Just teaching patients not to call their doctor at
4:30 on a Friday afternoon can reduce unnecessary emergency department
(ED) utilization, a trend that is sapping the resources of EDs around
the nation. According to the National Center for Health Statistics, 55
percent of the 90 million visits to EDs in the United States in 1996
were unnecessary. In healthcare dollars, that means that 40.5 million
people paid up to three times as much for routine care at the ED as
they would have paid at a physician’s office.
Teaching timely access to outpatient care is
just one tactic covered in this special report, which is based on an
October 2006 audio conference sponsored by the Healthcare Intelligence
Network (HIN). For Emergency Use Only: Curbing
Unnecessary Emergency Room Use Through Education, Accountability and
Physician Engagement provides a blueprint for
health plans, hospitals and providers desiring to address and reduce
unnecessary ED utilization in their populations.
In this 35-page special report, Roberta
Burgess, clinical case manager, Community Care Plan of
Eastern Carolina, and Gerald Kiplinger, vice
president and executive director of the Georgia Enhanced Care program
for APS Healthcare, detail how to target and reduce unnecessary and
inappropriate ED use.
In this special report, you'll get details on
initiatives and interventions for decreasing non-urgent ED use, mining
data to target high-utilization, high-cost individuals, implementing an
ED case management program, communicating proper ED use to targeted
populations and enlisting physicians' support in care redirection and
appropriate ED use.
Table of Contents
- Redirecting Care to Appropriate Settings
- Types of Care and the Costs of Chronic Illness
- Opportunities to Redirect Care to Appropriate
Settings
- The Role of Referral Agencies and Support
Services
- Increasing PCP Access To Reduce Emergency Care
Visits
- Call Centers Serve Multiple Purposes
- ED Reductions a Side Effect of Healthy
Together! DM Program
- Goodbye Emergency Room, Hello Primary Medical
Care
- Defining an Emergency
- Profiles of Serial Users and Frequent Fliers
- Benefits of Partnerships with Community
Organizations, Providers
- Communication Via Toolkits, Outreach and
Self-Management
- Mining Reports to Target High-Utilization,
High-Cost Individuals
- Case Management That Meets the Client in Their
Environment
- Motivating Physicians to Help
- Removing the Stigma of Case Management
- Making All Players Accountable
- Q&A: Ask the Experts
- Determining When Screenings are Billable
- ED vs. Urgent Care Facilities
- The Advent of “Minute
Clinics” in Retail Space
- Case Manager Work Schedules and Case Loads
- Models for ED “At-the-Door”
Screening
- Making the Case for Urgent Care Centers
- Redirecting Patients to Lower Levels of Care
- Costs for Running the “Healthy
Together” Program
- Dissecting Diabetes Results in
“Healthy Together” Effort
- Enlisting Providers’ Support for ED
Redirection Efforts
- Referral Turnaround Times
- Responsibilities of the ED Case Manager
- Monitoring ED Visits Related to Drug
Interactions
- Statewide DM and CM Efforts
- Future ED Redirection Initiatives
- Benchmarks for ED Utilization by Population
- Analyzing ED Visits by Type of Coverage
- Investigating FQHC-Hospital ED Partnerships
- Glossary
- For More Information
- About the Author
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