Reducing Emergency Department Visits
Medicaid Quality Incentive Program
FINAL DATE FOR SUBMISSION
September 1, 2011, 3:00 p.m.
Thuy Hua-Ly, Director of Rates and Finance
Reducing Emergency Department Visits Plan
Project Title: Emergency Department Plan, Medicaid Quality Incentive
Plan Due Date: All plans must be e-mailed by 3:00 p.m. Pacific Daylight time
on September 1, 2011
E-mail Address: MedicaidQualityIncentive@dshs.wa.gov
E-mail Subject Line <Name of hospital>
File name: <Name of hospital>_ <date>
For questions, contact: Thuy Hua-Ly
Director of Rates and Finance
Medicaid Purchasing Administration
Format of Plan: The plan must be submitted as a Word document or
readable PDF format, font size 12 or larger. Not to exceed
Publication: Hospital plans will be posted for the public via Medicaid’s
news website at http://hrsa.dshs.wa.gov/News/index.htm
The Hospital must answer all questions and must include all items requested in the order
requested for the Plan to be considered responsive.
Section 1: Community Partnerships
A. Documentation that infrastructure is in place which includes relevant community partners.
1. Provide Hospital name:
2. Provide name and address(s) of Emergency Department(s), both on and off campus:
3. Provide primary contact (name, position and contact information) responsible for supervising
the execution of the plan at the hospital:
4. Provide names and positions of members in plan workgroup.
i. Include names and positions of hospital staff responsible for executing the plan at the hospital.
ii. Names and positions of community partners (Medicaid managed care plans participating in the
county/adjacent county; community clinics; local health jurisdictions; major primary care providers)
who have participated in generating the plan and those who are part of the plan (primary care
referral sites, for example).
5. Provide minutes of workgroup meetings with future meeting dates. Workgroup with relevant
community partners must have met at least once prior to plan approval.
Section 2: Data Reporting
A. Evidence of collection and analysis of data upon which to create an informed plan.
1. Summarize data report which identifies preventable emergency department visits using
standard methodology such as MediCal groupings, New York University groupings, or own
version. Report should identify visits for Medicaid managed care clients by Healthy Options
plan, at a minimum.
2. Provide identification of the top five reasons for potentially avoidable emergency department
Section 3: Strategic Plan for Prevention of Visits
A. Creation of strategies to prevent patients from needless visits to the ER.
1. Provide evidence of at least two strategies with community partners to help patients learn in
advance of arriving in the emergency department how to access care in less expensive location.
Must include full work plan description, who, what, where, when, how. Examples could
include community education programs, brochures in the physician offices, extended hours of
primary care clinic, triage of patients.
2. Statement signed by the hospital administrator that the hospital will refrain from explicitly
soliciting primary care visits to the hospital’s emergency department in marketing materials
such as billboards, radio, scripts, etc.
Section 4: ER Visit Follow-up
A. Create strategies addressing patients who have arrived in the Emergency Department.
1. Provide evidence of a minimum of two strategies with community partners addressing patients
who have arrived in the emergency department but could be seen in less expensive location.
Must include full work plan description, who, what, where, when, and how. Potential
strategies could include education materials in the emergency department, phones to call
primary care physician for appointment, managed care staff to educate patients, primary care
2. Describe method of identifying patients and notifying managed care organizations or their
designated primary care clinics of the client’s use of the emergency department in a timely
way, either in-place or in process of implementation.
Section 5: Participation in Continuing Education
1. Provide evidence of at least one hospital team member attending educational programs by the
state, such as web conference for CEOs, ED Directors and key administrators or an in-person
meeting on best practices.