Medicaid Quality Incentive ER is for Emergencies Web Conference

1. Medicaid Quality IncentiveER is for EmergenciesWeb Conference July 11, 2013

2. WSHA Presenters Amber Theel Khin Latt • Director, Patient Safety • Washington State Hospital Association Director, Quality and Performance Improvement WSHA Partnership for Patients

3. Presenters AdamGreen Jackie Brown, RN President, Collective Medical Technologies Emergency Department Information Exchange (EDIE) Director of Emergency Services Providence St. Peter Hospital • Linda Marsh, RN, • Reid Buker, RN Consistent Care Program Manager Sacred Heart Medical Center / Holy Family Hospital • Program Coordinator Emergency Department Consistent Care Program Providence St. Peter Hospital 3

4. Today’s Presentation • Brief Overview of the Emergency Room Measure • Data Collection and Reports • New Tools Available to Hospitals • Care Guidelines • Questions

5. MedicaidQuality IncentiveJuly 1, 2013 • The program is included in the Hospital Safety Net Assessment legislation Passed as Part of the Budget

6. Timeline July 1, 2013 - December 31, 2013 Hospitals collect performance data (Work force flu immunization October 1, 2013 to March 31, 2014) April 2014 Chief Financial Officer attestation May 2014 HCA determines which hospitals qualify for payment July 2014 Qualifying hospitals receive incentive payment

7. PaymentIncreases • One percent inpatient Medicaid increase for non-critical access hospitals • Acute general and pediatric hospitals • Receive increase across services based on overall hospital performance • Behavioral health hospitals and units • Increase based on behavioral health measures

8. Funding for Incentives • Quality incentive provided to all qualifying Washington hospitals • No partial increases • Hospitals receive either zero or one percent increase

9. ER is for Emergencies Measure Overview Percent of Patients (all payors) with Five or More Visits to Emergency Room with Care Plans

10. ER is for Emergencies Measure will be used for the following: • Acute Care • Pediatrics (Adult and pediatric hospitals with emergency rooms only)

11. ER is for Emergencies Numerator: Number of care guidelines completed in the calendar month by the facility for patients with five or more visits in the last year without a care guideline Denominator: Number of patients without a care guideline with five or more visits in the last year seen by the facility in the month

12. ER is for Emergencies

13. ER is for Emergencies Data Collection and Reports Data: • Submitted to WSHA by EDIE. • Data will be collected monthly and distributed to the hospitals as part of the ER is for Emergency reports.

14. ED Monthly Report - Updated Random Hospital Medical Center

15. ED Monthly Report – Updated (cont)

16. What Does 10% Look Like?

17. ER is for Emergencies New Tools for Hospitals

18. Example Care Guideline

19. Robust Care Guideline

20. Revised Care Guideline Template Background • Template requested by members to assist with developing quality care guidelines that are standardized and ensure continuity of patient care Goal • To ensure crucial health and safety information is available for all providers involved in the patient’s care.

21. Standard Care Guideline Template Development Advisory Group

22. Revised Care Guideline Template • Quickly inform the next provider of important information needed to take care of the patient • Support smooth transitions, reduce complications • Bridge the communication between Emergency Departments, primary care providers and other specialty providers

23. Standard Care Guideline Template

25. Revised Care Guideline Template - Recommendations • Create the guidelines in partnership with the outpatient providers • Consider including not only care recommendation in ED but also in outpatient settings when appropriate • Make them available for the partners in care

26. Providence St Peter HospitalCare Guidelines Jackie Brown, RN, MS Director of Emergency Services Reid Buker, RN, MN Program Coordinator EDCCP

27. Referral Process • Patient Selection Criteria • EDIE ≥ 5 ED visits within 12 months • Drug seeking behavior • Abusive or violent behavior • Who can refer a patient? • ED Providers • Nursing staff • PCP’s

28. Care Guidelines Process • Initial/preliminary care plan developed using PSPH guidelines. • Preliminary care guideline is faxed to patient’s PCP for review and input. • Documentation from patients visits to ED reviewed by Care Coordination MD and RN. • Case review conducted at EDCCP meeting. • Feedback from PCP presented. • Recommendations on how to individualize care guideline specific to patient discussed. • Care plan revised as appropriate. • Care guideline placed in EDIE and in to the patients EPIC chart.

29. Basic Care Guidelines • Basic Guidelines (5 visits in 12 months) • Provider to perform MSE. • Minimize radiation exposure based on clinical history and shared decision making with the patient related to risks and benefits of further exposure. • Treat acute medical conditions as needed. • Address pain issues. • Restrict use of opiates in the ED to only obvious trauma or severe medical issues. • Discharge • Explain to patient that no opiates will be given or prescribed for chronic conditions or to replace lost/stolen prescriptions. • Refer the patient back to PCP for pain control and follow-up. • Instruct patient on importance of following up with PCP. • Provide instruction on proper use of Emergency Department.

30. Individualized Care GuidelinesAdditional Considerations • Patient Specific Guidelines • Patient is a safety risk for the following reasons: . Request security to stand-by. • Provide assistance making an appointment with the patients PCP. • Request ED Provider complete MSE in triage area whenever possible. • Do not provide patient with free bus passes or cab vouchers. • Do not allow patient to sleep in waiting room. • Review expected behaviors with patient – Patient will • Seek care from PCP for chronic and recurrent medical issues. • Contact PCP and/or urgent care clinic before visiting the ED for non emergent issues. • Cooperate with medical exam in the ED without being verbally or physically abusive. • Keep f/u appointment with PCP and utilize the ED for only emergent situations.

31. Questions? • For questions or other feedback contact: • ER is for Emergencies/ER Measure • Amber Theel at ambert@wsha.orgor 206-577-1820 • Care Guideline Template • Khin Latt at khinl@wsha.org or 206-216-2531