100% Of Washington Hospitals Enrolled In Program To Reduce Preventable Medicaid Emergency Department Visits, Saving State Millions Of Dollars

State's Hospitals and Physicians to Implement "Seven Best Practices" to Reduce Medicaid Emergency Visits

SEATTLE, June 25, 2012 /PRNewswire-USNewswire/ -- A coalition of health care providers including the Washington Chapter of the American College of Emergency Physicians (WA-ACEP), Washington State Medical Association (WSMA), and Washington State Hospital Association (WSHA), announced today that it has achieved 100 percent participation in a plan to reduce Medicaid emergency department visits while saving the state millions of dollars and protecting patient safety and patient access to care. While the plan called for hospitals representing 75 percent of Medicaid visits to enroll by July 1, 2012, the coalition secured 100 percent participation by mid-June.

"We are pleased that 100 percent of hospitals have enrolled in the Seven Best Practices program," said Scott Bond, president and CEO of the WSHA. "To achieve meaningful success in reducing preventable emergency department visits it will take all hospitals, all physicians, and the state working together to implement each best practice and direct patients to the appropriate place for care."

The goal of the Seven Best Practices program is to redirect care to the most appropriate setting, and to reduce low acuity and preventable Medicaid emergency department visits. The plan, which attempts to address the root of the problem—chronic medical conditions, substance abuse issues, and lack of primary care access—focuses on high users and will:

1. Track emergency department visits to reduce "ED shopping";
2. Implement patient education efforts to re-direct care to the most appropriate setting;
3. Institute an extensive case management program to reduce inappropriate emergency department utilization by frequent users;
4. Reduce inappropriate ED visits by collaborative use of prompt (72 hour) visits to primary care physicians and improving access to care;
5. Implement narcotic guidelines that will discourage narcotic-seeking behavior;
6. Track data on patients prescribed controlled substances by widespread participation in the state's Prescription Monitoring Program (PMP); and
7. Track progress of the plan to make sure steps are working.

"This isn't a problem only to be solved by hospitals and emergency medicine physicians," said Doug Myers, M.D., president of the WSMA. "Primary care physicians can help with the lack of access issue by making room in their schedules to accommodate Medicaid patients who are re-directed to the outpatient setting for care. And we can all educate our patients on the appropriate places to go for care."  

The next milestone will be to show a reduction in Medicaid emergency department costs by January 15, 2013.

"While we are thrilled to get 100 percent participation, we must now work hard to ensure we see a measurable difference in the trend in unnecessary Medicaid ED visits," said Nathanial Schlicher, M.D., JD, emergency physician and legislative chair of the WA-ACEP. "We believe our plan will benefit patients by re-directing them to the appropriate place for care while still protecting patient safety. But we know this is an uphill battle as we face some significant challenges, including adequate access to primary care and availability of mental health and substance abuse treatment programs."

Background

The Seven Best Practices program was enacted by the legislature as an alternative to the state's previous policy that would have denied payment retroactively for treating Medicaid patients in the emergency department for care the state deemed "unnecessary." The Seven Best Practices is a physician- and hospital-sponsored plan that works toward real cost savings for the state while at the same time protecting patient safety and access to care. It encompasses an effort to coordinate and integrate medical care and wellness within each community.

Before the state proposed the non-payment policy, it planned to implement a three visit limit policy that would have denied payment for Medicaid patients who visited the ED more than three times per year for care the state deemed "unnecessary." A November 2011 court ruling sided with physicians and hospitals in halting this plan. Washington physicians and hospitals have remained committed in their efforts to protect patient safety and access to care while working to save the state money by improving the quality of care delivered.

Washington ACEP represents over 650 emergency medicine physicians and is a chapter of the American College of Emergency Physicians, a national medical specialty society representing emergency medicine. WA/ACEP is committed to advancing emergency care through continuing education, research and public education.

The Washington State Medical Association's vision is to make Washington the best place to practice medicine and to receive care. The WSMA represents over 9,800 physicians throughout Washington state. For more information about the WSMA, please visit www.wsma.org.  

The Washington State Hospital Association represents all of Washington's 98 community hospitals. The association works to serve its members, increase access to health care, and improve health care quality. For more information about WSHA, please visit www.wsha.org.

SOURCE Washington State Medical Association