September 26, 2018

REDUCING INAPPROPRIATE EMERGENCY DEPARTMENT UTILIZATION

July 2018

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IHP plans to be more visible in bringing awareness to the community by having a presence at the Calhoun County Fair and by exploring opportunities to work with employers and area organizations.

In 2018, Integrated Health Partners (IHP) is putting extra effort into reducing inappropriate Emergency Department (ED) utilization in Calhoun County and decreasing the overall cost of care in the community. According to data collected on patients with Blue Cross Blue Shield of Michigan (BCBSM) insurance, over seven million dollars was spent in the ED in 2017, which includes ED hospital charges and associated imaging and laboratory tests completed during a visit. The imaging taken during an ED visit accounted for 20% of IHP’s total imaging cost in 2017, in which CT scans made up the largest fraction of the cost. The most common conditions likely to have a CT scan performed in the ED are headaches and abdominal pain. The cost savings to patients and the health care system can be tremendous if care for primary care treatable conditions occurs outside of the emergency department. The table below shows the average cost for several common conditions is four to nine times more expensive when performed in the ED compared to treatment in the primary care office.

 

 

Average ED Cost (includesassociated imaging/labs)

Average Office Visit Cost

Headache

$1,461

$133.40

Upper RespiratoryInfection

$509.72

$96.48

Bronchitis

$942

$98.54

Urinary TractInfection

$1,023.09

$112.98

OtitisMedia

$425.71

$97.57

 

Source: BCBSM claimsdata

 

To help you reduce primary care sensitive ED visits (those that can be treated outside of the ED), IHP is focusing on patient and provider education.  IHP currently provides offices with brochures to educate patients about appropriate ED use. IHP staff evaluate data routinely to identify trends and opportunities for improvement. Care managers and health coaches provide education to patients to avoid an initial or repeat visit to the ED.  Practice coaches share data with physicians and staff and work with practices to assess access to care, scheduling processes, and patient messaging. Several offices developed a “Call Us First” campaign throughout their entire office, which was very successful in reducing inappropriate ED utilization and increasing awareness of open and extended access to care.

 

We are expanding our efforts to educate patients to help them distinguish conditions that can be treated at an office and emergencies that can only be treated at the ED, as well as the cost associated with their choice for care. IHP plans to be more visible in bringing awareness to the community by having a presence at the Calhoun County Fair and by exploring opportunities to work with employers and area organizations. IHP is developing additional patient education materials and will be heightening efforts to evaluate and coach offices on opportunities to further educate and engage patients in avoiding unnecessary ED utilization.  IHP is providing information to offices about telemedicine, which could expand access for patients. Primary care offices will also receive office specific data on a regular basis to track the impact of the ED visit reduction campaign. IHP has a goal over the next nine months of reducing inappropriate ED visits for the conditions listed above by 5%.