Posts Tagged ‘reducing ER visits’

10 Things to Know About Reducing Avoidable ER Visits in 2014

September 18th, 2014 by Cheryl Miller

Despite expanded coverage available under the Affordable Care Act (ACA), the hospital emergency room (ER) remains a refuge for those unable to visit their primary care physician (PCP)— whether due to lack of access, insurance, or time, according to results from the latest Reducing Avoidable ER Visits Survey by the Healthcare Intelligence Network (HIN).

But more than half of respondents (65 percent) are confident CMS’s easing of telemedicine regulations (e.g. mandates for physician on-site hours) will help to reduce avoidable ER visits.

In the three years since HIN last administered this survey, health organizations have stepped up ER discharge follow-up efforts. Almost one-third of respondents (31 percent) in 2014 say they contact patients within 24 hours of their ER visit, versus 22 percent of respondents in 2011 who made provider appointments before discharge, and 18 percent who conducted phone follow-ups within two days of a visit.

Here are more metrics derived from the 2014 Reducing Avoidable ER Visits Survey:

  • Staffing solutions to reduce avoidable ER visits have changed: case managers, social workers and disease-specific care coordinators are increasingly utilized in the ED, replacing health educators, coaches, and nurse-only advice lines used in 2011.
  • The challenge of redirecting non-emergent patients, while still a primary barrier, decreased in priority from 29 percent in 2011 to 18 percent in 2014.
  • Insufficient care access remains a challenge, growing from 16 to 21 percent in 2014, along with PCP collaboration, which was still among the top three challenges, but decreased from 24 percent in 2011 to 18 percent in 2014.
  • The prevalence of programs to reduce avoidable ED usage remained relatively stable from 2011 to 2014, with nearly three quarters of respondents reporting such initiatives.
  • Among populations reported to generate the majority of avoidable ED visits, ER use by dual eligibles increased five-fold in the last four years, from 2 to 11 percent, while other populations — high utilizers, Medicare and Medicaid — remained roughly the same.
  • Chronic disease replaced pain management as the most frequently presented problem, at 54 percent.
  • Education and risk-based telephonic outreach are the top two patient-centered strategies used to reduce avoidable ER visits in 2014.
  • Behavioral health issues and privacy are considered two top legal and compliance obstacles in reducing avoidable ER visits, respondents say.

Source: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

Stratifying High-Risk Patients


2014 Healthcare Benchmarks: Reducing Avoidable ER Visits
delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital ER departments. Enhanced with more than 50 easy-to-follow graphs and tables, this third edition of comprehensive data points presents year-over-year trends and best practices for engaging ER and hospital staff, primary care physicians, community providers and patients in reducing avoidable ED utilization.

3 Reasons Home Visits Critical During Care Transitions

February 20th, 2014 by Cheryl Miller

As far back as 2010, home visits were a vital component of the Durham Community Health Network (DCHN), a primary care case management program for Medicaid recipients who live in Durham County, NC, explains Jessica Simo, program manager with Durham Community Health Network (DCHN) for the Duke Division of Community Health. Conducted in three-month increments, and designed initially to better address Medicaid recipients’ needs and link them to their medical homes, the face-to-face visits helped establish a level of trust between case manager and patient, eventually leading patients to better outcomes, including improving medication reconciliation.

Why are home visits so important? Number one, it is very challenging to observe problems that individual patients may have with adhering to their medication regimens if providers can’t see the medicines in the bottle in the patient’s home. You need to be available to count the medicines and ascertain definitively that they are not missing. Trying to do medication reconciliation over the phone is nowhere near as effective as being in a patient’s home.

Another reason home visits are more effective is that you can physically see what activities of daily living (ADL) or instrumental activities of daily living (IADL) deficits the patient may be experiencing in their natural environment. This is something you can’t directly observe within the confines of an exam room.

The engagement of family or other support persons is also important. Home visits are an excellent way to see somebody in their natural environment, find out who the support people are for the patient, have a comfortable discussion in their home about an individual plan of care and get the people who can assist with that on board.

For all of the previous reasons, home visits were critical to the DCHN pilot. It’s especially important in a medically complex patient population where there are frequent transitions, whether they be from the acute care setting, from any emergency department (ED) visit or back into the home from an assisted living facility.

Excerpted from 2013 Healthcare Benchmarks: Home Visits.

Time to Welcome Those in Need

December 17th, 2012 by Cheryl Miller


‘Tis the season to welcome those in need, and doctors’ offices are a good place to start.

Primary care physician offices need to be more accessible, because the majority of patients are finding their doors closed when they most need them, says a new report from the Center for Studying Health System Change

Of nearly 10,000 patients surveyed who have a usual source of primary care, more than half said their doctors did not provide care after hours and on the weekend. These patients were more likely to go to the ED as a result, or skip medical care completely, researchers said. At a time when reducing unnecessary ED visits totaling more than 136 million in 2009, according to the CDC is a major concern of healthcare experts, this could be a simple, potentially cost-effective solution.

Another reason to expand primary care access? Americans are living longer, given increasing medical advances, according to United Health Foundation’s 2012 America’s Health Rankings®. But they’re not necessarily healthier, because of increasingly unhealthy behaviors and diets, habits that unfortunately aren’t limited to the typically overindulging holiday season.

While rates of premature, cardiovascular and cancer deaths have declined since 1990 by 18 percent, 34.6 percent and 7.6 percent, respectively, preventable behaviors have increased: nearly a third of adults are obese, 10 percent of the population has diabetes, 31 percent has high blood pressure (BP) and 26 percent of adults are sedentary or do not exercise outside of work, resulting in increasing levels of diabetes and high BP.

There is another population that is living longer – former cancer victims who beat the odds but now have bodies weakened by cancer treatments. These ‘survivors” need a heavy dose of holiday cheer, in the form of a dedicated line of care, and today’s case managers can provide that care, says Sheryl Riley, managing partner at Clarion LLC. But they need to be trained not only to deal with the physical after-effects of their disease, but their emotional state and their families’ emotional state – as well.

And this could very well be a topic of discussion for our brand new LinkedIn forum: CaseTalk… a Forum for Care Coordinators, where case managers can talk about best practices, news and analysis, and network with others.

In our discussions with case managers over the years, we have found that they would appreciate an online meeting group where they can share ideas and concerns about their craft with the limited amount of time they have, all year round. We hope that CaseTalk becomes that go-to place for many of you, case managers and healthcare professionals alike.

Happy holidays!