The Consistent Care ProgramWednesday January 14, 2008

Darin Neven MS, MDMedical Director

Providence Sacred Heart Medical CenterSpokane, Washington

1

Outline

� Introduction to Spokane

� How the Consistent Care Program works

� Results of the Pilot Program

� Guidance for starting a similar program

Goals of the Program

� Strengthen the overburdened ED safety net system.

� Remove detrimental provider suspicion of every patient.

� Reduce prescription drug diversion.

� Increase staff morale.

� Save health care dollars.

Core Principles of Consistent Care

� Always what is best for the patient.

� Prevent enabling non-therapeutic behavior.

� Coordinate care.

� Keep the primary care provider in control.

� Enable patient to treat themselves.

� Protect from prescription overmedication and abuse.

280 miles to SeattleSpokane, Washington

Metropolitan Population 446,000 2400 miles to Atlanta

Four Spokane Hospitals

Providence Sacred Heart

Valley Hospital (CHS)Deaconess (CHS)

INHS

Providence Holy Family

The Problem

� Patients frequent multiple EDs for pain medicine.

� Concurrent mental health problems.

� Report chronic pain.

� Usually have a primary care physician.

� Have a hospital they prefer to frequent.

� Not forthcoming regarding their previous testing.

� Have Medicaid and/or Medicare.

Government Payer Problem

The Pilot Program

� 40 patients enrolled from Oct-Dec 2006.

� Average of 40 visits a year.� Most visits in one year 123

� Fewest visits in one year 14

� Total of 2037 ED visits the year before enrolled.

The Process

“Please review Jane Doe”

24 hour referral line compiled and researched.Reviewed for appropriateness Program Coordinator

(Linda Marsh, RN)calls PCP

Patient’s Primary Care Physician

PCPRecommendations

ED Care Guidelines CommitteeChaplin ED Nurse ED PhysiciansPsych Nurse Pharmacist Medical Director

ED Care Guidelines

ED Physician

The Process

ED Care Guidelines

EMR on INHS network

ED Care Guidelines

Emergency Department Information Exchangewww.ediecareplan.com

Patient Notification Letter

Mailed to patient’s home

PCP Office

Insurance

Consistent Care Staff

Consistent Care

Staff

ED Care Guidelines as displayed in shared EMR (Meditech PCI)

Consistent Care Hospitals

Emergency Department Information Exchange (EDIE) www.ediecareplan.com

Registration Reveals Patient on Consistent Care

Patient’s ED chart flagged for doctor

EDIEAuto-Notification

Auto-NotificationED case manager called.Medical Director sent text messagePCP emailedInsurance Company emailedED Care Guidelines Faxed to ED and ED Called

Physician reviews ED care guidelines

Patient Discharged

medical screeningexam by ED physician

No controlledsubstances

ED case manager talks to patient prior to discharge

ED Visit Process

Usual Triage

-71 %

Medicaid Expenditures

� 33% reduction in DSHS expenditures for ER claims.

� Savings of $2,379 in Medicaid ED expenditures per patient.

� Similar saving on total Medicaid expenditures.

Obstacles to Implementation

� HIPAA� No issues if treatment related.� Use consent forms when needed.

� EMTALA� Always perform the medical screening exam like every other patient.� Follow your hospital triage policy.

� Physician Liability Concerns� Give enough medical information to aid in decision making.� Assure follow up by listing the primary care physician.

� Physician Patient Satisfaction Concern� Attempt to eliminate frequent patients from satisfaction surveys.

� Physician Complaint Concern� Hospital treats complaints by frequent users differently.

� Information Technology� Use application service provider like EDIE. www.ediecareplan.com

Keys to Success

� Emergency Physician Leading the Project

� Start at the very top of every organization for approval.

� Emphasize the savings from inappropriate ED usage by government payers and uninsured payers.

� Emphasize care provided is in patient’s best interest and has the primary care physician’s approval.

How Many Patients are Left to Enroll

� 292 patients had over 9 visits to SHMC for a total of 4706 visits in 2006.

� Over 200 names currently on waiting list to be enrolled in Consistent Care.

� Probably over 1000 patients in Spokane that need ED Care Guidelines.

Who wins who looses?

� Everyone wins:� Patients get the care their primary care physician wants.

� Primary Care physicians happier.

� Emergency Physicians happier.

� Hospitals can reduce Medicaid and Medicare burden on ED payer mix.

� Medicaid spends less money on ineffective ED health care.

Take Home Points

� Electronic Medical Records alone are not the answer.

� Requires a community wide approach.

� Large savings to hospitals and payers possible.

� Most frequent users have Medicare or Medicaid.

� Better care for the patient.

� Physicians like the program.

Thank You

For further information contact

Darin Neven, MS, MDwww.consistentcare.com

darin@neven.us