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Health Care Final 02-18-10 -   2.1 - DSHS - Avoidable Emergency Department Visits

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Health Care Final 02-18-10
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 Extended Analysis

The number of avoidable ED visits for DSHS FFS eligible clients has been increasing at a rate of 2.2% per year over 9 years. At the same time, the percent of avoidable ED visits has remained stable (average 47%) because although the number of avoidable ED visits has been increasing, the total FFS ED visits has also increased over this period.

More Avoidable ED Utilization by Adults than Children in DSHS FFS Medical Programs: The 2.2% average annual increase in the number of avoidable ED visits between SFY 2000 and 2008 may be attributable, at least in part, to a substantial increase in the number of avoidable ED visits per 100 FFS eligible adults (ages 19-64) between SFY 2006 and SFY 2008. In contrast to the data for adults and to anecdotal reports that mothers who rush their children with mild colds or earaches to the ED at the first sign of illness are partly responsible for the rise in avoidable ED utilization, the number of avoidable ED visits per 100 FFS eligible children (ages 0-18) remained stable during the same time period.

Link Between Provider Supply and ED Utilization: Based on analysis of SFY 2008 ED utilization data and DSHS fee-for-service participating provider data, there is a statistically significant relationship between the number of avoidable ED visits and the number of primary care providers serving DSHS medical program clients in a given county.

Most Common Diagnoses for Avoidable ED Use: In SFY 2008, the most frequent avoidable ED visits were for headache, dental care, abdominal pain, acute upper respiratory infections of unspecified site, and low back pain.

Medicaid Managed Care Comparison: Although the number of overall ED visits per 1000 member months (MM) steadily increased among Medicaid FFS clients from 2004 through 2008, it was lower than that of Medicaid managed care (MC) enrollees in 2007 and 2008. The Medicaid MC increase from 2006 to 2007 and then 2008 was due primarily to the performance of two HO plans (CHPW and Regence BlueShield). However, between 2007 and 2008, Washington Medicaid MC experienced a statistically significant drop in overall ED visits per 1000 MM.

Both Washington DSHS FFS medical programs and Medicaid MC are consistently less than the National Committee for Quality Assurance (NCQA) average. The NCQA data includes Medicaid managed care enrollees.  In 2007, Washington DSHS FFS medical programs fell between the NCQA 10th and 25th percentiles (40.59 and 49.71, respectively) for overall ED visits per 1000 MM while Washington Medicaid MC was slightly above the 25th percentile at 55.2 ED visits per 1000 MM. This means that roughly 75% of the states had a higher number of overall ER visits per 1000 member months than Washington DSHS FFS medical programs and Medicaid MC.

National Comparison:  The number of ED visits per 100 persons for Medicaid or SCHIP at the national level for Calendar Year 2006 was 82 visits. [Source: National Health Statistics Reports, No. 7, August 6, 2008. CDC/National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey and 2006 National Health Interview Survey]. This is far above the DSHS medical programs level for CY 2006, which was 53.7 ED visits per 100 persons (CY 2005 was 52.0 and CY 2007 was 57.6).

Washington ED Diversion Pilot Project Detailed Update:  

 Action Plan

Expand/Collapse ForumDate‎(5)
Provider payment rate increasesUse SHIFT+ENTER to open the menu (new window).
Thuy Hua-Ly1/1/2008Completed8/31/2009
Pilot projects with up to 4 community health clinicsUse SHIFT+ENTER to open the menu (new window).
MaryAnne Lindeblad4/15/2010In Progress11/26/2009
Considering P4P incentive payments to DSHS Healthy Options managed care plans Use SHIFT+ENTER to open the menu (new window).
MaryAnne Lindeblad7/1/2010In Progress12/4/2009
Considering adoption of a ED copayment for children in higher income families who are enrolled in Apple Health for KidsUse SHIFT+ENTER to open the menu (new window).
DSHS HRSA Facilities Steering Committee1/1/2010Deferred
Develop an automated ED Utilization report using the new ProviderOne payment systemUse SHIFT+ENTER to open the menu (new window).
MaryAnne Lindeblad7/15/2010In Progress12/4/2009