The New Jersey Hospital Association, based on Alexander Road, has released findings from a two-year project studying the problem of people using hospital emergency rooms for non-emergency care. NJHA believes the information can help deliver better care, reduced department costs, and shorter waits.
According to NJHA, more than one-third of emergency department care is for non-emergency conditions that would be treated more appropriately — and more affordably — in a doctor’s office or clinic.
In New Jersey alone, emergency department use increased 27 percent between 2000 and 2010. And more than $400 million a year is spent on avoidable emergency department visits, according to the National Association of Community Health Centers.
The Community Partnership For Emergency Department Express Care and Case Management is a two-and-a-half-year demonstration project conducted by NJHA’s Health Research and Educational Trust, the state Department of Human Services, and the New Jersey Primary Care Association (NJPCA) that studied the issue of non-emergency cases turning up in hospital emergency departments.
Newark Beth Israel Medical Center and Monmouth Medical Center served as the pilot sites, in tandem with their local health centers — the Newark Community Health Center and the Monmouth Family Health Center. Key conclusions:
The capacity and accessibility of the state’s primary care system — particularly for Medicaid patients — are insufficient; primary care solutions are needed especially for behavioral health and mental health patients; and relationships among healthcare providers are key to improving care coordination and patient education.
“This project is all about patients — making sure they get the right care in the right setting,” said NJHA President and CEO Betsy Ryan. “But this is one of those scenarios in which doing the right thing for the patient also can produce savings in healthcare costs. It’s a win-win.”
The project, which ran from September, 2008, to April, 2011, tested a model for providing alternate non-emergency services to patients who came to the emergency department with non-urgent primary care needs.
The model used an “express care process,” in which patients who came to the emergency department with a non-emergency situation were assessed by a clinician and provided the appropriate services.
Then the emergency department staff took extra steps to refer the patient for a follow-up visit with a primary care provider, or if the patient had no regular physician, immediately scheduled an appointment at the partnering health center. The emergency department staff also educated the patient on the appropriate site of care for various healthcare needs and the importance of having a “medical home” for primary care needs.
In addition, case managers stationed at both of the hospitals’ emergency departments and health centers coordinated services and arranged transportation and support services.
The sites also identified repeat emergency department users, tracked compliance with follow-up care, and assisted with referrals for specialty care.
Throughout the project, the initiative stressed communication between the hospitals and health centers, supported by mutual electronic systems that could schedule appointments and coordinate care.
“The NJPCA considers this to be one of the most timely projects that we have been involved in,” said President and CEO Kathy Grant Davis. “This was about making sure that patients have a medical home in a primary care setting and that hospital emergency rooms are not being used to serve this purpose.
“The federally qualified health centers in New Jersey will now continue the best practices learned during this project. Patients will be given educational information that helps them determine when to use the emergency room and when to use their primary care provider. The goal is to reduce overall health care costs by utilizing settings that are proven to be less costly.”
According to NJHA, the project and its interventions yielded progress toward the goal of promoting “medical homes” and appropriate sites of care and in reducing the use of emergency departments for non-emergency conditions.
Recommendations resuling from the project that would take advantage of the model in the future include:
• Consumer outreach is needed to educate the general public about the importance of using emergency departments only for true emergencies.
• Federally qualified health centers must promote their services competitively, making the availability and quality of their services known to all populations.
• Medicaid HMOs must increase their involvement and the network of primary care providers.
• Policy changes are needed to create economic incentives for patients to use primary care sites. Poor and low-income patients are more inclined to go to emergency departments, where care is effectively “free,” rather than pay the sliding-scale fees at health centers.
• Connectivity between hospital emergency departments and community primary care providers is essential.
• This study was unable to demonstrate total cost savings due to inadequate cost data from the community health centers. Future pilots should incorporate a more comprehensive cost impact analysis.
“The project and its findings provide valuable information to help improve care coordination for New Jersey patients and ultimately achieve the goals of healthcare reform: improved care at reduced costs,” said the NJHA in a press release.
“The Department of Human Services has made great strides developing emergency department alternatives,” said DHS Commissioner Jennifer Velez. “As the state advances medical home and accountable care organization pilot programs, an administrative services organization (ASO) for behavioral health and payment reform, I’m confident we’ll see improved coordination of care that effectively changes patient behavior and reduces unnecessary emergency department visits.”
New Jersey Hospital Association (NJHA), 760 Alexander Road, Box 1, Princeton 08543-0001; 609-275-4000; fax, 609-452-8097. Elizabeth Ryan, president & CEO. www.njha.com.