A Win for Washington: Cutting Emergency Rooms Visits
In the summer of 2012, Washington state emergency rooms (“ER”) began tracking patients in a statewide database. Expanding Medicaid rolls and legislative attempts to cap reimbursements for non-emergency visits to ERs left the state, hospitals, and physicians knowing they had to do something to cut costs and improve quality of care within the ER setting. The product of their collaboration was the creation of seven “best practices,” known collectively as the “ER is for Emergencies” campaign. In addition to the mandatory, statewide database, the campaign urged health care providers to:
- Educate patients on the difference between emergencies and non-emergencies;
- Establish ER awareness of patients who are frequent visitors;
- Implement systems that effectively refer non-emergency patients to primary care providers within 3-4 days;
- Adopt stricter guidelines for prescribing narcotics in ERs; and,
- Enroll at least 90 percent of ER prescribers in the state’s Prescription Monitoring Program.
This process has paid off in a big way. 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 annual visits) dropped by 10.7 percent;
- The rate of visits resulting in a scheduled drug prescription fell by 24 percent; and,
- The rate of visits with a low-acuity diagnosis decreased by 14.2 percent.
Perhaps most impressive is the fact that the state’s Medicaid ER costs fell by $33.7 million within the same time period. In ERs, physicians often have no ongoing relationship with the patient and are unaware of the patient’s medical history. The premise is simple – by equipping ER physicians with easily accessible, detailed information about patients and their medical history, physicians can make more informed decisions about care and refer them to the less-costly primary care setting as appropriate. With a database, a physician can immediately know if a patient was seen in the ER two weeks ago for the same condition and failed to follow up with a specialist. This database also allows physicians and other clinicians to identify when a patient is “doctor shopping” for a narcotics prescription. This study or project resulted in a 24% drop in ER visits resulting in controlled substances prescriptions. These results provide evidence that physicians are using the data to make quality health care decisions.
In the summer of 2013, Kentucky was selected by the National Governors’ Association to participate in a collaborative effort to design and improve state-level health systems for ER “superusers,” which is defined as a person who uses the ER for regular health care instead of selecting a lower cost alternative. In 2012, 4,400 Medicaid recipients used an ER ten or more times and Kentucky Medicaid spent $219 million on services provided in ERs. Kentucky could benefit from following Washington’s model and implementing the seven best practices in its own ERs. A mandatory ER database could curb superusers’ visits and cut costs for the state’s Medicaid system – a critical necessity in the wake of the expansion of Medicaid.
See the full report from Washington State Health Care Authority here.