Strategies for reducing ER visits, costs

A new report from the Washington Health Care Authority (HCA) offers solutions to high emergency department use by Medicaid patients.

After implementing several best practices, ED visits by Medicaid frequent fliers dropped 23 percent in only six months. The preliminary findings also revealed lower spending, as Washington saved more than 10 percent in Medicaid fee-for-service emergency care costs and expects to save $31 million for the entire fiscal year.

Moreover, 85 Washington hospitals are now exchanging ED information electronically, up by more than 500 percent. Emergency physicians know if a particular patient has visited multiple EDs in the past week with the same complaint and intervene accordingly, HCA noted.

In addition to tracking frequent ED users and adopting electronic information systems, other best practices include distributing patient education materials at arrival or at discharge to explain where Medicaid patients should go for non-emergent conditions. Hospitals also assigned employees to review and provide feedback reports on ED utilization to monitor progress, according to HCA.

The report also pointed to a lack of community resources as a main factor sending Medicaid patients to hospital EDs for care. For example, inadequate access to primary care and preventive dental care lead to the unnecessary ED use.

Before embracing HCA emergency care best practices, hospitals should take note of research suggesting nonurgent, Medicaid patients aren't clogging up EDs. Most Medicaid ED patients go because they have to, seeking emergent care for serious medical problems, FierceHealthcare previously reported.

Emergency care in Washington made headlines last year when the state planned to implement one of nation's most restrictive Medicaid ED policies, in which hospitals in the state would no longer receive Medicaid reimbursement for any "unnecessary" emergency room visits. But Gov. Gregoire suspended the policy, allowing hospitals to maintain payment for roughly 500 conditions the state had deemed nonurgent.

For more:
- here's the ACEP announcement
- check out the HCA report (.pdf)