Medicaid Quality Incentive
ER is for Emergencies
Web Conference
July 11, 2013
Washington State Hospital Association
1
WSHA Presenters
Amber Theel
Khin Latt
Director, Patient Safety
Director, Quality and Performance
Washington State Hospital Association Improvement
WSHA Partnership for Patients
Washington State Hospital Association
2
Presenters
Adam Green
President, Collective Medical Technologies
Emergency Department Information
Exchange (EDIE)
Linda Marsh, RN,
Consistent Care Program Manager
Sacred Heart Medical Center / Holy
Family Hospital
Washington State Hospital Association
Jackie Brown, RN
Director of Emergency Services
Providence St. Peter Hospital
Reid Buker, RN
Program Coordinator Emergency
Department Consistent Care Program
Providence St. Peter Hospital
3 3
Today’s Presentation
• Brief Overview of the Emergency Room
Measure
• Data Collection and Reports
• New Tools Available to Hospitals
• Care Guidelines
• Questions
Washington State Hospital Association
Medicaid Quality Incentive
July 1, 2013
• The program is included in the Hospital Safety
Net Assessment legislation
Passed as Part of the Budget
Washington State Hospital Association
Timeline
July 1, 2013 - December 31, 2013
Hospitals collect performance data
(Work force flu immunization October 1, 2013 to March 31, 2014)
April 2014
Chief Financial Officer attestation
May 2014
HCA determines which hospitals qualify for payment
July 2014
Qualifying hospitals receive incentive payment
Washington State Hospital Association
Payment Increases
• One percent inpatient Medicaid increase for
non-critical access hospitals
• Acute general and pediatric hospitals
Receive increase across services based on overall
hospital performance
• Behavioral health hospitals and units
Increase based on behavioral health measures
Washington State Hospital Association
Funding for Incentives
• Quality incentive provided to all qualifying
Washington hospitals
• No partial increases
Hospitals receive either zero or one percent
increase
Washington State Hospital Association
ER is for Emergencies
Measure Overview
Percent of Patients (all payors) with
Five or More Visits to Emergency
Room with Care Plans
Washington State Hospital Association
ER is for Emergencies
Measure will be used for the following:
• Acute Care
• Pediatrics
(Adult and pediatric hospitals with emergency
rooms only)
Washington State Hospital Association
ER is for Emergencies
Numerator: Number of care guidelines
completed in the calendar month by the facility
for patients with five or more visits in the last
year without a care guideline
Denominator: Number of patients without a
care guideline with five or more visits in the last
year seen by the facility in the month
Washington State Hospital Association
ER is for Emergencies
Washington State Hospital Association
ER is for Emergencies
Data Collection and Reports
Data:
• Submitted to WSHA by EDIE.
• Data will be collected monthly and distributed
to the hospitals as part of the ER is for
Emergency reports.
Washington State Hospital Association
ED Monthly Report - Updated
Random Hospital Medical Center
Washington State Hospital Association
ED Monthly Report – Updated (cont)
Washington State Hospital Association
What Does 10% Look Like?
Washington State Hospital Association
ER is for Emergencies
New Tools for Hospitals
Washington State Hospital Association
Example Care Guideline
Washington State Hospital Association
Washington State Hospital Association
Revised Care Guideline Template
Background
• Template requested by members to assist
with developing quality care guidelines that
are standardized and ensure continuity of
patient care
Goal
• To ensure crucial health and safety
information is available for all providers
involved in the patient’s care.
Washington State Hospital Association
Standard Care Guideline Template
Development Advisory Group
Washington State Hospital Association
Revised Care Guideline Template
• Quickly inform the next provider of
important information needed to take
care of the patient
• Support smooth transitions, reduce
complications
• Bridge the communication between
Emergency Departments, primary care
providers and other specialty providers
Washington State Hospital Association
Standard
Care
Guideline
Template
Washington State Hospital Association
Washington State Hospital Association
Revised Care Guideline Template Recommendations
• Create the guidelines in partnership with the
outpatient providers
• Consider including not only care
recommendation in ED but also in outpatient
settings when appropriate
• Make them available for the partners in care
Washington State Hospital Association
Jackie Brown, RN, MS Director of Emergency Services
Reid Buker, RN, MN Program Coordinator EDCCP
Referral Process
 Patient Selection Criteria
 EDIE ≥ 5 ED visits within 12 months
 Drug seeking behavior
 Abusive or violent behavior
 Who can refer a patient?
 ED Providers
 Nursing staff
 PCP’s
Care Guidelines Process
 Initial/preliminary care plan developed using PSPH
guidelines.
 Preliminary care guideline is faxed to patient’s PCP for
review and input.
 Documentation from patients visits to ED reviewed by Care
Coordination MD and RN.
 Case review conducted at EDCCP meeting.
 Feedback from PCP presented.
 Recommendations on how to individualize care guideline
specific to patient discussed.
 Care plan revised as appropriate.
 Care guideline placed in EDIE and in to the patients EPIC
chart.
Basic Care Guidelines
 Basic Guidelines (5 visits in 12 months)
 Provider to perform MSE.
 Minimize radiation exposure based on clinical history and shared
decision making with the patient related to risks and benefits of
further exposure.
 Treat acute medical conditions as needed.
 Address pain issues.
 Restrict use of opiates in the ED to only obvious trauma or severe
medical issues.
 Discharge
 Explain to patient that no opiates will be given or prescribed for
chronic conditions or to replace lost/stolen prescriptions.
 Refer the patient back to PCP for pain control and follow-up.
 Instruct patient on importance of following up with PCP.
 Provide instruction on proper use of Emergency Department.
Individualized Care Guidelines
Additional Considerations
 Patient Specific Guidelines
 Patient is a safety risk for the following reasons:
. Request security to stand-by.
 Provide assistance making an appointment with the patients
PCP.
 Request ED Provider complete MSE in triage area whenever
possible.
 Do not provide patient with free bus passes or cab vouchers.
 Do not allow patient to sleep in waiting room.
 Review expected behaviors with patient – Patient will




Seek care from PCP for chronic and recurrent medical issues.
Contact PCP and/or urgent care clinic before visiting the ED for non
emergent issues.
Cooperate with medical exam in the ED without being verbally or
physically abusive.
Keep f/u appointment with PCP and utilize the ED for only emergent
situations.
Questions?
For questions or other feedback contact:
ER is for Emergencies/ER Measure
• Amber Theel at ambert@wsha.org or 206-577-1820
Care Guideline Template
• Khin Latt at khinl@wsha.org or 206-216-2531