1. Welcome to the Safe Table

2. Carol Wagner, Senior Vice President Patient Safety Washington State Hospital Association Susan Callahan, Director of Community Affairs Washington State Medical Association 2 Reducing Preventable Emergency Room Visits September 24, 2012 1

3. Partnering for Change Washington State Hospital Association Washington State Medical Association Washington Chapter of the American College of Emergency Physicians 3 2

4. Emergency Room Overuse: It Is a Problem 4 3

5. Education Activities Physician Education – Dedicated webpage – Regular communication to membership – Working with primary care (communication and survey) Patient Education – Patient brochure (English, Spanish, Russian, Vietnamese) – WSMA’s Know Your Choices-Ask Your Doctor campaign 5 7

6. 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 6 4

7. State Approaches to Curbing ER Use 7 5

8. Ultimate Goal: Reduce Trend 8 Current projected trend Changing the trend 6

9. An Opportunity: Patients, when possible, should be treated by their primary care provider for non-emergency conditions in order to promote consistent, quality care helping protect physician/hospital payments. By June 15, 2012 hospitals must have implemented best practices on: – Electronic health information – Patient education – High-user client information/identification – High-user client care plans – Narcotics prescriptions – Prescription monitoring – Use of feedback information By January 1, 2013 hospitals must demonstrate reduction in low acuity visits If unsuccessful, physicians and hospitals will suffer major cuts in Medicaid ER payments 9 7

10. Best Practices Just First Step HCA will perform a preliminary fiscal analysis and report to the legislature by January 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 10 8

11. 9

12. >=5 Visits - ED Visit Rate Per 1000 Medicaid Clients 2011 January 2012 January 2012 June 0 5 10 15 20 25 10 Data from HCA

13. Low Acuity ED Visit Rate Per 1000 Medicaid Clients 2011 January 2012 January 2012 June 0 5 10 15 20 25 11 Data from HCA

14. PRC ED Visit Rate Per 1000 Medicaid Clients 2011 January2012 January 2012 June 0 1 4 5 6 8 7 3 2 12 Data from HCA

15. 13

16. Number of Visits per Assigned PRC Client July 2012 14

17. 15 Percent of PRC Patients Seen with Treatment Plan July 2012 Rapid adoption of care plans even though many hospitals just getting on EDIE.

18. 16 Percent of Visits from Patients with 5 or More Visits in the Last 12 Months

19. 17 Ratio of PRC Visits to PRC Clients Assigned to Hospital

20. 18 Percent of Completed Treatment Plans for PRC Patients

21. 19

22. 20 Scheduled Drug Average Units Per Prescription at Hospital by Prescriber May 2012

23. 21 Visits by PRC Clients with a Narcotic Prescription May 2012

24. 22 Prescriber Trends

25. Special Thanks to EDIE for their collaboration and assistance in obtaining data. 25 23

26. If Unsuccessful Revert to the no-payment policy. $38 million in annual cuts! 26 24

27. Ongoing Oversight and Measurement: 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 27 25

28. Questions and Comments 28 26