A patient walks into an emergency room as a blank slate to doctors, who must quickly gauge the likelihood of an acute problem. Were a doctor to know that the patient suffers from chronic headaches, that a recent CT scan didn’t reveal any problems, and that just a week earlier a doctor at a different ER told the patent to follow-up with a specific primary care physician, the slate wouldn’t be quite so blank. “All of a sudden, it changes the whole nature of the conversation with the patient,” says Dan Lessler, the chief medical officer for Washington state’s Medicaid program.
Getting doctors in Washington just that type of information is the backbone of an effort to divert patients from trips to ERs for non-urgent problems. Starting in the summer of 2012, Washington ERs began tracking patients in a mandatory, statewide database. Data (PDF) released last week show that the approach appears to be working.
ER visits by Medicaid patients fell by 10 percent in the program’s first year, and the rate of ER visits that resulted in non-acute diagnosis decreased more than 14 percent. Overall, the state says its Medicaid ER costs fell $33.7 million in the 2013 fiscal year. Because other changes to ERs were made at the time, the state says it can’t definitively attribute all the savings to this effort.