Note: This is an authorized excerpt from 2014 Healthcare Benchmarks:Reducing Avoidable ER Visits. To download the entire report, go to

Transcription

1 Note: This is an authorized excerpt from 2014 Healthcare Benchmarks:Reducing Avoidable ER Visits. To download the entire report, go to or call

2 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits In this third comprehensive survey, 125 healthcare organizations describe tactics employed to reduce avoidable emergency room use, including patientand staff-level solutions, primary care engagement stategies, results, ROI, and much more. We are analyzing the predictors and diagnoses that cause either repeat or avoidable visits. We are expanding the hours and number of urgent care centers and trying to educate patients on level of care. > Hospital Patient education in multiple languages is important. Patient need to know the difference between an ER and urgent care setting and where to go for nonemergent conditions. > Management Services Organization The hard part is primary care practice transformation to provide 24/7 nurse phone advice and open access. > (Organization type not identified) Housing is a big component, particularly for serial inebriants, who essentially make up much of the frequent fliers in Medicaid. Medication management challenges seem to be a greater problem in Medicare. > Consultant 2014, Healthcare Intelligence Network 2

3 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits This special report is based on results from the Healthcare Intelligence Network s third comprehensive industry survey on reducing avoidable emergency room visits conducted in August Executive Editor Melanie Matthews HIN executive vice president and chief operating officer Project Editors Patricia Donovan Cheryl Miller Document Design Jane Salmon 2014, Healthcare Intelligence Network 3

4 Table of Contents About the Healthcare Intelligence Network... 6 Executive Summary... 6 Survey Highlights... 7 Key Findings... 7 Program Components... 7 Results and ROI... 7 Successful Work Flows, Processes and Tools...8 About the Survey... 8 Respondent Demographics... 8 Using This Report... 9 Responses by Sector...10 The Hospital/Health System Perspective The Physician Organization Perspective Year-Over-Year Survey Data Respondents in Their Own Words...18 Most Effective Tool, Process or Workflow Legal and Compliance Challenges Future Program Expansion or Launch...20 Conclusion...22 Tips for Staffing a Nurse Advice Line...23 Figure 1: All - Existing Program to Reduce Avoidable ED Usage Figure 2: All - Plans for Future Program Figure 3: All - Population Generating Majority of Avoidable ED Visits...26 Figure 4: All - Most Frequently Presented Problem in ER High Utilizers...26 Figure 5: All - Tools to Discourage Avoidable ER visits Figure 6: All - Patient-Level Strategies for Reduction of ER Visits Figure 7: All - Post-Visit Contact with ER Patients...28 Figure 8: All - Staffing Solutions for Reduction of ER Visits...28 Figure 9: All - Engagement of Primary Care Providers in ER Visit Reduction...29 Figure 10: All - Effectiveness of Strategies to Reduce Avoidable ER Visits...29 Figure 11: All - Overall Impact of Strategies on ER Efficiency...30 Figure 12: All - Greatest Challenge of Reducing Avoidable ER Visits...30 Figure 13: All - Reduction in Avoidable ER Visits Figure 14: All - ER Visit Reduction Program ROI Figure 15: All - Barriers to Program Launch Figure 16: All - Telehealth Impact on Avoidable ER Use Figure 17: All - Organization Type Figure 18: Hospital - Existing Program to Reduce Avoidable ED Usage...33 Figure 19: Hospital - Plans for Future Program...34 Figure 20: Hospital - Population Generating Majority of Avoidable ED Visits...34 Figure 21: Hospital - Most Frequently Presented Problem in ER High Utilizers Figure 22: Hospital - Tools to Discourage Avoidable ER Visits , Healthcare Intelligence Network 4

5 Figure 23: Hospital - Patient-Level Strategies for Reduction of ER Visits...36 Figure 24: Hospital - Post-Visit Contact with ER Patients...36 Figure 25: Hospital - Staffing Solutions for Reduction of ER Visits Figure 26: Hospital - Engagement of PCPs in ER Visit Reduction Figure 27: Hospital - Effectiveness of Strategies to Reduce Avoidable ER Visits...38 Figure 28: Hospital - Overall Impact of Strategies on ER Efficiency...38 Figure 29: Hospital - Greatest Challenge of Reducing Avoidable ER Visits...39 Figure 30: Hospital - Reduction in Avoidable ER Visits...39 Figure 31: Hospital - ER Visit Reduction Program ROI Figure 32: Hospital - Barriers to Program Launch Figure 33: Hospital - Telehealth Impact on Avoidable ER Use Figure 34: Physician Org. - Program to Reduce Avoidable ER Usage Figure 36: Physician Org. - Population Generating Majority of ER Visits...42 Figure 37: Physician Org. - Most Frequent Problem in ER High Utilizers...43 Figure 38: Physician Org. - Tools to Discourage Avoidable ER Visits...43 Figure 39: Physician Org. - Patient-Level Strategies to Reduce ER Visits...44 Figure 40: Physician Org. - Post-Visit Contact with ER Patients...44 Figure 41: Physician Org. - Staffing Solutions for Reduction of ER Visits...45 Figure 42: Physician Org. - Engaging PCPs in ER Reduction...45 Figure 43: Physician Org. - Effectiveness of Strategies to Reduce Avoidable ER Visits...46 Figure 45: Physician Org. - Greatest Challenge of Reducing Avoidable ER Visits...47 Figure 46: Physician Org. - Reduction in Avoidable ER Visits Figure 47: Physician Org. - ER Visit Reduction Program ROI...48 Figure 48: Physician Org. - Barriers to Program Launch...48 Figure 49: Physician Org. - Telehealth Impact on Avoidable ER Use...49 Appendix A: 2014 Reducing Avoidable ER Use Survey Tool , Healthcare Intelligence Network 5

6 About the Healthcare Intelligence Network The Healthcare Intelligence Network (HIN) is an electronic publishing company providing high-quality information on the business of healthcare. In one place, healthcare executives can receive exclusive, customized up-to-the-minute information in five key areas: the healthcare and managed care industry, hospital and health system management, health law and regulation, behavioral healthcare and long-term care. 69% of respondents have programs to reduce avoidable ER use. Executive Summary Despite expanded coverage available under the Affordable Care Act (ACA), the emergency room (ER) remains a refuge for those unable to visit their primary care physician (PCP) whether due to lack of access, insurance, or time, according to the results of the latest Reducing Avoidable ER Visits Survey by the Healthcare Intelligence Network (HIN). But more than half of respondents (65 percent) are confident CMS s easing of telemedicine regulations (e.g. physician on-site hours) will help to reduce avoidable ER visits. In the three years since HIN last administered this survey, health organizations have stepped up their ER discharge follow-up strategies. More than one third of respondents (31 percent) in 2014 say they contact patients within 24 hours of their ER visit, versus 22 percent of respondents in 2011 who made provider appointments before discharge, and 18 percent who conducted phone followups within two days of a visit. Staffing solutions to reduce avoidable ER visits have also changed: case managers, social workers and disease-specific care coordinators are increasingly utilized in the ED, replacing health educators, coaches, and nurse-only advice lines used in Perhaps in response to this shift in staffing solutions, the challenge of redirecting non-emergent patients, while still a primary hurdle, decreased in importance from 29 percent in 2011 to 18 percent in Insufficient care access remains a challenge, growing from 16 to 21 percent in 2014, along with PCP collaboration, which was still among the top three challenges, but decreasing from 24 percent in 2011 to 18 percent in Most successful workflow: 24- hour nurse help line and facility to treat medical, physical and behavioral problems. 2014, Healthcare Intelligence Network 6

7 Using This Report This benchmarking report is intended as a resource for healthcare organizations searching for comparable data and means to measure implementation and progress. It is also a helpful planning tool for organizations readying initiatives in this area. The initial charts and graphs presented here represent results from all respondents; images in subsequent sections depict data from high-responding sectors. (Figure titles begin with the segment they represent; for example, All, Health Plans, Hospitals, etc.) 42% of respondents assign patients to a medical home to reduce avoidable ER use. Often, one of the largest responding sectors is composed of respondents identifying their organization type as Other. In general, we do not depict results from this segment because it represents a wide range of organization types, including consultants and product vendors. However, you will always find a graph indicating the demographics of respondents. Here are some additional tips for using this report: 99 See how you measure up: Scan this report for your sector, and see how your program compares to others. Note where you are leading and where you are behind. 99 Evaluate your efforts: Think about where you have been focusing your efforts in this area. Look for trends in the data in this report. Look for benchmarks set by your sector and others. 99 Set new goals: Use the data in this report to set new goals for your organization, or to raise the bar on existing efforts. 99 Use it as a reference book: Keep this report accessible so you can refer to it in your work. Use these data to support your efforts in this area. If you have questions about the data in this report, or have feedback for our team, don t hesitate to contact us at info@hin.com or Most effective tool: ED followup followed by high touch visit to coordinate social services and do medication management. 2014, Healthcare Intelligence Network 9

8 Figure 31: Hospital - ER Visit Reduction Program ROI What level of ROI have you achieved from your program? 20.0% Don't know 0.0% 40.0% Less than 2:1 Between 2:1 and 3:1 20.0% Between 3:1 and 4:1 (0%) Higher than 4:1 (0%) Too early to tell 20.0% 2014 HIN Reducing Avoidable ER Use Survey August, 2014 Figure 32: Hospital - Barriers to Program Launch What is the greatest barrier to launching a program to reduce avoidable ED use? 0.0% 12.5% 25.0% Staffing Care access (0%) ID high-utilizers 25.0% PCP collaboration (0%) 12.5% Hospital-MD collaboration (0%) Redirect non-urgent 25.0% 0.0% Funding CM/social worker Other 2014 HIN Reducing Avoidable ER Use Survey August, , Healthcare Intelligence Network 40

9 Healthcare Intelligence Network Benchmark Members Received This Report for FREE! Sign up today for $695 for a year of Healthcare Benchmark Data Fax Form to: Learn more about why you should become a HIN Benchmark Series Member, scan with your smart phone QR reader to view HIN s Benchmark Series Membership Infographic. Thank You For Your Order! Five easy ways to order: 1. Online: 2. Phone: Fax: info@hin.com Tax ID No Mail to: Healthcare Intelligence Network PO Box 1442, Wall, NJ TT Check Enclosed - payable to Healthcare Intelligence Network in U.S. dollars - NJ residents, please add 7% sales tax Name & Title Company Address City State Phone The Healthcare Intelligence Network s Healthcare Benchmarking Series provides continuous qualitative data on industry trends to empower healthcare companies to assess strengths, weaknesses and opportunities to improve by comparing organizational performance to reported metrics. As a HIN Benchmarks Member you will have access to ALL of our benchmark reports published during your membership year. Sign up today for just $695 per year, a savings of over $500. You ll get: Feedback from 1,000 respondents annually; Thousands of sector-specific data points, sorted by hospital, health plan and provider; Year-over-year data analysis; 8 to 10 trending topics annually; Upcoming topics include: Care Transitions Telehealth Other key topics of interest to healthcare executives. As a subscriber, you will also have direct access to: Auto-delivery of new benchmarks to your box; Preview copy of the latest executive summaries - even before respondents; enewsletters of your choice; Healthcare Infographics; White Papers and Case Studies; Educational Videos; ebooks; and Healthcare Podcasts. TT Yes, I need actionable healthcare metrics on the industry s top trends. Please sign me up for HIN s Benchmark Series Membership, today for $695. Zip Fax Charge my Visa MC AMX Account No. Exp. Date Signature Security Code IPF