Washington’s hospitals saved money and improved care during the past year by discouraging the overuse of emergency rooms. So says a report released Thursday by hospitals, physicians and the state agency that operates Medicaid, the rapidly growing coverage plan for low-income people.
“Progress came not from blocking access but from coordinating care,” said Dr. Stephen Anderson, an Auburn physician representing the American College of Emergency Physicians.
Impetus for the changes came from a 2012 state law that required emergency rooms to communicate better with each other and with their patients’ primary care physicians. All 98 of Washington’s hospitals joined in the effort.
One focus of the reform was to do a better job with “frequent fliers” – people who often suffer from mental illness, substance addiction, untreated dental pain and other chronic medical problems that can lead them to “shop” from emergency room to emergency room for addictive pain medications, tests for chronic illnesses and other types of care that may not be handled well in an ER.
Part of the solution was a new computerized information network that allows all emergency rooms to know on the spot if a just-arrived patient recently received a narcotic prescription from another hospital, or underwent a major diagnostic test, or is being treated for a chronic condition such as diabetes.
When ER physicians discover information like this, they can direct a patient to a primary care physician or mental health clinic, and can avoid dispensing a redundant prescription or giving an unnecessary dose of radiation for a costly test that already was administered somewhere else.
Results from the past year show progress toward what one physician described as the “holy grail” of health care reform: cost control.
• Overall, emergency room visits by Medicaid clients dropped 10 percent.
• Emergency room visits by frequent ER users dropped 10.7 percent.
• Emergency room visits resulting in a prescription for an addictive painkiller dropped by 24 percent.
• Emergency room visits for nonemergency medical issues dropped by 14.2 percent.
• Deaths from narcotic drug overdoses dropped in Washington while increasing in most other states.
• The state measured $33.6 million in savings to its Medicaid budget, and officials believe at least some of the savings are from the emergency room reforms.
Some of those reforms, now being adopted in other states such as New York, began at Spokane’s Providence Sacred Heart Medical Center. Dr. Darin Neven, an ER physician and medical director of the consistent care program at Sacred Heart, said the new information tracking system was pioneered there. Also developed at Sacred Heart, he said, was a collaboration between the emergency room, which does not provide emergency dental care, and Spokane-area CHAS clinics, which do.
Neven helped edit the new system’s guidelines for when emergency rooms should and shouldn’t prescribe addictive pain-relieving drugs. Although drugs such as Dilaudid and Oxycontin can be legitimate as pain relievers after surgery, “we shy away from treating chronic pain in the emergency department,” Neven said. That’s because people who receive potentially addictive drugs “need supervision. We can’t provide that in a one-time encounter in the ER.”
Doctors are aware, he said, that people with addictions or a desire to resell a medical narcotic will try to “shop” for prescriptions at emergency rooms. The new computer system, sharing information among all hospitals in the state, now alerts physicians to prescriptions a patient has received elsewhere.
Also important, Neven noted, is the timing of the state’s reforms. This year Medicaid expanded to cover low-income adults up to 138 percent of the poverty level. Through March 13, 357,381 new recipients qualified for Medicaid. Physicians around the state have been worried that emergency rooms might be overwhelmed with newly covered adults seeking help with their medical needs. But so far, Neven said, that hasn’t happened.
Instead, he said, it looks like people will be able to seek help at appropriate clinics with chronic issues such as mental illness and substance abuse. “That’s great because it was really tough (for emergency rooms) to treat those people in the past. We were putting Band-Aids on issues that are better treated in a clinic. I think most emergency doctors think it’s a great thing, because we see the people who are the most underserved.”
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