Flashpoint

December 21, 2012

ER is for Emergencies: Celebrating Success, Continuing Progress

The collaborative effort of hospitals and physicians to reduce unnecessary emergency room visits and coordinate care is showing significant progress. The improvements stem from seven best practices implemented under the “ER is for Emergencies” initiative sponsored by the Washington State Hospital Association (WSHA), the Washington State Medical Association (WSMA), and the Washington Chapter of the American College of Emergency Physicians (WA-ACEP). The Washington State Health Care Authority (HCA) also played a critical role in developing the program.

In January, the state will submit an initial report to the Legislature detailing the effort to reduce excessive emergency department visits by Medicaid clients and save program costs. It is likely that payment cuts to hospitals and physicians will be averted if progress continues. Hospitals have a new deadline for continued improvement with a second report to the legislature due in October 2013. While the state’s report focuses on care for Medicaid clients, hospitals are applying these best practices for promoting consistent, coordinated care to all patients.

Program achievements to date include:

• More than doubling the number of shared care plans.
• A 250% increase in the number of providers registered in the state’s Prescription Monitoring Program.
• Increasing the number of hospitals exchanging emergency department information electronically from 17 to 85, with 10 more in the process of implementing the exchange system.

ER for Emergencies has achieved a 23% reduction in emergency room visits by Medicaid patients with five or more visits.

This program was initially developed as an alternative to the state’s proposal to eliminate payment to hospitals and physicians for visits to the emergency department by Medicaid clients that could have been treated in another setting. Instead, hospitals and physicians implemented seven best practices that are beginning to result in fewer visits and lower costs to the state.

It is critical that reductions in both emergency room visits and overall cost to the state continue to avoid future budget cuts. Areas for continued focus include:

• Implementation of shared care plans for 90 percent of Medicaid clients in the Patient Review and Coordination Program (PRC).
• Registration of at least 90 percent of emergency room physicians in the prescription monitoring program.
• Coordination of narcotic prescriptions through the primary care physician.
• Identification of top ten patients with highest number of ED visits in the last year for your emergency room and cut in half going forward.
• Education of the public about appropriate settings to seek care for various conditions.

The Health Care Authority will identify and contact organizations with significant opportunities to improve. They will also recognize those hospitals that should receive accolades for their work.

WSHA, WSMA, and WA-ACEP will continue to provide resources and education for this effort through webcasts and other learning opportunities. Individualized assistance is also available. For more information about the ER is for Emergencies program and the seven best practices, visit our website. If you would like assistance implementing the seven best practices, please contact Carol Wagner at (206) 577-1831 or CarolW@wsha.org.