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

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15

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Data from HCA

Low Acuity ED Visit Rate Per 1000 Medicaid Clients

2011 January 2012 January 2012 June0

5

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15

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Data from HCA

PRC ED Visit Rate Per 1000 Medicaid Clients

2011 January 2012 January 2012 June

0

1

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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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