Best Practices Slides - Washington State Hospital Association

Report
Reducing Unnecessary
Emergency Room Use:
Best Practices
1
WSHA Presenters
Scott Bond
Claudia Sanders
Chief Executive Officer
Senior VP,
Policy Development
Carol Wagner
Barbara Gorham
Senior VP,
Patient Safety
Policy Director,
Access
2
Partner Presenters
Washington State
Medical Association
Tim Layton
Washington Chapter American
College of Emergency Physicians
Dr. Stephen
Anderson
Dr. Nathan
Schlicher
3
Webcast Objectives
•
•
•
•
•
•
•
Overview
Emergency room overuse: a significant issue
History
The seven best practices
A fast timeline!
How we can help
Questions and comments
4
An Opportunity
Redirecting Care to the Most
Appropriate Setting
5
Health Care is Changing
• Work with the state and partner physicians
• To be sustainable in the long term:
– Adequate payment
– Cost reduction
6
Partnering for Change
• Washington State Hospital Association
• Washington State Medical Association
• Washington Chapter of the American College
of Emergency Physicians
7
Emergency Room Overuse:
It Is a Problem
8
Medicaid ER Use Is High
In the past year:
• About 40% of Medicaid clients visited an ER
• About 18% of people with private insurance
visited an ER
Contributing factors:
 Lack of primary care
 Substance abuse
 Mental health
9
One client:
Frequent Users
All clients:
Focus on Patients Requiring Coordination (PRC)
Enrollees per county
.
009
.005
0
Is the ER the new medical home
of the 21st century?
Legislative Solutions
13
State Approaches to Curbing ER Use
When
Original
proposal
Revised
proposal
Current
policy
What
3-visit limit on
unnecessary
use
No-payment
for
unnecessary
visits
Adoption of
best practices
Impact
Cuts payments to
providers
Status
Won lawsuit;
policy abandoned
Cuts payment to
providers
Delayed by the
Governor just
prior to
implementation
Passed in latest
state budget
Improves care
delivery and
reliance on ER as
source of care
14
Voices Heard
• Contact with legislators
• Contact with media
• Discussion of legal barriers
15
Savings without Penalties
Provides the state with savings by
asking hospitals, and their
physician partners, to implement
the right systems for care
16
If Unsuccessful
Revert to the
no-payment policy.
$38 million in
annual cuts!
17
Ultimate Goal: Reduce Trend
Current projected trend
Changing the trend
18
Partners Will Be There
• Emergency room physicians will be pushing
for hospital adoption
19
The Seven Best Practices
20
A) Electronic Health Information
Goal: Exchange patient information among
Emergency Departments
• Identify frequent users
• Get access to treatment plans
• Use in providing care
• Exceptions for CAHs with
financial burden
21
How to Accomplish
Emergency Department Information Exchange (EDIE)
• 30 hospitals in Washington already using
• EDIE can:
– Notify ED physician of frequency of ED visits and summary
of ED discharges for past 12 months
– Share guidelines for patient with other hospitals
– Load patient’s treatment plan, so ED physicians can view
• Costs:
– Depends on number of ED visits
– $2,000 to $5,000 setup plus $1,200 to $30,000 a year
22
B) Patient Education
Goal: Help patients
understand and use
appropriate sources of care
• Active distribution of
educational materials
• WSHA/WSMA/ACEP brochure
• Discharge instructions
23
How to Accomplish
• Use WSHA brochures or customize for your hospital
• Decide when and how to distribute
– Upon arrival, at discharge, or display prominently
• Incorporate into electronic discharge instructions, if
warranted
• Train ED physicians on educating patients about the
appropriate care setting
– Presentation disseminated by ACEP
24
C) Patients Requiring Coordination
(PRC) Information
Goal: Ensure hospitals know when they are
treating a PRC patient and treat accordingly
• PRC clients = frequent ER users, often narcotic
seekers
• Receive and use client list
• Identify patients on arrival
• Develop and coordinate case
management programs
• Use care plans
25
How to Accomplish
• Identify who at hospital receives and
disseminates information on PRC clients
• Use information in EDIE to alert physicians
– Frequent user = someone who has used ER five or
more times in the past 12 months
• Make PRC care plans available to ER physicians
• Best success with case management in ER
26
D) PRC Client Care Plans
Goal: Assist PRC clients with their care plans
• Contact the primary care provider when PRC client
visits the ER
• Efforts to make an appointment with the primary
care provider within 72 hours when appropriate
• If no appointment required, notify primary care
provider that a visit occurred
• Relay barriers to care to Health Care Authority
27
How to Accomplish
• Develop system to call
primary care providers
during and after PRC visit to
emergency room
• Develop system to relay
issues regarding access to
primary care to the HCA
28
E) Narcotic Guidelines
Goal: Reduce drug-seeking and drug-dispensing
to frequent ER users
• Implement ACEP guidelines for prescribing and
monitoring of narcotics
• Direct patients to better resources
• Track data and follow-up with
providers who excessively
prescribe
29
How to Accomplish
• Change hospital policy to conform with
ACEP guidelines:
–
–
–
–
Prohibit long-acting opioids and discourage injections
Screen patients for substance abuse
Refer patients suspected of Rx abuse to treatment
Other
• Train ER prescribers in narcotic guidelines
• Consider joining “oxy-free” movement
• When guidelines implemented, hospitals
have seen significant drop in visits
30
F) Prescription Monitoring
Goal: Ensure coordination of prescription drug
prescribing practices
• Enroll providers in Prescription Monitoring Program:
electronic online database with data on patients prescribed
controlled substances
• Target enrollment for ER providers :
– 75% by June 15, 2012
– 90% by December 31, 2012
31
How to Accomplish
• WSMA and WA/ACEP encourage members to
sign up
• Educate and encourage medical staff to enroll
• Hospitals track enrollment of ER prescribers to
report to HCA by June 15 and December 31,
2012
32
G) Use of Feedback Information
Goal: Review reports, ensure interventions are
working
• Report specified information to Health Care
Authority
• Designate ER leader and quality manager to receive,
review, and act on utilization management reports
• Involve executive-level leadership
33
ED WORK GROUP
WSHA, WSMA, WA/ACEP and the state Health Care
Authority will develop and monitor metrics on
performance by hospital and by physician
– Example measures:
•
•
•
•
Rate of unnecessary visits
Rate of visits by PRC clients
Rate of PRC clients with treatment plans
Rate of prescriptions with long-acting opioids
34
How to Accomplish
• EDIE produces standard reports
• Hospitals may be called on to gather and
report other easily available data
• Feedback reports will be made public
35
Provider Training
• Hospitals must ensure providers
are trained
• WA/ACEP will provide template:
– Training providers on how to educate
patients on choosing the appropriate care setting
– Training providers on guidelines for narcotic
prescribing and monitoring
36
Quality Assurance
Each practice concludes:
“Hospital has a system of quality
assurance and intervention and
can routinely identify, report,
and correct cases of provider
noncompliance with these best
practices.”
37
Do Other Laws Still Apply?
•EMTALA
•Medical malpractice
•Prudent layperson preserved
38
Quick Action Needed!
• Hospitals must submit attestations and best
practice checklists to HCA by June 15, 2012
39
If Unsuccessful in Signing Up
If hospitals
representing at least
75% of Medicaid ER
visits do not sign up,
the state will revert
to the no-payment
policy.
40
Best Practices Just First Step
• HCA will perform a preliminary fiscal analysis
by January 15, 2013
• Focus:
– Outlier hospitals with high rates of unnecessary
visits
– High ER visits by PRC clients
– Low rates of treatment plans for PRC clients
– High rates of opiate prescriptions
41
If Unsuccessful in Changing Trend
Actual trend
Projection
If the trend does
not go down, the
state could revert
to the no-payment
policy.
42
Attestation Mailed to You
• Complete entire
form
• Send to HCA
• Send to WSHA
• We will follow up!
43
Ongoing Oversight:
Emergency Department Workgroup
• Health Care Authority
• Washington State Chapter of the
American College of Emergency
Physicians (WA/ACEP)
• Washington State Medical Association
• Washington State Hospital Association
44
Next Steps
How We Will Help
45
Best Practices Are a Foundation
If we are serious
about achieving this:
Projection
Actual trend
Hospitals and
emergency
physicians need to
be looking for
trends and patterns,
intervene, make
continuous change!
46
For More Information
Carol Wagner, Senior VP, Patient Safety
(206) 577-1831, [email protected]
Claudia Sanders, Senior VP, Policy Development
(206) 216-2508, [email protected]
Barbara Gorham, Policy Director, Access
(206) 216-2512, [email protected]
47
For More Information
Pauline Proulx
www.washingtonacep.org
Tim Layton
[email protected]
48
Questions and Comments
49

similar documents