patients end up getting kicked out of the primary care practice—if they even sought one to begin with—Stepworks believes that they need different types of treatment and attention.
“If you don’t understand the disease and you are not able to help shepherd them through the medical community, then they have an even higher probability of failure,” he says. For example, Bibb offers, it can be something as simple as sending the patient to a cardiologist for a heart issue, which ends up leading to another referral, which then results in a medication that triggers a relapse. “The ability to give and receive that information is so important, and if healthcare really does move to a value-based contracting model, this will be a requirement in order for providers to survive financially.”
