2. Implementation of an education program for all providers, administrators, and patients via forums, webinars, handouts, and posters in ED waiting rooms (see the January 2014 issue of ACEP Now for more on these posters).
3. Identification of the highest utilizers, along with follow-up and care plans for them. This population had significant issues, including 86 percent with mental health issues and 41 percent with addiction issues. The key for these patients was an emphasis on case management with care plans and coordination with primary care.
4. A requirement that “frequent flyers,” or overutilizers, are seen by primary care within 72 hours.
5. Creation of a statewide narcotics program. A 17-point program was adopted by all ED providers that created a statewide standard for prescribing opioids for chronic, noncancer pain.
6. A requirement that providers enroll in the prescription-monitoring program (PMP). Despite 96 percent enrollment, the reality is that the current data pull system is difficult to use. Thus, this summer, the PMP data will be pushed through the Emergency Department Information Exchange system. This eliminates the pull method and the inherent bias in provider selection.
7. Creation of a feedback system to track success for both the HCA and individual departments and their providers.
The first-year results of this effort exceeded everyone’s expectations. A full report is available at http://www.hca.wa.gov/Documents/EmergencyDeptUtilization.pdf. Highlights include a 9.9 percent reduction in overall ED Medicaid visits and a 10.7 percent reduction among frequent utilizers. The ER is for Emergencies campaign resonated, and our low-acuity visits dropped 14.2 percent.
What about opioid-overdose deaths? We reduced narcotic prescriptions from the EDs 24 percent! This contributed to Washington being one of several states to decrease opioid-related deaths annually for the last three years. Finally, in what began as a budget-generated policy, we saved the state more than $34 million and counting.
The economics of health care are changing, but the foundation of preserving access to care should remain paramount. With expanding Medicaid enrollment, many states will be trying to rein in costs, and Washington’s solution is an option for significant savings. The Centers for Medicare & Medicaid Services recently moved to protect the prudent layperson standard by preventing Florida from enacting a visit limit.
ACEP must continue to be where all of health care looks for solutions. The way to solve issues is through innovation and building alliances. Seven Best Practices proved we can—but we cannot rest on our successes. With dramatic changes in health care on the horizon, opportunities abound for ACEP to continue to lead.