UNITED THEY STAND
In Cleveland, competing hospitals band together to fight opioid epidemic
By early 2017, Thomas Zenty, CEO of University Hospitals in Cleveland, knew all too well how bad the opioid epidemic was in northeast Ohio.
“We saw this early. We saw these trends first-hand as providers,” he said.
By the end of this year, opioid deaths in Cuyahoga County will likely double from the 2015 total to more than 800 people.
So when his staff came to him with the idea of forming a consortium with the other largest hospitals in northeast Ohio to battle the opioid epidemic, he didn’t hesitate.
“We are competitors,” he said of the other hospitals in the consortium — Cleveland Clinic, MetroHealth and St. Vincent Charity Medical Center. “But
there was no reticence whatsoever.”
He did more than agree to become part of the consortium. University, the other hospitals, and the regional hospital association all agreed to put in $50,000 each to pay the salary of the consortium’s full-time executive director, who starts work Tuesday.
Despite competitive fervor between the Cleveland hospitalsthat can rival that of Pittsburgh’s two health care giants — UPMC and Highmark/Allegheny Health Network — they all agreed to set that aside and form what is believed to be the first formal opioid-focused consortium among metro hospitals in the country.
“The crisis is so overwhelming, no one institution could handle the burden alone,” said Tracy Carter, who was part of the discussions on forming the consortium as the head of government relations for MetroHealth. “There’s no time for competition on this. We have to pull together to save lives.”
Among the initiatives the Northeast Ohio Consortium on Opioid Addiction will pursue are sharing data and best practices, finding new and better ways to manage pain without using the prescription painkillers that lead to addiction in the first place, and applying for grantstogether as one entity.
“We would be in a unique position [when we apply for grants] where we’re not just one hospital applying,” said Allysyn Leppla, the consortium’s newly hired executive director. “We really want to approach this as common funding.”
Of course, the consortium’s creation in Cleveland begs the question of why there isn’t yet one here in Pittsburgh, let alone anywhere else.
“The consortium idea is outstanding,” said Michael Flaherty, a longtime Pittsburgh clinical psychologist who is co-chair of the U.S. Attorney’s Working Group on Drug Overdoses and Addiction that began work in 2014. “Clearly we need a vehicle for implementation of strategiesthat we know work.”
“All the best solutions to [the opioid epidemic] are local. We have the best science. We have 10 years of practice that we know works,” he said.
His co-chair on the working group, Neil Capretto, medical director of Gateway Rehab, agrees.
“That’s great if [the Cleveland consortium] is getting health care systems together,” he said. “I think that’s a step in the right direction.”
“This is something we’ve been trying to coordinate. We need better communication between our emergency rooms, between facilities,” he said. “That would improve having a ‘ warm handoff’ of patients.”
A “warm handoff” is when medical staff work with a patient — in this case someone who suffered an overdose and is in a physician’s care, perhaps in an emergency room — to get the person into addiction treatment. It is in contrast to a “hard handoff,” where patients are involuntarily committed because they have been deemed a risk to themselves or others, or no handoff. When hospital systems are cooperating, they can channel patients to the best facility for their care, regardless of whether it belongs to a competitor.
Both Dr. Flaherty and Dr. Capretto said there have been efforts at forming something like Cleveland’s consortium here in southwest Pennsylvania. But with the bulk of the medical care and insurance coverage in the region provided by just two networks — UPMC and Highmark/ AHN — the two bitter business competitors have been reluctant to agree on any formal collaborations.
“You have individual interest,” Dr. Flaherty said. “But coordination of the effort is still lacking.”
Dr. Capretto hopes both UPMC and Highmark/AHN reconsider. “We need to put the needs of the people above the political needs of competinghealth systems,” he said.
Karen Hacker, director of the Allegheny County Health Department, said she has met with both UPMC and Highmark/AHN to talk aboutthe opioid epidemic.
“They tend to think together and even contribute data together” on projects, Dr. Hacker said. “But then they’ve gone off and done their own interventions.”
“It does make things very challenging” that they can’t come together in a more formal way, she said.
And there are historic precedents for hospitals in our region to put aside their differences to work jointly on health issues.
Perhaps the most famous occurred not long ago when, from 2000 to 2005, the region’s hospitals — including UPMC and the largest of AHN’s hospitals, then known as West Penn Hospital System — formed a coalition to drive downhospital-acquired infections. It was incredibly successful, saving many lives, and resulted in changes in how hospitals across the countrydeal with infections.
“The idea of it is absolutely similar” to dealing with the opioid epidemic, Dr. Flaherty said.
Antoine Douaihy, medical director of addiction medical services at Western Psychiatric Institute and Clinic of UPMC, said he believes that UPMC and AHN have shared information about their experiences with the opioid epidemic, just “not directly.”
Plus he believes the ongoing work of the U.S. Attorney’s task force chaired by Dr. Flaherty and Dr. Capretto — which Dr. Douaihy is part of — is doing a good job of helping different institutions, agencies and governments to worktogether.
“We are seeing better responses [to the opioid crisis] on the city and county levels now” because of the work of that task force, he said.
The task force continues to meet, and its 2014 report was expanded in a 2016 report by theUniversity of Pittsburgh’s Institute on Politics. But neither the U.S. Attorney’s task force nor the Institute of Politics had anyone on their working groups from either Highmarkor AHN.
Dr. Flaherty said that was unintentional when it came to the U.S. Attorney’s task force.
“They were invited,” he said of Highmark and AHN. But participation “was by interest” of each party.
TheresaMiller, director of the Pitt Institute of Politics, said in an email that her report relied heavily on Pitt-related organizations because she did not want the group that provided information to become “so large that completing work within the tight deadlines demanded by the urgency of the epidemic’s public health threat would havebeen impossible.”
But a recent change at AHN could soon begin fostering more cooperation between the health giants.
Mitchell West, who previously worked with Gateway Rehab, was appointed last month as AHN’s first-ever medical director of addiction medicine, at the same time that AHN got a $500,000 grant along with a designation of its flagship Allegheny General Hospital as a “center of excellence” to deal with addiction.
He already is on the U.S. Attorney’s task force and said, “I don’t anticipate barriers from AHN and Highmark to cooperate.”
As for working with UPMC on the opioid epidemic, he said: “I don’t know. I would love to see it.”
“This is something everyone should be working together on,” he said.