Implementing Emergency Room Best Practices: Improves Care, Reduces Costs 1

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Speakers

Representative Eileen Cody, R.N.

– Chair, House Health Care & Wellness Committee Stephen Anderson, MD – Washington Chapter – American College of Emergency Physicians Nathan Schlicher, MD, JD – Washington State Medical Association Carol Wagner, R.N.

– Senior Vice President for Patient Safety, Washington State Hospital Association Dan Lessler, MD – Chief Medical Officer, Washington State Health Care Authority 2

Why ER is for Emergencies?

• Some patients visiting emergency departments could be treated effectively in a less costly setting • There are evidence-based practices that can reduce low-acuity emergency room visits, coordinate care, and save health care dollars 3

Creating the Partnership: Government

• In 2012, the Legislature passed House Bill 2127 • Requires all Washington hospitals to implement seven best practices

Keys to Successful State Initiatives

• • • • • Evidence-based Measurable Achievable benchmark, possible for everyone to succeed with commitment and hard work Clear positive outcomes Strong partnerships

Creating the Partnership: Coordinating Care

• • • • Washington State Hospital Association Washington State Medical Association Washington Chapter of the American College of Emergency Physicians Washington State Health Care Authority

Power of a Statewide Goal

• • • Standard policies in every hospital – No patient shopping for a different physician Safe Table Learning Collaboratives to share best practices Friendly competition towards a shared goal

Seven Best Practices

1. Track emergency department visits to avoid ED “shopping” 2. Implement patient education 3. Institute an extensive case management program 4. Reduce inappropriate ED visits by collaborative use of prompt visits to primary care physicians 5. Implement narcotic guidelines to discourage narcotic seeking behavior 6. Track data on patients prescribed controlled substances 7. Track progress of the plan to make sure steps are working 8

Project Impact

• • • • 98 hospitals now sharing emergency room information electronically 97 hospitals developed and use a standardized care plan format, providing consistent care no matter where a patient goes Expansion of care coordination efforts to all frequently utilizers, regardless of payer Instant notification of Primary Care Providers 9

Innovations

• • • Newport Hospital integration of mental and physical health into primary care PMH Medical Center community based paramedic program Kitsap Community Mental Health Center enhanced relationship with local medical center 10

50 48 46 44 42 40 38 36 34 32 30

Reduced ED visits by 9.9%

Rate of ED Visits per 1000 Medicaid Clients

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Reduced number of visits by frequent clients by 10.7 %

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Reduced visits resulting in a narcotic prescription by 24%

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Reduced low-acuity visits by 14.2%

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Results: Better Care & Significant Savings

“Given the apparent success of the Seven Best Practices in reducing ED utilization and the rate of ED-related opiate prescribing, HCA will work with hospitals and health plans to sustain these efforts.”

- Health Care Authority January 2014 Report to the Legislature

Emergency Department Utilization: Assumed Savings From Best Practices Implementation

Savings of $33.65 million were achieved through reductions to the Health Care Authority budget. 15

Ongoing Barriers to Care

• • • Mental Health Among high utilizers of ER services, 80% have mental health issues Access to Dental Care Restoration of adult dental for Medicaid Patients Access to Primary Care Expanded medical health homes 16

Next Steps

• • • Maximize benefit of integrated care and plan of care as patients leave the hospital – Primary care – Payors Integrate information into medical records across the care continuum Enhance utilization of the prescription monitoring program 17

How the Public Can Help

• • • • Only go to the ER for emergencies If you aren’t sure, call the nurse line or your primary care physician For ear aches and sore throats, make an appointment with your primary care physician When you have a doctor’s appointment, ask what you should do if you need care after hours or on weekends 18

Questions & Comments

• Full report: www.hca.wa.gov/leg_reports.html “ This is the kind of creative thinking, new approaches and collaboration that I want to foster in health care. Not only is the system saving money and physicians’ time, it is also improving the quality of care by making sure patients receive treatment that is both appropriate and timely.” - Governor Jay Inslee 19