3 Key Questions to Ask ED Patients to Reduce Utilization

Tuesday, April 24th, 2012
This post was written by Cheryl Miller

Establishing when a patient first had problems, and when they needed to go to the ED, are two questions that help physicians establish a timetable, a particularly valuable tool with the Medicaid population, who utilize the ED twice as often as their insured counterparts because of primary care access barriers, says Mina Chang, Ph.D., chief of the health services research and program development section of the Bureau of Health Services Research for the Ohio Department of Job and Family Services.

(Dr. Mina Chang) I try to recommend three questions to ask five patients. The first question is: When did you first start having problems? The second is: When did you first recognize you might need a medical opinion? And the third question is: When did you realize you needed to go to the ED? Those questions are trying to help you establish a timetable. Hopefully it will be early enough so that you can find out how early you can develop a test intervention to address the patient’s upstream issues. This is very relevant for the disadvantaged population, including Medicaid. Those patients oftentimes have social service needs, and those issues may exacerbate to a point that they would have to seek ED care. One of the examples could be transportation.

Another very typically asked question about our interventions to reduce ER use is whether we need patient consent. The follow-up effort between the healthcare providers and the patient, or the payors between the patients is considered permissible under HIPAA because that will be considered part of the treatment, payment and healthcare operations. And also included later in the test intervention that we developed will be focusing on better coordinating care for the patient as a part of quality improvement. So, that would also fall under the Treatment, Payment and Healthcare Operations (TPO) under HIPAA.

However, we do recommend that since each institution has a very different review process and requirements, that you involve them early on. We are encouraging participants in the ED Collaborative to have very good knowledge about what’s involved so they can make a very good business case for their internal review team. Also, involve your leadership. Having their commitment and support early on is also key.

Source: 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population

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