10 Ways to Engage Physicians in Appropriate ER Utilization

Friday, July 29th, 2011
This post was written by Jackie Lyons

About a third of unnecessary ER use is categorized as “avoidable,” followed by visits from high utilizers, often referred to as ‘frequent flyers,’ who generate 29 percent of avoidable use, according to a recent HIN survey on reducing avoidable ER use. Survey respondents include physicians in many strategies to reduce avoidable ER use. For example, 63 percent of respondents alert primary care physicians (PCPs) to ED visits by recently discharged patients.

Here are 10 ways to engage physicians in efforts to reduce avoidable ER utilization as suggested by survey respondents:

  • Establish an alliance of hospital and post-hospital providers to address avoidable readmissions and ED visits. Collaborate between cross-spectrum of services to break down silos of healthcare providers;
  • Perform in-person reviews of ED utilization profiles comparing PCP to others in network – encourage PCPs to offer rapid appointment availability when requested by case manager, use e-notification of PCP re: ED visit occurrence and encourage PCP open access hours;
  • Allow PCP to cover absence of an employee from the first day off work, not from first day seen in medical office. EDs are a tool of convenience prior to PCP appointment;
  • Use a transfer call center with the hospitalist assuming admission on unassigned patients;
  • Work with providers to have “walk-in” or urgent care slots built into daily appointment templates;
  • Facilitate PCP group relationships with the Regional Health Information Organization (RHIO), in which ERs of various hospitals collaborate;
  • Introduce coaching module follow-up for 30 days post-discharge;
  • Develop community care plans that involve the frequent flyer patient, PCP and ED. Then develop an agreed-upon coordinated plan of care. The first priority is that the patient contacts the PCP before entering the ED. If the patient still presents to the ED, it is the goal of the ED case manager to contact the PCP and discuss better options;
  • Establish a medical home with risk-sharing reimbursement if office-specific ER rates for ambulatory care sensitive conditions (ACSC) or multiple visits improve;
  • Identify PCPs that encourage ER visits through a mailout survey;

    More ways to engage physicians in Appropriate ER Utilization.

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