Confluence Health joins effort to reduce ER visits

March 27--WENATCHEE -- Confluence Health now has a social worker stationed in its emergency room on weekdays.

The new employee's role is not to turn patients away from the ER. But for the past six months, they have been talking to patients, including mental health clients and frequent visitors, to find out why they came to the ER. If the reason wasn't an emergency, they talk to them about where to go the next time they face a non-emergency situation, discussing the benefits of using primary care physicians or walk-in clinics instead.

Dr. Peter Rutherford, CEO of Confluence Health, said directing people to the right place for health care is both less expensive and more effective.

"I think it will improve outcomes, and is clearly less expensive," he said.

A typical visit to a primary care doctor costs less than $100, while a visit to the emergency room is easily a few thousand dollars, or more, said Jim Stevenson, spokesman for the Washington Health Care Authority which oversees the state's Medicaid program.

Emergency rooms around the state are finding new ways to educate visitors about when it's appropriate for them to visit an emergency room, and when it's not.

These and other efforts -- including sharing information on ER visits and adhering to strict guidelines for prescribing narcotics -- were part of the statewide implementation of seven best practices for emergency departments.

The year-long effort to reduce unnecessary visits by Medicaid patients to emergency rooms culminated with a report to the state Legislature last week touting a number of successes statewide in 2013, including:

A 9.9 percent drop in ER visits

A 10.7 percent drop in ER use by frequent visitors (those with five or more visits annually)

A 24 percent drop in visits resulting in prescribing a controlled drug

A $33.6 million savings resulting from the changes and other initiatives

Rutherford said a combination of efforts -- including local initiatives that were already underway, and the statewide push to adhere to the new ER reforms -- have helped Confluence Health reduce unnecessary visits to its ER. One of the efforts already underway was to make sure people weren't using local emergency rooms to get pain medications.

"I want to give a lot of credit to Dr. Malcolm Butler at Columbia Valley Community Health," he said that facility's medical director. "Because of him, we've had a lot of discussions in this community about the appropriate role of narcotics, and we have a pretty strict procedure around narcotic prescriptions."

In addition, he said, the new affiliation between Wenatchee Valley Medical Center and Central Washington Hospital prompted the newly formed Confluence Health to close the clinic's ER, and focus instead on increasing options for urgent care for cases that are not a true emergency.

Reducing unnecessary ER visits by Medicaid patients statewide was a joint effort by the Washington State Hospital Association, two physician groups and the Health Care Authority, which reported findings to the Legislature last week.

The issue surfaced a few years ago, when state lawmakers tried to limit Medicaid patients to only three paid ER visits for non-emergencies. Instead, hospitals and physicians initiated a volunteer effort to institute best practices in emergency rooms.

The findings came out Thursday, the same day that the American College of Emergency Physicians published its report warning states that the Affordable Care Act is likely to result in a jump in ER visits. When Massachusetts implemented mandatory health insurance, ER visits rose by 1.2 percent in the first year, and 2.2 percent in the first three years, that report said.

Rutherford said its too soon to know how much the emergency room at Confluence Health will be impacted by the increasing numbers of people insured under Medicaid, or whether the new practices will help reduce the expected surge in ER visits.

State officials and organizations stressed that they're not trying to block access to emergency rooms by those who need it.

"There's a time and place to be here, and we always want people to have that access," Dr. Stephen Anderson, past president of Washington's chapter of the American College of Emergency Room Physicians, said. He said the cost savings came not from preventing access, but from coordinating care.

Anderson added that it's fortunate to have a plan in place to address the expected bump in ER visits as more people insured through Medicaid and private plans begin visiting emergency rooms.

Since Oct. 1, more than 505,000 Washingtonians have signed up for free or low-cost health insurance, in addition to the 390,000 who were previously covered by Medicaid.

Reach K.C. Mehaffey at 509-997-2512 or [email protected]. Read her blog An Apple a Day or follow her on Twitter at @KCMehaffeyWW.

___

(c)2014 The Wenatchee World (Wenatchee, Wash.)

Visit The Wenatchee World (Wenatchee, Wash.) at www.wenatcheeworld.com

Distributed by MCT Information Services