1 The Consistent Care Program Wednesday January 14, 2008 Darin Neven MS, MD Medical Director Providence Sacred Heart Medical Center Spokane, Washington
Outline Introduction to Spokane How the Consistent Care Program works Results of the Pilot Program Guidance for starting a similar program
Goals of the Program Strengthen the overburdened ED safety net system. Remove detrimental provider suspicion of every patient. Reduce prescription drug diversion. Increase staff morale. Save health care dollars.
Core Principles of Consistent Care Always what is best for the patient. Prevent enabling non-therapeutic behavior. Coordinate care. Keep the primary care provider in control. Enable patient to treat themselves. Protect from prescription overmedication and abuse.
Spokane, Washington 280 miles to Seattle Metropolitan Population 446,000 2400 miles to Atlanta
Four Spokane Hospitals Providence Holy Family Deaconess (CHS) INHS Valley Hospital (CHS) Providence Sacred Heart
The Problem Patients frequent multiple EDs for pain medicine. Concurrent mental health problems. Report chronic pain. Usually have a primary care physician. Have a hospital they prefer to frequent. Not forthcoming regarding their previous testing. Have Medicaid and/or Medicare.
Government Payer Problem
The Pilot Program 40 patients enrolled from Oct-Dec 2006. Average of 40 visits a year. Most visits in one year 123 Fewest visits in one year 14 Total of 2037 ED visits the year before enrolled.
The Process Please review Jane Doe ED Physician 24 hour referral line compiled and researched. Reviewed for appropriateness Program Coordinator (Linda Marsh, RN) calls PCP PCP Recommendations ED Care Guidelines ED Care Guidelines Committee Chaplin ED Nurse ED Physicians Psych Nurse Pharmacist Medical Director Patient s Primary Care Physician
The Process EMR on INHS network ED Care Guidelines Consistent Care Staff ED Care Guidelines PCP Office Patient Notification Letter Insurance Mailed to patient s home Emergency Department Information Exchange www.ediecareplan.com Consistent Care Staff
ED Care Guidelines as displayed in shared EMR (Meditech PCI)
Consistent Care Hospitals
Emergency Department Information Exchange (EDIE) www.ediecareplan.com
ED Visit Process Registration Reveals Patient on Consistent Care Patient s ED chart flagged for doctor Usual Triage Physician reviews ED care guidelines medical screening exam by ED physician No controlled substances EDIE Auto-Notification ED case manager talks to patient prior to discharge Auto-Notification ED case manager called. Medical Director sent text message PCP emailed Insurance Company emailed ED Care Guidelines Faxed to ED and ED Called Patient Discharged
-71 %
Medicaid Expenditures 33% reduction in DSHS expenditures for ER claims. Savings of $2,379 in Medicaid ED expenditures per patient. Similar saving on total Medicaid expenditures.
Obstacles to Implementation HIPAA No issues if treatment related. Use consent forms when needed. EMTALA Always perform the medical screening exam like every other patient. Follow your hospital triage policy. Physician Liability Concerns Give enough medical information to aid in decision making. Assure follow up by listing the primary care physician. Physician Patient Satisfaction Concern Attempt to eliminate frequent patients from satisfaction surveys. Physician Complaint Concern Hospital treats complaints by frequent users differently. Information Technology Use application service provider like EDIE. www.ediecareplan.com
Keys to Success Emergency Physician Leading the Project Start at the very top of every organization for approval. Emphasize the savings from inappropriate ED usage by government payers and uninsured payers. Emphasize care provided is in patient s best interest and has the primary care physician s approval.
How Many Patients are Left to Enroll 292 patients had over 9 visits to SHMC for a total of 4706 visits in 2006. Over 200 names currently on waiting list to be enrolled in Consistent Care. Probably over 1000 patients in Spokane that need ED Care Guidelines.
Who wins who looses? Everyone wins: Patients get the care their primary care physician wants. Primary Care physicians happier. Emergency Physicians happier. Hospitals can reduce Medicaid and Medicare burden on ED payer mix. Medicaid spends less money on ineffective ED health care.
Take Home Points Electronic Medical Records alone are not the answer. Requires a community wide approach. Large savings to hospitals and payers possible. Most frequent users have Medicare or Medicaid. Better care for the patient. Physicians like the program.
Thank You For further information contact Darin Neven, MS, MD www.consistentcare.com darin@neven.us