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Editorial: Cooperative emergency room effort yields results

Sat., March 22, 2014

Reducing emergency room use would contribute greatly to a rollback in overall health care expenditures. Treatment in an ER is expensive and not the best way to manage chronic health conditions.

Nor do they make a good medical “home” for patients who would be better monitored and treated by a doctor or clinic that sees them on an ongoing basis.

But a report earlier this year based on Medicaid data from Oregon was an ominous indication that the Affordable Care Act might have the troubling effect of channeling more patients into emergency rooms, not fewer. With health insurance now almost universally available, emergency rooms might be jammed.

That does not have to be the case, and a study released Thursday by Washington hospitals and Medicaid officials suggests widespread use of best practices and the sharing of patient information has the potential to reduce costs. During a one-year period ending in June 2013, the real savings to the state’s Medicaid program were almost $34 million.

The cooperative effort to control costs was the outgrowth of a controversial 2011 proposal to limit to three the number of nonemergency ER visits the state’s Medicaid program would pay for. At the time, Washington officials were trying to close a $5 billion budget gap, and everything was on the table.

The head of Medicaid projected savings of as much as $76 million over the next biennium if a cap was in place. But the idea was a nonstarter among doctors, hospitals and advocates for the poor, who might forgo needed care for fear they would exceed the cap, and ultimately become more critically ill.

Instead, the Legislature in 2012 set forth seven best practices that were adopted by every Washington ER. The hospitals also began an “ER is for emergencies” campaign to steer patients away from their doors and toward clinics and primary care doctors who can give them the long-term attention they need.

The result: ER visits by Medicaid patients fell nearly 10 percent, visits for moderate medical complaints fell 14 percent and, least surprisingly, visits that resulted in prescriptions for controlled substances fell 24 percent. The drug-dependent or those copping drugs for resale were serial ER users.

But among that population were individuals, many with mental conditions, who just needed ongoing care and didn’t know where to get it outside an emergency room. That’s still a problem, one the report identifies as the next priority.

Patient education on appropriate use of emergency care providers must intensify, but progress will only go so far with more primary doctors and more doctors willing to take on new patients at low Medicaid reimbursement rates.

The health care system in the United States, “affordable” or otherwise, must control unnecessary care. Patient tracking and patient education will play big parts. So will systems like that developed by INHS in Spokane that identify best-care practices and reward doctors for adopting them.

Best care can be less expensive care.