City sets standards for scoring hospitals on how well they can treat opioid addiction

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Hydrocodone pills. Photo via Flickr, CC by 2.0

Baltimore now has a scoring system in place for highlighting the hospitals best equipped to serve people addicted to pain medication.

The criteria, released today, cover everything from emergency room care to judicious prescribing of opioids to post-discharge support services for patients. The scores range from three to one, one being the highest.

A “level 3” hospital will: screen patients for substance use disorder (or those at risk of it); set a protocol for referring discharged patients with the disorder to community treatment; prescribe the overdose-reversing drug naloxone to emergency room patients at risk of overdosing; keep medication-assisted treatment ready for ER patients with opioid use disorder; and promote guidelines for careful prescribing of opioids, among other criteria.

A “level 2” hospital will do everything that a “level 3” facility would, plus: offer peer recovery support services to ER patients; screen all directly admitted patients (not just those coming through the ER) for substance use disorder or risk of it, and prescribe them naloxone; keep medication-assisted treatment ready for all patients (not just ones from the ER) with opioid use disorder; and monitor how well hospital staff adhere to prescribing guidelines.

A “level 1” hospital will do all of that, plus: dispense naloxone to patients at high risk of overdosing; offer peer recovery support services to all; screen for substance abuse disorder (or risk of it) at outpatient clinics on-campus; and keep enough of at least one form of federally approved medication-assisted treatment—buprenorphine, methadone and naltrexone—ready to treat patients with opioid use disorder, among other criteria.

Dr. Leana Wen, Baltimore’s health commissioner, announced the plan for a scoring system in April at a press conference, joined by Mayor Catherine Pugh and local hospital executives. Wen noted that Rhode Island had adopted such a ranking for its hospitals, and had managed to reduce overdose deaths in a one-year period.

More than 1,500 people died of an opioid overdose in the first nine months of 2017, a three-fold increase from the number of opioid OD deaths in all of 2010, per the most recent available figures released by the state. Baltimore accounted for more than a third of those deaths through September 2017.

The health department collected public feedback on suggested criteria for its scoring system through May and revised it with help from hospitals, the Maryland Hospital Association, community health providers and other experts, according to a release.

The city will hand out its first scores in December, after the department evaluates documentation from Baltimore’s 11 participating hospitals.

“Hospitals play a central role in responding to the opioid epidemic,” Wen said in a statement.

The hope is to “make Baltimore City a national model for treating addiction alongside every other disease,” she added. “That means treating addiction in our traditional health care institutions, including hospitals.”

Ethan McLeod
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Ethan McLeod

Senior Editor at Baltimore Fishbowl
Ethan has been editing and reporting for Baltimore Fishbowl since fall of 2016. His previous stops include Fox 45, CQ Researcher and Connection Newspapers in Northern Virginia. His freelance writing has been featured in Baltimore City Paper, Leafly, DCist and BmoreArt, among other outlets. He enjoys basketball, humid Mid-Atlantic summers and story tips.
Ethan McLeod
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