Diverting ED patients could save New Jersey hospitals millions

For hospitals looking to curb emergency department use and cut costs, a demonstration project found that diverting nonemergency patients away from the hospital ED to less-expensive healthcare sites could save New Jersey more than $400 million a year, the New Jersey Hospital Association (NJHA) announced yesterday.

More than one-third of the state's ED visits come from non-emergent patients who could receive more appropriate and less expensive treatment in a doctor's office or clinic.

The demo project by the NJHA, the state Department of Human Services and the New Jersey Primary Care Association involved 10,000 non-urgent visits to the emergency rooms at Newark Beth Israel Medical Center and Monmouth Medical Center from September 2008 and April 2011.

Using an "express care process," clinicians evaluated patients with less-urgent issues and matched them with appropriate healthcare services. The ED staff also referred patients for follow-up visits with primary care providers or immediately scheduled appointments at partnering federally qualified health centers for patients without a regular physician, according to the NJHA. The model also stationed case managers at the hospital EDs and health centers to coordinate services and organize transportation.

"Once a patient is determined to have non-emergency primary care needs, the [advanced practice nurse] will provide express primary care services and prescriptions, and then schedule a follow-up appointment with a primary care provider in the community, such as a doctor or at a health center such as the Monmouth Family Health Center," Catherine Hanlon, chair of emergency medicine at Monmouth, said in an announcement last year. "All uninsured patients will also be screened for eligibility in public health coverage programs."

After implementing the model for 21 months, ED use for less-urgent conditions dropped 22 percent, while patient volume rose 19 percent at the local health centers. Thanks to reduced ED use for non-emergent healthcare, wait times for all ED patients fell 15 percent.

"This project is all about patients--making sure they get the right care in the right setting," NJHA President and CEO Betsy Ryan said in the statement yesterday. "But this is one of those scenarios in which doing the right thing for the patient also can produce savings in healthcare costs. It's a win-win."

The project not only encourages using the express care process to eliminate unnecessary ED visits and costs, but it also highlights the need for proper capacity and accessibility of primary care services.

To learn more:
- check out the NJHA statement
- read Monmouth's announcement about the project