A coalition of health care providers including the Washington Chapter of the American College of Emergency Physicians, Washington State Medical Association and Washington State Hospital Association announced (pdf) 100 percent participation in an initiative to reduce Medicaid emergency department visits.
One-hundred percent of hospitals representing 75 percent of Medicaid visits enrolled in the Seven Best Practices program by mid-June, surpassing its goal of 100 percent enrollment by July 1. The program aims to redirect care to the most appropriate setting and reduce low-acuity and preventable Medicaid ED visits by addressing chronic medical conditions, substance abuse issues and lack of primary care access. In addition, the program aims to show a significant reduction in Medicaid ED costs by Jan. 15, 2013.
The state legislature enacted the Seven Best Practices program after halting an initial plan to deny payments for more than three "unnecessary" Medicaid ED visits per year and a later plan to deny payments for treating any Medicaid ED visits the state deemed unnecessary.
The hospitals will follow these seven best practices for preventing unnecessary ED visits:
1. Adoption of an electronic system on a regional or statewide basis to exchange information among EDs.
2. Active dissemination of patient educational materials.
3. Designation of hospital personnel and ED physician personnel to receive and appropriately disseminate information on Medicaid clients, including monthly utilization reports for frequent ED users.
4. Assistance of Medicaid clients in visiting a primary care provider within 72 to 96 hours of the ED visit when follow-up is appropriate.
5. Implementation of narcotic guidelines that will discourage narcotic-seeking behavior.
6. Physician enrollment in the state's prescription monitoring program to collect data on patients who are prescribed controlled substances.
7. Designation of hospital and emergency physicians and staff to review the state's Medicaid utilization management feedback reports and respond appropriately.
Washington State Suspends Medicaid ER Limits
Washington Medicaid Won't Reimburse for "Unnecessary" ER Visits
One-hundred percent of hospitals representing 75 percent of Medicaid visits enrolled in the Seven Best Practices program by mid-June, surpassing its goal of 100 percent enrollment by July 1. The program aims to redirect care to the most appropriate setting and reduce low-acuity and preventable Medicaid ED visits by addressing chronic medical conditions, substance abuse issues and lack of primary care access. In addition, the program aims to show a significant reduction in Medicaid ED costs by Jan. 15, 2013.
The state legislature enacted the Seven Best Practices program after halting an initial plan to deny payments for more than three "unnecessary" Medicaid ED visits per year and a later plan to deny payments for treating any Medicaid ED visits the state deemed unnecessary.
The hospitals will follow these seven best practices for preventing unnecessary ED visits:
1. Adoption of an electronic system on a regional or statewide basis to exchange information among EDs.
2. Active dissemination of patient educational materials.
3. Designation of hospital personnel and ED physician personnel to receive and appropriately disseminate information on Medicaid clients, including monthly utilization reports for frequent ED users.
4. Assistance of Medicaid clients in visiting a primary care provider within 72 to 96 hours of the ED visit when follow-up is appropriate.
5. Implementation of narcotic guidelines that will discourage narcotic-seeking behavior.
6. Physician enrollment in the state's prescription monitoring program to collect data on patients who are prescribed controlled substances.
7. Designation of hospital and emergency physicians and staff to review the state's Medicaid utilization management feedback reports and respond appropriately.
More Articles on Washington ED Visits:
Washington Physicians Aim to Reduce ED Overutilization Through Care CoordinationWashington State Suspends Medicaid ER Limits
Washington Medicaid Won't Reimburse for "Unnecessary" ER Visits