Just teaching patients not to call their doctor at 4:30 on a Friday afternoon can reduce unnecessary emergency department (ED) utilization, a trend that is sapping the resources of EDs around the nation. According to the National Center for Health Statistics, 55 percent of the 90 million visits to EDs in the United States in 1996 were unnecessary. In healthcare dollars, that means that 40.5 million people paid up to three times as much for routine care at the ED as they would have paid at a physician’s office.

Teaching timely access to outpatient care is just one tactic covered in this special report, which is based on an October 2006 audio conference sponsored by the Healthcare Intelligence Network (HIN). For Emergency Use Only: Curbing Unnecessary Emergency Room Use Through Education, Accountability and Physician Engagement provides a blueprint for health plans, hospitals and providers desiring to address and reduce unnecessary ED utilization in their populations.

In this 35-page special report, Roberta Burgess, clinical case manager, Community Care Plan of Eastern Carolina, and Gerald Kiplinger, vice president and executive director of the Georgia Enhanced Care program for APS Healthcare, detail how to target and reduce unnecessary and inappropriate ED use.

In this special report, you'll get details on initiatives and interventions for decreasing non-urgent ED use, mining data to target high-utilization, high-cost individuals, implementing an ED case management program, communicating proper ED use to targeted populations and enlisting physicians' support in care redirection and appropriate ED use.

Table of Contents

• Redirecting Care to Appropriate Settings
  • Types of Care and the Costs of Chronic Illness
  • Opportunities to Redirect Care to Appropriate Settings
  • The Role of Referral Agencies and Support Services
  • Increasing PCP Access To Reduce Emergency Care Visits
  • Call Centers Serve Multiple Purposes
  • ED Reductions a Side Effect of Healthy Together! DM Program
• Goodbye Emergency Room, Hello Primary Medical Care
  • Defining an Emergency
  • Profiles of Serial Users and Frequent Fliers
  • Benefits of Partnerships with Community Organizations, Providers
  • Communication Via Toolkits, Outreach and Self-Management
  • Mining Reports to Target High-Utilization, High-Cost Individuals
  • Case Management That Meets the Client in Their Environment
  • Motivating Physicians to Help
  • Removing the Stigma of Case Management
  • Making All Players Accountable
• Q&A: Ask the Experts
  • Determining When Screenings are Billable
  • ED vs. Urgent Care Facilities
  • The Advent of “Minute Clinics” in Retail Space
  • Case Manager Work Schedules and Case Loads
  • Models for ED “At-the-Door” Screening
  • Making the Case for Urgent Care Centers
  • Redirecting Patients to Lower Levels of Care
  • Costs for Running the “Healthy Together” Program
  • Dissecting Diabetes Results in “Healthy Together” Effort
  • Enlisting Providers’ Support for ED Redirection Efforts
  • Referral Turnaround Times
  • Responsibilities of the ED Case Manager
  • Monitoring ED Visits Related to Drug Interactions
  • Statewide DM and CM Efforts
  • Future ED Redirection Initiatives
  • Benchmarks for ED Utilization by Population
  • Analyzing ED Visits by Type of Coverage
  • Investigating FQHC-Hospital ED Partnerships
• Glossary
• For More Information
• About the Author

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