Medicaid seeks to curb nonessential emergency room visits
Utah's Medicaid program wants to help its insured find a home.
A medical home, that is.
Visits to emergency room doctors for sore throats and stomach aches aren't a good way to get comprehensive medical care. And it's expensive. That's why Medicaid, with the help of a $503,000 federal grant, is ramping up its efforts to reroute patients to personal physicians who can provide better continual care at a lower cost.
After just one visit to the ER for an ailment that is considered "non-emergent care," Medicaid patients will get a phone call from the state encouraging them to strike up relationships with family doctors, including those at community health centers. They'll also be educated on when it's appropriate to go to an ER.
"If they have a medical home, we want to find out why it is they need to go to the ER for a non-emergency visit," said Gail Rapp, director of the state's Bureau of Managed Health Care.
Contacting Medicaid patients who overuse ERs is nothing new. In the past, however, only those who reached "frequent flier" status - making three or more trips to an ER in a single year - were contacted and placed in a "restricted" program through which they had to follow specific protocols to receive services.
And, Rapp said, the current program targets overutilization of all health care services, not just ERs. Two full-time staffers paid with the new federal grant will zero in on ER overuse exclusively.
"The hope is if we demonstrate cost savings - which is what we'll be measuring - then perhaps the Legislature would allows us to continue to fund those two (staffers)," Rapp said.
Helping steer Medicaid patients away from emergency rooms when they don't need them is part of a broader effort by the Centers for Medicare and Medicaid Services to cut costs while improving patients' care.
Created by the Deficit Reduction Act of 2005, about $50 million in grants will help Medicaid programs in 20 states fund local and rural initiatives to provide alternative health care settings for individuals with non-emergency medical needs.
In 2006, the latest year for which Utah Department of Health data is available, nearly one quarter of Medicaid patients' 130,000 ER visits were considered non-emergent. Between 2001 and 2006, the average number was about the same.
These patients often come in for help with health needs as basic as prescription refills, said Craig Shane, medical director of LDS Hospital's ER. That's because they're working two, sometimes three jobs, and 2 a.m. is the only time they have to take care of it.
Others, meanwhile, may not have the transportation to go anywhere else.
But for many, the problem is rooted in a lack of education - and a connection to a primary care doctor. One man, Shane said, actually came to the ER complaining of chapped lips.
"We told him to go get Chapstick," he said. "Nobody should come in (for that.)"
Mike Baker, Health Access Team director at the Midtown Community Health Center in Ogden, helps educate patients on the proper use of ERs. Patients paired up with professionals who helped them navigate the health care system, his team found, made far fewer visits to ERs.