Emergency-room visits decrease

Staff writerMarch 20, 2014 

Puyallup stock

MultiCare Good Samaritan Hospital in Puyallup

PETER HALEY — staff photographer file, 2013 Buy Photo

Efforts to curb the use of emergency rooms for routine care are showing some success, according to a state agency's report Thursday to the Legislature.

Changing practices at hospitals may help explain why Washington's Medicaid patients were nearly 10 percent less likely to visit emergency rooms last year than they were a year earlier.

The state Health Care Authority reports the rate of emergency-department visits per 1,000 people on Medicaid dropped 9.9 percent from mid-2012 to mid-2013.

The drop corresponded with the first year of a program for hospitals to voluntarily adopt practices such as tracking of ER visits and narcotics prescription among hospitals. Officials want to discourage patients from treating emergency rooms as primary-care providers and from "shopping" for treatment and drug prescriptions.

Efforts to target "frequent fliers" who use emergency rooms several times a year became contentious in 2011 when the state put a three-visit limit on nonemergencies. Doctors and hospitals disputed the definition of nonemergencies and won a lawsuit to block the regulation. They partnered with the state on voluntary practices that they predicted would still achieve a $33 million-a-year cut state lawmakers ordered for Medicaid.

The authority's report said those savings have been reached, although it doesn't give full credit to the best-practices program. Savings could also have come from moving more patients from a fee-for-service system to a managed-care system with incentives for avoiding repeat visits.

The drop in ER visits also could have multiple causes, according to the report.

“A 10 percent reduction is almost unprecedented," said former state Sen. Nathan Schlicher, an emergency-room doctor at St. Joseph Medical Center who helped organize the program.

The report also found a 10.7 percent decrease in the number of "frequent fliers" who visited five or more times a year.

For ER visits that resulted in prescription of federally-scheduled drugs, the rate dropped 24 percent.

Statewide, 98 hospitals now share ER information electronically, all but one including a standardized care plan, according to the report. Hundreds of clinics and primary care providers are also connected to a notification system.

 

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