Pa. Department of Human Services Adding New Opioid Measure to Hospital Quality Incentive Program

Last Updated: Aug 1, 2018

emergency-roomPennsylvania’s Department of Human Services (DHS) is adding a new opioid measure to its Hospital Quality Improvement Program (HQIP). The measure has been designed to help address the state’s opioid epidemic.

In this bulletin issued by the Hospital and Healthsystem Association of Pennsylvania (HAP), HAP notes that DHS’ measure proposal includes two components:

1. Process Incentive—During 2019, hospitals will be able to earn process incentives by implementing defined clinical pathways. The pathways will help health systems get individuals with opioid use disorder (OUD) into treatment and improve the seven-day follow-up performance in 2019. Hospitals can implement any or all the following clinical pathways:

  • Emergency department (ED) initiation of buprenorphine with warm hand-off to the community
  • Direct warm hand-off to the community for medication-assisted treatment (MAT) or abstinence-based treatment
  • Specialized protocol to address pregnant women with OUD
  • Direct inpatient admission pathway for methadone or observation for buprenorphine induction

Health system emergency departments will be awarded a base payment of $25,000 for the initial pathway implemented. Additional payments will be awarded for the second, third, and fourth pathways. Hospitals that implement all four pathways would be eligible for a total of $193,000. Payments will be made by July 31, 2019.

Hospitals must develop and submit written documentation of clinical pathways by Sept. 28, 2018 and verify the pathways as operational by Jan. 17, 2019.

2. Outcome Incentive—This is based on a modified Healthcare Effectiveness Data and Information Set (HEDIS) specification of follow up within seven days for opioid treatment after a visit to the ED for OUD. DHS says that the event denominator will be any HealthChoices member seen in the ED for OUD, and the event numerator will be anyone seen for OUD treatment within 7 days of discharge from the ED.

Emergency Departments (EDs) will have the opportunity to earn benchmark and incremental improvement incentives using calendar year (CY) 2018 as a base year and CY 2019 as the first year to earn a performance incentive. $35 million has been allocated for outcome incentive payments, which will be made in 2020.

For additional details on the measure, you can access this DHS’ draft document on the OUD measure. You can also find this draft version of the hospital attestation form for the measure.

Pennsylvania Medical Society (PAMED) Resources on Opioid Abuse

PAMED has developed several resources to educate Pennsylvania physicians and help them navigate the growing opioid abuse epidemic. You’ll find CME on topics like the warm hand-off, information on helping addicted patients, and prescribing guidelines at 

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