The three-way collaborative effort –Washington Chapter of the American College of Emergency Physicians, WSMA and the WSHA – to reduce excessive Emergency Department visits by Medicaid patients is showing good progress. Initial data bode well for the future – and as a response to the early skepticism shown by some that the private sector couldn’t successfully achieve that goal, let alone better manage those patients enrolled in the Patient Review and Coordination (PRC) Program. The PRC is part of our broader effort to educate patients to properly use the Emergency Department.
For the Medicaid initiative:
- Between June and October 2012, the percent of total emergency room visits by Medicaid patients who frequently use the ED (100 visits or more per year) has decreased by 23%.
- During the same period, Washington hospitals have more than doubled the percentage of completed care plans for Medicaid patients who frequently use the ED (from 28% to 64%).
- From January through November 2012, the number of registered providers in the state’s Prescription Monitoring Program has increased over 250% (from 2,174 to 7,771).
- Between November 2011 and November 2012, the number of hospitals exchanging emergency department information electronically has increased from 17 to 85 (with ten additional hospitals in the process of implementing the information exchange system).
There will be a report to the legislature on the project in January. These encouraging numbers should help keep the effort on track. The program is in response to an ill-advised idea that excessive ED use could be curbed by defining a list of “non-emergent” conditions for which Medicaid payment would not be provided. After a lawsuit, our three organizations countered with this collaborative effort.
It is a strong example of what the private sector can accomplish collaboratively as an alternative to across-the-board budget cuts. And this initiative may prove to be helpful model as we work our way through the difficult budget discussions coming up with the 2013 legislative session.
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