Welcome to the

Safe Table
 Reducing Preventable
Emergency Room Visits
September 24, 2012
Carol Wagner, Senior Vice President Patient Safety
Washington State Hospital Association
Susan Callahan, Director of Community Affairs
Washington State Medical Association
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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 High
In the past year:
• About 40% of Medicaid clients visited an ER
• About 18% of people with private insurance
visited an ER
Contributing factors:
 Lack of primary care
 Substance abuse
 Mental health
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 State Approaches to Curbing ER Use
When What Impact Status
Original 3-visit limit on Cuts payments Won lawsuit; policy
proposal unnecessary use to providers abandoned

Revised No-payment for Cuts payment to Delayed by the

proposal unnecessary providers Governor just prior
visits to implementation

Current Adoption of best Improves care Passed in latest

policy practices delivery and state budget
reliance on ER as
source of care
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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
payments
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 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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>=5 Visits - ED Visit Rate Per 1000 Medicaid Clients
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Data
from
0
HCA 2011 January 2012 January 2012 June

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Low Acuity ED Visit Rate Per 1000 Medicaid Clients
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Data
from
HCA 0
2011 January 2012 January 2012 June

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 PRC ED Visit Rate Per 1000 Medicaid Clients
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Data 1
from
HCA 0
2011 January 2012 January 2012 June

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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
Prescription
May 2012

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Prescriber Trends

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Special Thanks to
EDIE 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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