Health information technology, care coordination, and cost containment have increasingly become entwined in health care policy. Medicare and Medicaid both have electronic health record (EHR) incentive programs to encourage physicians, hospitals, and other providers to use them. Electronic patient communication also is part of care coordination models, such as patient-centered medical homes (PCMH).
Washington State Adopts EHR Best Practices for Emergency Rooms:
Last year, the Washington State Legislature took a big step to promote electronic health records as a means to save money in the Medicaid budget. The legislature directed the state Health Care Authority, which runs the Washington Medicaid program, to establish seven best practices that would reduce emergency room expenditures by 12 percent. Hospitals serving Medicaid enrollees would help to craft and would be expected to adopt the practices.
The best practices included:
- Establish an electronic health records system through which emergency department physicians could see patient emergency visits, including the diagnoses and treatments, at all hospitals within the past year.
- Adopt a program to educate Medicaid enrollees about when and when not to visit the emergency room.
- Create a process to share information among hospital staff about frequent emergency department visitors.
- Implement a process to help those frequent users with their care plans and to schedule follow-up visits with primary care physicians soon after the patient went to the emergency room.
- Adopt strict guidelines for prescribing pharmaceutical narcotics.
- Enroll 75 percent or more of emergency department prescribers in an online Prescription Monitoring Program, which tracks data on patients who received prescription drugs that are controlled substances.
- Assign hospital staff to review and respond to emergency department usage data.
EHRs Save Medicaid Money, Reduce Emergency Room Visits:
The Washington Health Care Authority recently gave the legislature a progress report on the Medicaid EHR program. Though the report is careful to say the program has not been in place long enough to draw final conclusions, the initial results are very promising.
The most important finding is that the electronic health records program led to annual Medicaid savings of about $33 million: $23 million in Medicaid managed care and another $10 million for fee-for-service Medicaid, though estimating FFS savings are always more difficult.
Other key findings were:
- Total emergency department visits at 32 hospitals dropped 23 percent among Medicaid beneficiaries who were frequent users, from June to October 2012.
- Hospitals completed care plans for 64 percent of frequent users by October 2012, almost double the 28 percent completion rate from five months earlier. The care plans are available to 85 emergency rooms across the state and include information about chronic diseases, prescription drug use, and mental health conditions.
- The number of hospitals sharing electronic health records increased six-fold.
Kudos to MaryAnne Lindeblad and her excellent team at the Washington Health Care Authority for their great work.
