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Washington State Hospital Association
Medicaid Quality IncentiveER is for Emergencies
Web Conference
July 11, 2013
1
Washington State Hospital Association 2
Amber Theel
Director, Patient Safety Washington State Hospital Association
Khin Latt
Director, Quality and Performance Improvement WSHA Partnership for Patients
WSHA Presenters
Washington State Hospital Association
Presenters
3 3
Jackie Brown, RN
Director of Emergency Services
Providence St. Peter Hospital
Adam Green
President, Collective Medical Technologies Emergency Department
Information Exchange (EDIE)
Program Coordinator Emergency Department
Consistent Care Program Providence St. Peter Hospital
Reid Buker, RN
Consistent Care Program ManagerSacred Heart Medical Center / Holy
Family Hospital
Linda Marsh, RN,
Washington State Hospital Association
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 IncentiveJuly 1, 2013
• The program is included in the Hospital Safety Net Assessment legislation
Passed as Part of the Budget
Washington State Hospital Association
TimelineJuly 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 hospitalsReceive increase across services based
on overall hospital performance
• Behavioral health hospitals and unitsIncrease based on behavioral health
measures
Washington State Hospital Association
Funding for Incentives
• Quality incentive provided to all qualifying Washington hospitals
• No partial increasesHospitals 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 guidelineDenominator: 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
Robust Care Guideline
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
Providence St Peter HospitalCare Guidelines
Jackie Brown, RN, MS Director of Emergency Services
Reid Buker, RN, MN Program Coordinator EDCCP
Referral Process
Patient Selection CriteriaEDIE ≥ 5 ED visits within 12 monthsDrug seeking behaviorAbusive or violent behavior
Who can refer a patient?ED ProvidersNursing staffPCP’s
Care Guidelines ProcessInitial/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 GuidelinesBasic 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 GuidelinesAdditional ConsiderationsPatient 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 [email protected] or 206-
577-1820
Care Guideline Template• Khin Latt at [email protected] or 206-216-2531
