Posts Tagged ‘ER’

3 Emergency Department Interventions to Curb ‘Ultra-Utilizer’ Use

March 31st, 2015 by Patricia Donovan

Drawing upon an 18-month pilot to curtail wasteful utilization in Ohio ERs, especially by Medicaid beneficiaries identified as ‘ultra-utilizers,’ Mina Chang, Ph.D., chief, health services research and program development section of the Bureau of Health Services Research for the Ohio Department of Job & Family Services, looks at three ED-based interventions targeting this population.

The ED care team approach is very similar for the three targeted ultra-utilizer groups: severe mental illness, non-mental health conditions, and chronic back pain. It’s based on a strong medical and clinical leadership oversight. The integrated interdisciplinary teams include managed care and community providers, and care management or care managers. They came together based on the patients’ medical profiles, developing an individual care treatment plan for each of the patients including the testing. The team would continue to outreach to those patients, to address their social and medical needs and to coordinate care for those patients.

The treatment plan at the summary level was made available to older participating EDs in the past intervention. The patient will be also flagged at those EDs. And the intent is if the member showed up at the ED, the ED attending physician would be able to reference on the treatment plan and also communicate with the interdisciplinary teams as necessary.

For the mental health stream, the designated provider is a comprehensive mental health center that works together with the managed care claims to develop treatment plans. And the summary level of the treatment plan will be shared with the participating EDs from the two health systems.

For these streams we also have a 24/7 crisis center so the EDs can tap into them to have the most updated treatment plan faxed over as needed.

We also have another integrated care team for the non-mental health population led by Metro Health’s medical home team. These designated providers work with our managed care plans to develop a treatment plan for each participating patient and the summary will be shared with the participating ED from the three health systems.

Finally, similar of design was a back pain stream with a pain clinic as the designated provider. This designated team works with our managed care plan care managers. In turn, they built a care treatment plan for those participating patients, and shared the treatment plan summary with the participating ED and the three health systems.

We already have very encouraging results. Almost all members reported their outreach from the team has been excellent or good. And that’s after we instituted the intervention. The majority of the members reported they have input into treatment plans, so most of them slowly follow up with their providers.

The unique area noted by the mental health team is that transportation, fear and timely appointments are the most common barriers preventing ultra-utilizer patients from seeking follow-up care after ED visits.

We also observed increasing success for members keeping appointments. Our teams also noted that communication is key, not only between the participating test site, since there are so many moving parts, but also within the test site, such as the pain clinics or the emergency department.

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

Reducing Avoidable ER Use

5 Interventions to Reduce Avoidable ER Use by the Medicaid Population looks at the collaborative effort among five Ohio regions to target key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.

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2 Performance Improvement Tools Help Physicians Work Smarter, Not Harder

February 13th, 2014 by Cheryl Miller

In light of health reform, physicians need tools to help them work smarter, not harder, says Mark Shields, MD, MBA, senior medical director for Advocate Physician Partners (APP) and vice president of medical management for Advocate Health Care. Among the tools the organization has introduced since 2004 is the eICU®, which enables physicians to monitor ICU patients 24/7. If physicians engage in this sophisticated tool at the highest level, they can change course or therapy if clinically appropriate.

You have to give physicians tools to re-engineer their practice and improve performance. We are not talking about working harder; these are clinicians who are already working very hard. Instead we are talking about working smarter. Many of those tools are technology tools.

Between 2004 and 2010 we added more technology tools to assist our physicians. We used disease registries — online tools to track patients with a given condition to drive outcomes. They were a key tool for us long before we had electronic health records (EHRs). We do not have EHRs fully deployed across our independent physicians. Therefore, an enormous amount of change can occur with other tools without the full EHR. Sometimes physician groups feel that they must have such a record fully deployed before they can change clinical performance, and that is not true.

We also introduced the electronic intensive care unit (eICU) — a sophisticated tool that supplements bedside staffing in ICUs. Every adult ICU bed is connected to the eICU command post, where intensive physicians and intensive care nurses work 24/7 using electronic and visual monitoring of the ICU patients, with computerized prompts and reminders. It is very important that physicians engage in this at the highest level, so they agree that physicians or the intensives and the ICU can change course or therapy if clinically appropriate.

Excerpted from Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Clinical Integration and Data Sharing.

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Healthcare Business Week in Review: Post-Surgery ER Visits Up; Medicare Spending Debate; EHRs and Diabetes

September 20th, 2013 by Cheryl Miller

Nearly one in five older adults who have common operations will end up in the ER within a month of their hospital stay, finds a new study from the University of Michigan Medical School.

There is also wide variation among hospitals, with some having four times the rate of post-surgery emergency care for their patients than others, suggesting that hospitals should be graded based on their performance on this measure.

But researchers agree that further study is needed before post-surgical ED visits join such measures as hospital readmissions and infections in assessing the quality of hospital care, researchers note. More inside.

Experts and the public disagree on whether Medicare spending should be reduced in order to lower the federal budget deficit, according to a special report in the New England Journal of Medicine. In fact, a majority of the public says they will vote against candidates who favor the reductions.

Americans feel that Medicare recipients have prepaid or are paying for the cost of their healthcare, and that the benefits they do receive are the same or less than what they paid during their working lives. But experts maintain, among other issues, that one of the most important reasons for rising Medicare costs is unnecessary care provided to patients.

There is widespread agreement that the use of EHRs in clinical settings can decrease ER visits and hospitalizations for patients with diabetes, according to researchers from Kaiser Permanente (KP).

Following the implementation of HealthConnect&#174, the organization’s comprehensive EHR system, KP researchers found that diabetic patients visited the ER 29 fewer times per 1,000 patients and were hospitalized 13 fewer times per 1,000 patients annually after the implementation.

Do you input EHR data for health risk assessments? Sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material for the development of prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health in our e-survey by October 15, 2013 and get a FREE executive summary of the compiled results.

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Most Patients Want to Self-Manage Healthcare

July 9th, 2012 by Cheryl Miller


Most Americans want to manage their healthcare information electronically, but not at the expense of losing face time with their doctors.

At least that’s what the results of a new survey from Accenture Health show: a hefty 90 percent of patients prefer to monitor their medical information, refill prescriptions and book appointments online via e-mail, Web sites, and mobile devices.

Not only aren’t the majority of Americans willing to sacrifice personal interactions with their physicians, but they aren’t sure how they want their records managed. And a third admitted that they didn’t know if they could access electronic tools like ‘bill pay.’ More results from this survey inside this week’s issue.

Closer management is also key to a new tool from the Joint Commission Center for Transforming Healthcare, designed to improve patient handoffs. Data shows that an estimated 80 percent of serious medical errors result from miscommunication between caregivers when patients are transitioned from one facility to another. In addition to patient harm, defective handoffs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. This new tool, which monitors current organizational handoff processes and provides proven solutions, has been effective in reducing readmissions and hospitalization time, and increasing patient, family and staff satisfaction.

Managing costs is at issue in a new global survey from Towers Watson, showing that the cost of providing employee medical benefits is rising at double-digit levels everywhere in the world but Europe, which is anticipating only single-digit increases. The survey goes on to state the reasons for these increases, and avenues that medical insurers are taking to contain their costs, including implementing wellness programs and health promotion strategies.

And young adults are letting their parents manage their healthcare coverage. According to a new study from Indiana University economists, children ages 19 to 25 are taking advantage of the ACA ruling that private insurance policies offer to cover dependents’ children up to age 26. The report goes on to cite other findings, including the gender, marital status and ethnicity of children being covered; details in this week’s issue of Healthcare Business Weekly Update.

And how do you manage your asthmatic population? Asthma accounted for nearly half a million hospitalizations in 2009 and nearly 2 million ED visits; the estimated total cost of asthma in the United States in 2007 amounted to $56 billion. Describe your organization’s efforts to manage what is one of the most common, lifelong chronic diseases by July 27, 2012 and you’ll receive a free e-summary of our survey results once it is compiled.

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UPMC Home Visits Target Unplanned Care in Emergency Departments

June 18th, 2012 by Jessica Fornarotto

UPMC members who treat the ER as a primary care provider can expect a home visit from the health plan’s community teams of nurses and social workers. Community teams visit these members at home to perform assessments and care management.

That’s one of the ways UPMC Health Plan is reducing the rates of avoidable emergency room use, according to Debra Smyers, senior director of program development at UPMC, who presented these strategies during a recent webinar on Identifying, Engaging and Breaking Down Patient Barriers To Reduce Avoidable ED Use.

UPMC developed community teams to engage members who were having “unplanned care” — members who thought of the ER as their own personal PCP. These teams focus primarily on the Medicaid and special needs populations. UPMC sends health plan nurses and social workers into the community to visit the targeted members in their homes. These visits continue for a few months. Then, the nurse or social worker hands the member over to a different caregiver to continue the care.

UPMC calls it a “real team approach;” they even have nurses located in the patient-centered medical home (PCMH) who can link members to an appropriate caregiver, explains Ms. Smyers. For instance, if the member is a smoker and wants to quit, the nurse would link that member to the lifestyle health coach who helps with smoking cessation.

UPMC Health Plan has also placed a patient navigator in the ER to educate patients on appropriate ER use. These navigators ask patients coming into the ER for a minor illness, such as for a sore throat, if there are any care alternatives they could use instead, such as visiting their PCP. Should the patient not have a PCP, the navigator will then help the patient to find one.

Originally, to identify patients using the ER inappropriately, UPMC would go through a monthly stratification process that included data from previous months. However, this identified patients too long after their ER visit, when it was irrelevant to help the patient. The health plan now uses actual registration data from the ERs to find their targeted patients.

With this new plan, UPMC was then able to reach the patient about their ER use on the actual day of the hospital visit. Also, to have a more direct focus on the different patients that were coming into the ER, UPMC stratified all patients into three targeted groups: those with high ER use, those with ER visits for conditions, and those patients with level 1 or 2 ER visits.

Smyers also discussed UPMC’s Connected Care Program to help improve care coordination for patients with serious mental illnesses. The health plan based this program on the PCMH model of care to address how physical and behavioral healthcare providers can manage the care of this specific population.

One of the components of this program is integrated care team meetings with staff members to focus on how to support patients with their personal and social needs. For instance, if a patient is constantly going to the ER for an illness only because the ER staff treats them well, the patient needs to understand why that constitutes inappropriate use of the ER.

This UPMC program engaged 2,500 members over two years.

In 2010, UPMC added an ER measure to their pay-for-performance (PFP) program. This measure is made up of two parts: one looks at utilization of the ER in comparison to other practices in the PFP program, and the other part looks at the rate of the practice’s improvement from the previous year.

One of the many outcomes from the ER measure was that in 2011, the PFP practices had a rate of ER visits of 34/1,000 less than the overall performance and 145/1,000 less than the non-PFP practices.

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