The ER is for Emergencies campaign encourages adoption of the “Seven Best Practices” program by hospitals, emergency and primary care physicians and other health professionals.

The program attempts to address the root of the problem of ER overuse—chronic medical conditions, substance abuse issues and lack of primary care access—by focusing on high users with targeted strategies, including patient education, improved access to primary care as well as participation in the state’s Prescription Monitoring Program, which tracks data on patients prescribed controlled substances.

Joining the WSMA in the ER initiative is a coalition of health partners including the Washington State Hospital Association, the Washington Chapter of the American College of Emergency Physicians and the Health Care Authority.

WSMA's ER is for Emergencies initiative is an integral part of its larger Know Your Choices - Ask Your Doctor statewide campaign, which promotes various patient-centered health initiatives to encourage meaningful conversations about treatment options, expected outcomes and quality-of-life choices.

About ER is for Emergencies




Seven Best Practices Program

The goal of the Seven Best Practices program is to redirect care to the most appropriate setting, reduce low acuity, and reduce preventable Medicaid emergency room visits. The plan, which attempts to address the root of the problem—chronic medical conditions, substance abuse issues, and lack of primary care access—focuses on high users and will:

  1. Track emergency department visits to reduce “ED shopping”;
  2. Implement patient education efforts to re-direct care to the most appropriate setting;
  3. Institute an extensive case management program to reduce inappropriate emergency department utilization by frequent users;
  4. Reduce inappropriate ED visits by collaborative use of prompt (72 hour) visits to primary care physicians and improving access to care;
  5. Implement narcotic guidelines that will discourage narcotic-seeking behavior;
  6. Track data on patients prescribed controlled substances by widespread participation in the state’s Prescription Monitoring Program (PMP); and
  7. Track progress of the plan to make sure steps are working.

Click here for one-page document outlining Seven Best Practices. Our success will work to prevent the state from enacting payment cuts to both hospitals and physicians for emergency room services.




Role of primary care physicians

This isn’t a problem only to be solved by hospitals and emergency medicine physicians. Primary care and community physicians can help achieve success by:

  • Educating patients on the appropriate places to go for care;
  • Helping with the lack of access issue by making room in their schedules to accommodate Medicaid patients who are re-directed to the outpatient setting for care;
  • Participating in Prescription Monitoring Program (PMP) that allows physicians and pharmacies to track what controlled substances patients are having filled.

Patient brochure available—A Guide to Help You Choose the Best Place to Go for Health Care—for use with your patients to help redirect care to the most appropriate setting.

Download and view the brochure. To order a supply for your waiting room, click here.
View Spanish language version only, no printed version
View Russian language version only, no printed version
View Vietnamese language version only, no printed version.

Video – Role of Primary Care and Community Physicians new link:Role of Primary Care and Community Physicians

Video – Prescription Monitoring Program (PMP) and Narcotics Guidelines

Enroll in PMP – WSMA encourages all physicians to enroll in the Prescription Monitoring Program (PMP), an electronic online database with data on patients prescribed controlled substances.




Educational videos and archived webinars

Video: Reducing Preventable ER Visits

A presentation by Nathan Schlicher, MD, JD, emergency room physician, legislative affairs chairman, WA-ACEP, WSMA member. Dr. Schlicher talks about implementing the alternative plan to the state's "zero tolerance" plan to deny payment for Medicaid emergency room visits. He discusses in detail the seven best practices that must be implemented by hospitals and physicians across the state as part of the alternative plan.

Video: Alternative Plan to Reduce Preventable ER Visits

Dr. Nathan Schlicher gives a brief overview of the above presentation about implementing the alternative plan to the state's "zero tolerance" plan to deny payment for Medicaid emergency room visits.

Video: Role of Primary Care and Community Physicians

Primary care and community physicians as well as specialty physicians play an critical role in a successful effort to reduce preventable emergency room use. Lack of access to care is a major contributing factor. Dr. Nathan Schlicher talks about how physicians can help the effort.

Video: Narcotics Guidelines and PMP

Dr. Nathan Schlicher gives an overview of the Narcotics Guidelines that standardizes narcotic prescribing in the emergency room. In addition, Dr. Schlicher discusses the Prescription Monitoring Program (PMP) that allows physicians and pharmacies to track what controlled substances patients are having filled. All physicians are encouraged to participate in the PMP.

Archived webinar | ER is for Emergencies Series Best Practice A: Emergency Department Information Exchange (archived here)

Archived webinar | ER is for Emergencies Series Best Practice C & D: Patients Review and Coordination Program (PRC) Clients and Care Plans (archived here)

Archived webinar | ER is for Emergencies Series Best Practice F: Prescription Monitoring Program (PMP) (archived here)




Additional resources

  • Reduce drug seeking and drug-dispensing to frequent ER users – Washington emergency department opioid prescribing guidelines

  • Helping patients with drug use disorders – from the state Health Care Authority. Studies show that when health professionals ask their patients about their alcohol/drug use and explain how misuse affects their health and well-being, people with drug use disorders are much more likely to seek help. Please consider using any of the tools on this site that will help you address your patient need.

  • Provider education and outreach – from the Agency Medical Directors' Group. Courses and seminars offered to providers on occupational medicine, evaluation of disability, and other issues relevant to the care of injured workers, medicaid patients, or other state agency health plan participants.

  • Innovative ways to slash emergency department overuse – from American Medical News. Intensive efforts addressing problems that again and again send the same patients to the emergency department are showing promise, according to a recent article in American Medical News. The article examines a variety of new programs targeted at helping these patients identify the cause of their ailments and manage them outside of the emergency department.




Background

After an intense effort, the WSMA, along with our coalition partners WSHA and WA-ACEP, were successful in getting the state to abandon its “zero tolerance” policy that would have denied Medicaid emergency visits and cut hospital and physician payments. Now we need to show that our alternative plan will be successful in reducing preventable Medicaid emergency room visits—and we need to show progress by January 15, 2013. This plan will benefit our patients, physicians, and hospitals so we need everyone to participate to make it successful.

Best practices have been developed and we are working to redirect care to the most appropriate setting. This initiative will redesign the way care is delivered to maintain high quality care at a lower cost. Our success will work to prevent the state from enacting payment cuts to both hospitals and physicians for emergency room services.