Emergency room sign with ER is for Emergencies in text


New! ER is For Emergencies Results in Better Care Coordination and Cost Savings

A new report released by the Washington State Health Care Authority confirms a partnership of doctors, hospitals and state Medicaid representatives is making a big difference in utilization, quality of care and savings. The report also concludes The ER is for Emergencies initiative reached its targeted savings goal of $33.6 million in Medicaid fee-for-service emergency care costs.  The report showed that during Fiscal Year 2013:

  • The rate of emergency department visits declined by 9.9 percent.
  • The rate of “frequent visitors” (five or more visits annually) dropped by 10.7 percent.
  • The rate of visits resulting in a scheduled drug prescription fell by 24 percent.
  • The rate of visits with a low-acuity (less serious) diagnosis decreased by 14.2 percent.


“The ER is for Emergencies campaign demonstrates how public-private partnerships can benefit everyone,” said Scott Bond, President and CEO of the Washington State Hospital Association. “Hospitals are dedicated to working with our partners to do the right thing for patients, and sometimes that means seeking care that is not delivered in a hospital.”

View the Press Confernece Recording 

View the press release

Download the Report

Download the Press Conference PowerPoint 


Emergency Department Information Exchange Update

  • ·A new group is available in EDIE that lists all patients that have visited your ED in the last month that have met or exceeded five ED visits in the last twelve months. The group is available in the Referrals & Groups section and is titled "5 in 12 Population."
  • ·A new Care Guidelines template is also available in EDIE. The new template was developed by clinicians from across the state and is located in the Care Guidelines section on each Patient Screen in EDIE.

Partnership to Reduce ER Visits Shows Initial Success!

The first report  from HCA to the legisalture on a collaborative effort of hospitals and physicians to reduce “unnecessary” emergency room visits and coordinate patient care also contains good news for the state budget. Preliminary data from the first six months of the initiative suggest the state is saving more than 10 percent in Medicaid fee-for-service emergency care costs.  Accumulated savings could reach $31 million for the fiscal year. Learn more by reading the press release downloading slides from the press conference, or read the full report from the Washington State Health Care Authority.

Read the news coverage of the ER is for Emergencies program.

Seven Best Practices Program

The goal of the Seven Best Practices program is to redirect care to the most appropriate setting, reduce low acuity, and reduce preventable Medicaid emergency room visits. The plan, which attempts to address the root of the problem—chronic medical conditions, substance abuse issues, and lack of primary care access—focuses on high users and will:

  1. Track emergency department visits to reduce “ED shopping”;
  2. Implement patient education efforts to re-direct care to the most appropriate setting;
  3. Institute an extensive case management program to reduce inappropriate emergency department utilization by frequent users;
  4. Reduce inappropriate ED visits by collaborative use of prompt (72 hour) visits to primary care physicians and improving access to care;
  5. Implement narcotic guidelines that will discourage narcotic-seeking behavior;
  6. Track data on patients prescribed controlled substances by widespread participation in the state’s Prescription Monitoring Program (PMP); and
  7. Track progress of the plan to make sure steps are working.

Click here for one-page document outlining Seven Best Practices [PDF]. Our success will work to prevent the state from enacting payment cuts to both hospitals and physicians for emergency room services.

September 24, 2012 - Safe Table, ER is for Emergencies

Safe Table Presentations:

Introduction - Carol Wagner

Seven Best Practices - Schlicher, Anderson, Neven

Managing Difficult Conversations - Anderson

How Payors can Contribute - Thompson

EDIE demonstration screen - Rudberg

Oregon St. Charles - Henderson

San Francisco - Kathy O'Brian

Additional Resources:

DPA Naxolone Issue Brief

MMWR Naxonone Prescribing Info

Naxolone Instructions

Naxolone Blank Collaborative Drug Therapy Treatment Form

Washington Law allowing Narcan administrations

Prescribe to Prevent FAQs

Example Patient Follow Up Referral Form

Sample Patient Notification Letter

Safe Table Summary
This week about 150 people from across the state attended a Safe Table Learning Collaborative and engaged in the implementation of strategies to reduce unnecessary emergency department visits. 
National experts from rural and urban communities shared innovative ideas for building regional collaborations with primary care providers, insurers, and community organizations to help patients access the care they need in the most appropriate setting. Dr. Jeff Thompson from the Washington State Health Care Authority shared opportunities for working together on this issue. Participants also received information detailing practices in their own emergency departments.
The Safe Table program is led by the Washington State Hospital Association in collaboration with the Washington State Medical Association and the Washington Chapter of the American College of Emergency Room Physicians.
All hospitals in Washington State are working to implement seven best practices to reduce unnecessary emergency department visits. The goal is to show a measurable reduction by January 2013.  A complete list of the seven best practices is available through the WSHA website.  (Amber Theel, ambert@wsha.org)


May 31, 2012: Translations of Patient Education Brochures

Clicking the link above will direct you to the page with downloadable patient brochures translated into English, Spanish, Vietnamese, Russian.

Education Opportunities

Web Conferences:

September 12, 2012 -- to listen and view webcast, click here: Managing Patients with Chemical Dependencies and Behavioral Health Issues in the Emergency Department

June 11, 2012 -- to listen and view webcast, click here: Improving Care Through Case Management in the Emergency Department


Best Practice A:

Best Practice C & D:

Best Practice F:


Updated April 23, 2012

The legislature enacted a budget proviso that gives hospitals the opportunity to avoid the state Medicaid ER no-payment policy by adopting seven “best practices” to reduce unnecessary ER. If a sufficient number of hospitals implement the best practices by June 15, 2012, the no-payment policy will be avoided; if not, the no-payment policy will go into effect on July 1, 2012.

Hospitals have only eight weeks to implement these best practices before the attestations are due on June 15, 2012. The Washington State Hospital Association (WSHA), Washington State Medical Association (WSMA), and the Washington Chapter of the American College of Emergency Physicians (WA-ACEP) are working together to provide hospitals with the information and tools to accomplish these goals and avoid the no-payment policy.

In order to avoid reversion to the no-payment policy on July 1, 2012, hospitals are expected to adopt and implement seven best practices by June 15, 2012. An attestation letter must also be submitted to the Health Care Authority. The best practices are outlined below. Click on each best practice for more information.


Best Practice Goal

A) Electronic Health Information

Exchange patient information among emergency departments

B) Patient Education

Help patients understand and use appropriate sources of care
C) Patient Review and Coordination (PRC) Information Ensure hospitals know when they are treating a PRC patient and treat accordingly
D) PRC Client Care Plans Assist PRC clients with their care plans
E) Narcotic Guidelines Reduce drug-seeking and drug-dispensing to frequent ER users
F) Prescription Monitoring Ensure coordination of prescription drug prescribing practices
G) Use of Feedback Information Review reports, ensure interventions are working

Additional Resources:

List of HCA-defined low acuity visits

Policy: Narcotic Guidelines (Sample Policy)

Policy: Care Management in the ED (Sample Policy)

Background Letter
Instructions for completing best practice documentation
Attestation Letter
Background information on Medicaid Emergency Department Use

Other Materials

EMTALA Fact Sheet

Media Coverage

Coverage from the orginal three visit emergency room benefit limit

Judge Rules Against Emergency Room Benefit Limit

Read news coverage of the court ruling


Amber Theel

Partner Organizations

WSHA is partnering with the Washington State Medical Association and the Washington Chapter of the American College of Emergency Physicians. Visit WSMA's ER Page