A new plan to cut down on emergency room ‘frequent flyers’

When members of the Legislature proposed limiting the
number of emergency room visits medicaid would pay for
each year, there was a public uproar. Still, many state
lawmakers say cutting health care costs and pricey visits
to the ER is a great place to start.

Starting this summer, hospitals all over the state will be
taking part in a new project to cut down on emergency room
visits for non-emergency situations. It is part of a
state mandate included in the supplemental budget passed
last month.

The collaborative effort between hospitals and ER
doctors will incorporate a new computer system to help
them better share information. Hospitals will be able to
see if a patient has visited another emergency room
recently. Doctors will be able to see how their
performance compares with other physicians around the
state. And, they will be able to cut down on narcotics
abuse by seeing if a patient has already been prescribed a
medication elsewhere.

Dr. Nathan Schlicher is an emergency physician at St.
Joseph’s Medical Center in Tacoma and a spokesman for the
American College of Emergency Physicians. He says while
ER doctors were not happy with the idea of limiting the
number of visits patients that would be allowed, they do
support the plan.

“We’ve got to do it. It’s tough to deal with these folks
sometimes. Eighty-five percent of them often have
concurrent mental illness that are two out of three times
going untreated, so they’re tough conversations. But,
they’re the ones we have to have, and we’re going to help
folks do it,” says Schlicher.

The professional group of Emergency Physicians is working
with the state to educate doctors on how to talk to
patients about the appropriate use of the ER.

“Waiting a day if you’ve got a cough or cold is probably a
good thing,” Schlicher says.

There is a small percentage of the population, many of
them on medicaid, who Schlicher says will need more than
just a talking-to. He says most emergency room “frequent
fliers” have either a mental illness or substance abuse
problem that is going untreated.

“Just saying that they shouldn’t be in the ER, but not
actually doing anything to fix the system is not a
solution. So, that’s the next step. We’ve got to work to
fix the system,” says Schlicher.

He admits getting people those services will come at a
price, but he says it will save money on the emergency
side of things.

The Washington State Health Care Authority projects $31
million in health care savings as a result of this new
program. It is scheduled to be fully implemented by July
1.