Emergency Visits Decline, $33 Million Savings After Adoption of Best Practices

Emergency department (ED) visits among Medicaid beneficiaries have declined in Washington after the state legislature adopted seven best practices according to a report published by the Washington State Health Care Authority (HCA). In the report, the HCA also indicated that after the implementation of these best practices, which were created to address Medicaid patient’s high rates of unnecessary trips to hospital’s EDs, the HCA realized a savings of $33,650,000 for fiscal year 2013. However, the HCA report and accompanying press release noted that the reported decline in visits and increased savings may be due to factors other than the implementation of the seven best practices such as the transition to managed care organizations. The report was published as part of a Washington partnership initiative called “ER is for Emergencies” which joined the forces of the Washington State Hospital Association, the Washington State Medical Association, the Washington Chapter of the American College of Emergency Physicians, and the HCA in an effort reduce costs and improve care quality in EDs.

Best Practices

In 2012, the Washington state legislature adopted a bill that outlined seven best practices created to reduce the high number of unnecessary visits to hospital’s EDs among Medicaid beneficiaries. The seven practices include: (1) adoption of a shared electronic patient information system among hospitals; (2) adoption of educational procedures to inform patients that EDs should be used only for true emergencies; (3) dissemination of lists of frequent ED patients among hospitals; (4) implementation of processes to assist frequent patients with care plans including post ED visit primary care follow-ups; (5) adoption of a system of strict guidelines with respect to prescribing narcotics; (6) enrollment of at least 75 percent of hospitals in the state monitoring system, the Prescription Monitoring Program; and (7) designation of certain hospital personnel to review feedback reports regarding the implementation of these steps and to address problems as necessary.

Impact

While the report recorded a 9.9 percent decline in ED hospital visits of Medicaid patients between June of 2012 and June of 2013, it also revealed other reduced rates including a 10.7 percent drop in the rate of visit of frequent clients and a 24 percent decline in the rate of visits that resulted in a scheduled drug prescription. The HCA data also indicated a 14.2 percent drop in terms of visits with a low acuity diagnosis. In addition to these reductions, the study noted other important positive trends after the implementation of the best practices such as the sharing of electronic patient data among 98 percent of hospitals, development of standardized care plans that are also available for sharing in the electronic system, and increased coordination between EDs and primary care providers. Yet, along with reporting this data, the report’s authors opined that these positive trends were not necessarily due to the seven best practices but could also be a result of the transition from the fee-for-service model to managed care systems in many instances.

Next Steps

The future of Washington’s Medicaid beneficiaries with respect to ED visits was also considered. HCA predicted that the statewide introduction of medical health homes and the availability of dental health benefits for Medicaid patients would positively impact ED visit rates. HCA also announced its intention to continue to work with hospitals and health plans to further integrate the seven best practices into hospital service models using several plans of action including encouraging robust information exchange and promoting electronic patient care plans.