Emergency Department Plan Template

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Reducing Emergency Department Visits
  Medicaid Quality Incentive Program
          September 1, 2011, 3:00 p.m.

                  RETURN TO
    Thuy Hua-Ly, Director of Rates and Finance


                 Reducing Emergency Department Visits Plan
                          SUBMISSION PROCESS

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
                            15 pages.

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.

#                                            DESCRIPTION
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.

#                                             DESCRIPTION
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
       clinic referrals.

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

#                                            DESCRIPTION
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.


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