New plan to avoid ER visits could save state $31 million

The Seattle TimesJanuary 25, 2013 

A plan by doctors and hospitals to avoid expensive emergency-room care for Medicaid patients with chronic conditions is on track to save as much as $31 million for the year, a coalition of medical providers and state officials said Thursday.

The plan — as well as a newly cooperative approach between the medical community and state Medicaid officials — was developed as an alternative to a controversial proposal by the state in 2011 to sharply limit payments for conditions it deemed “nonemergent.”

The current approach, outlined in a state Health Care Authority report, turns on what doctors call “best practices,” including developing care plans for repeat patients, electronically tracking patients’ visits to other hospitals so care can be coordinated and unnecessary tests avoided, educating patients about improper ER use and helping connect patients with primary-care providers.

Almost all hospitals in the state voluntarily signed up, worried the state would impose cuts otherwise.

Visits by “frequent fliers” — patients who often seek care in emergency departments — declined by 23 percent, the report said.

The numbers are preliminary, based on five months’ data. But the seven-point program was hailed in announcements Thursday by the state, hospitals and the national emergency-medicine society.

“This program is a great example of the success public-private partnerships can have in applying evidence-based solutions to problems,” said Acting Health Care Authority Director MaryAnne Lindeblad. “Through shared best practices and cooperation, we all win.”

Cooperation was in short supply after the state proposed to simply not pay after the third ER visit by Medicaid patients for what the state said were nonemergency conditions.

That plan spurred months of acrimony between medical providers and the state, a lawsuit by doctors, and eventually, its suspension by then-Gov. Chris Gregoire.

The plan, one of many state attempts to pare medical assistance to low-income residents amid a $5 billion budget shortfall, could save millions of dollars a year, officials had said.

At the time, Dr. Jeff Thompson, then-state Medicaid medical director, said there had been “tremendous overuse and abuse” of emergency rooms, and accused ER doctors of “abusing their privileges as providers” by making the state pay for unnecessary services.

“We will not pay for diaper rash treated in the emergency room,” he famously said. “We simply can’t afford it any more.”

Angry doctors said the issue wasn’t diaper rash, but other conditions the state deemed nonemergency, such as some chest pains, abdominal pains and early-pregnancy hemorrhages, which need to be medically evaluated.

Dr. Nathan Schlicher, now a state senator, D-Gig Harbor, is part of the newly cooperative coalition.

But in 2011 and early 2012, as an emergency-medicine doctor in Tacoma and legislative chairman for the state chapter of the American College of Emergency Physicians (ACEP), Schlicher led the fight against the state’s plan.

He argued that the nonemergency designations were solely based on cost savings, and would end up harming patients.

Thursday, he said the “house of medicine” would no longer stand in opposition to Olympia, but would work with lawmakers to improve care and save money.

The national ACEP praised Washington’s plan as a “model for the nation” because it shows that best practices and coordinated efforts, including doctors and hospitals sharing information and working together, can help Medicaid patients and reduce costs.

Next steps must improve existing efforts and address systemic reasons why patients go to ERs for care, coalition members said. Among the goals: helping Medicaid patients avoid dental emergencies, securing treatment for those with mental-health and chemical- dependency issues — who make up a large portion of frequent ER patients — and helping patients connect with primary-care providers.

State Rep. Eileen Cody, D-West Seattle, chairwoman of the House Health Care & Wellness Committee, said she hopes the cooperative effort will be a model for future partnerships to improve care and save money.

“I think the best message is it shows that if we work together it actually works better than if we have to fight things out in the court.”

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