Transcript Washington State Best Practices Update Fall 2012

Washington State Best Practices
Update Fall 2012
Dr. Stephen H. Anderson, MD, FACEP
Dr. Nathan Schlicher, MD, JD, FACEP
Dr. Darin Nevin, MD
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
The State Budget
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
Health Care Portability Act of 1996
• You have the right to access emergency
services 24 hours a day. By law, a situation is
considered to be an "emergency" if a prudent
layperson believes that failing to act
immediately would put your health or the
health of others in danger.
Both State & Federal legislative
protection for insured & managed
care patients…
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
The Seven
Best
Practices
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
A) Electronic Health Information
Goal: Exchange patient information among
Emergency Departments
• Identify frequent users
• Get access to treatment plans
• Use in providing care
• Exceptions for CAHs with
financial burden
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
B) Patient Education
Goal: Help patients
understand and use
appropriate sources of care
• Active distribution of
educational materials
• WSHA/WSMA/ACEP brochure
• Discharge instructions
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
C) Patients Requiring Coordination
(PRC) Information
Goal: Ensure hospitals know when they are
treating a PRC patient and treat accordingly
• PRC clients = frequent ER users, often narcotic
seekers
• Receive and use client list
• Identify patients on arrival
• Develop and coordinate case
management programs
• Use care plans
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
D) PRC Client Care Plans
Goal: Assist PRC clients with their care plans
• Contact the primary care provider when PRC client
visits the ER
• Efforts to make an appointment with the primary
care provider within 72 hours when appropriate
• If no appointment required, notify primary care
provider that a visit occurred
• Relay barriers to care to Health Care Authority
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
F) Prescription Monitoring
Goal: Ensure coordination of prescription drug
prescribing practices
• Enroll providers in Prescription Monitoring Program:
electronic online database with data on patients prescribed
controlled substances
• Target enrollment for ER providers :
– 75% by June 15, 2012
– 90% by December 31, 2012
– Enroll is one thing… USE is another!
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
G) Use of Feedback Information
Goal: Review reports, ensure interventions are
working
• Report specified information to Health Care
Authority
• Designate ER leader and quality manager to
receive, review, and act on utilization
management reports
• Involve executive-level leadership
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
Managing Difficult Conversations
Social Psychology 201
For ED’s
Stephen H. Anderson M.D., FACEP
President, WA State Chapter ACEP
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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I Think You Have A
Drug/ Alcohol Problem
Society/ Legislature/ Peers now tell us
We MUST have these conversations
THIS is the pivotal time.
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Drug & Alcohol Problems
The Principles
• There are rules/ guidelines
• Listen first
• Your allies/ their allies
“Their support” might turn out to be your best ally!”
• WIN-WIN
• Be true to yourself
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Drug & Alcohol
Tools to Help
• Old Records
• EDIE
• WA state Prescription Monitoring Program
Educate patients that these exist
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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I Think You’re Here Too Often
PRC
Patients
Requiring
Co-ordination
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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You’re Here Too Often
New WA Hospital Requirements
• Identify PRC clients upfront
• Notify their PCP of visit
• Discharge patient with instructions along:
“the right patient-to the right place-at the right time”
Shouldn’t be a punitive discussion
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Warning!
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Nathan Schlicher, MD, JD
Legislative Affairs Chairman, WA ACEP
Associate Director, St. Joseph’s MC ED
Associate Director, TeamHealth PSO
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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5000
4500
All State ED Visits

ED visit rate per 1000 Medicaid clients
4000
3500
3000
2500
Total
2000
1500
1000
500
0
201101201102201103201104201105201106201107201108201109201110201111201112201201201202201203201204201205201206
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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SJMC Medicaid Visits

Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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PRC Visits with
Narcotics

Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Average Pills per Script
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
Pills per Script
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Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
Takeaway Points

 We are doing well overall
 One of the best on pills per scripts
 Room to improve on PRC folks
 Fewer narcotics
 State improving, must continue to climb
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Darin Neven, MS, MD
Providence Sacred Heart Medical Center and Children’s
Hospital
Spokane, WA
[email protected]
www.consistentcare.com
Draft ED Care Plan
Standard

Header Information
– Date Plan First Created
– Date Plan Last Updated
Security Alert
Pain Contract and
Scheduled Prescribing
Draft ED Care Plan Standard

Primary Care Provider and
Specialist
• Past Medical and Surgical
History
• Substance Use and Abuse
History
• Mental Health Conditions
Optional (Phase 2)

Optional sections, may be made mandatory
later.
•
•
•
•
•
Barriers to Care Delivery
Radiation Alert
Overdose Alert
Special Care Recommendation
Details
New Initiatives

 Protect Providers from False Complaints
 Prescribed Naloxone
 www.prescribetoprevent.org
Best Practices Are a Foundation
If we are serious
about achieving this:
Projection
Actual trend
Hospitals and
emergency
physicians need to
be looking for
trends and patterns,
intervene, make
continuous change!
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Best Practices 2.0 ?
• Access to follow-up primary care
• Access to dental health care
• Reimbursement incentives for same day
scheduling of PRC clients
• Accountability to Health Care Systems for
coordination of care
• Persistent pressure for Tort reform to decrease
costs of “defensive medicine”
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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BEWARE!
Newest Twist in HCA rules, July 2012
(13) Client financial responsibility
” A client placed in the PRC program may
be billed by a provider and held financially
responsible for health care services when
the client obtains non-emergent services
and the provider who renders the services
is not assigned or referred under the PRC
program.”
Presented at WSHA Safe Table – ER is for Emergencies 9/24/12
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Questions?
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