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Welcome to theSafe Table
Carol Wagner, Senior Vice President Patient SafetyWashington State Hospital Association
Susan Callahan, Director of Community AffairsWashington State Medical Association
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Reducing Preventable Emergency Room Visits
September 24, 2012
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Partnering for Change
• Washington State Hospital Association • Washington State Medical Association• Washington Chapter of the American College
of Emergency Physicians
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Emergency Room Overuse: It Is a Problem
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Education Activities• Physician Education
– Dedicated webpage– Regular communication to membership– Working with primary care (communication and survey)
• Patient Education– Patient brochure (English, Spanish, Russian, Vietnamese)– WSMA’s Know Your Choices-Ask Your Doctor campaign
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Medicaid ER Use Is HighIn the past year: • About 40% of Medicaid clients visited an ER• About 18% of people with private insurance
visited an ERContributing factors:
Lack of primary care Substance abuse Mental health
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State Approaches to Curbing ER Use
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When What Impact Status Original proposal
3-visit limit on unnecessary use
Cuts payments to providers
Won lawsuit; policy abandoned
Revised proposal
No-payment for unnecessary visits
Cuts payment to providers
Delayed by the Governor just prior to implementation
Current policy
Adoption of best practices
Improves care delivery and reliance on ER as source of care
Passed in latest state budget
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Ultimate Goal: Reduce Trend
Current projected trend
Changing the trend
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An Opportunity: Patients, when possible, should be treated by their primary care provider for non-emergency conditions in order to promote
consistent, quality care helping protect physician/hospital payments.
• By June 15, 2012 hospitals must have implemented best practices on:– Electronic health information– Patient education – High-user client information/identification– High-user client care plans– Narcotics prescriptions– Prescription monitoring– Use of feedback information
• By January 1, 2013 hospitals must demonstrate reduction in low acuity visits• If unsuccessful, physicians and hospitals will suffer major cuts in Medicaid ER
payments7
Best Practices Just First Step
• HCA will perform a preliminary fiscal analysis and report to the legislature by January 2013
• Focus:– Outlier hospitals with high rates of unnecessary
visits– High ER visits by PRC clients– Low rates of treatment plans for PRC clients– High rates of opiate prescriptions
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Emergency Department Reports
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>=5 Visits - ED Visit Rate Per 1000 Medicaid Clients
2011 January 2012 January 2012 June0
5
10
15
20
25
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Data from HCA
Low Acuity ED Visit Rate Per 1000 Medicaid Clients
2011 January 2012 January 2012 June0
5
10
15
20
25
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Data from HCA
PRC ED Visit Rate Per 1000 Medicaid Clients
2011 January 2012 January 2012 June
0
1
4
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6
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7
3
2
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Data from HCA
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Number of Visits per Assigned PRC Client
July 2012
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Percent of PRC Patients Seen with Treatment Plan
July 2012
Rapid adoption of care plans even though many hospitals just getting on EDIE.
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Percent of Visits from Patients with 5 or More Visits in the Last 12 Months
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Ratio of PRC Visits to PRC Clients Assigned to Hospital
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Percent of Completed Treatment Plans for PRC Patients
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Scheduled Drug Average Units Per Prescription at Hospital by Prescriber
May 2012
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Visits by PRC Clients with a Narcotic PrescriptionMay 2012
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Prescriber Trends
Special Thanks toEDIE for their
collaboration and assistance in
obtaining data.
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If Unsuccessful
Revert to the no-payment policy.
$38 million in annual cuts!
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Ongoing Oversight and Measurement: Emergency Department
Workgroup• Health Care Authority• Washington State Chapter of the American
College of Emergency Physicians (WA/ACEP)• Washington State Medical Association• Washington State Hospital Association
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Questions and Comments
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