Could comprehensive primary care decrease ER use in Medicaid population?

Although almost 25 state programs employ higher copays for emergency department visits in an effort to decrease ED use, charging more when Medicaid recipients go to the ED may not be effective, reported Stateline.

At least one multistate study determined that charging higher copays doesn't necessarily lower ED use in Medicaid. And some ED doctors are concerned that copays could prevent Medicaid recipients from obtaining emergency care when they actually need it.

"It will inevitably lead to people who should have gone to the ER dying instead," Zachary Meisel, a Philadelphia ED doctor and co-director of the Center for Emergency Care Policy Research at the University of Pennsylvania, told Stateline.

That's why Washington state and some Medicaid managed care plans are trying to decrease ED use with a different method--paying for comprehensive primary care to hopefully make ED visits unnecessary.

To do that, Washington created an information-sharing network among EDs to identify Medicaid beneficiaries who frequently use the emergency room. Hospital personnel then make primary care appointments for those Medicaid recipients, ideally within 96 hours of their emergency room visits. The state also created a 24-hour hotline staffed by nurses who advise callers whether they have a true health emergency.

Washington's innovative approach led to ED visits by all Medicaid enrollees dropping 9.9 percent and visits by frequent users (those with more than four visits in a year) decreasing 10.7 percent in just one year, which saved $33.6 million.

Another way to help reduce the overuse of EDs is to use "patient navigators" who conduct patient follow-ups, connect patients to local care services and schedule physician appointments, FierceHealthcare previously reported.

To learn more:
- read the Stateline article