A $550,000 grant from the federal Centers for Disease Control and Prevention will help three Tri-City hospitals collaborate on a new system to track prescription drug addicts who visit multiple emergency rooms to get painkillers.
Kadlec Regional Medical Center in Richland, Kennewick General Hospital and Lourdes Medical Center in Pasco are working with a Spokane doctor to replicate the program he created at Providence Sacred Heart Medical Center.
Dr. Darin Neven, medical director for the Consistent Care Program at Sacred Heart, was able to reduce by half the number of emergency room visits by patients enrolled in the program.
"Dr. Neven's experience and success in Spokane gave us confidence that this program will result in better care for patients, while controlling costs from nonemergency visits," said KGH CEO Glen Marshall.
Emergency room departments are the primary source of prescription pain medications, according to the Benton-Franklin Community Health Alliance.
National statistics indicate ER visits and unintentional overdoses related to prescription drug abuse are rising.
Neven's system will allow the three Tri-City hospitals to share information about how patients are using emergency rooms. That will allow the hospitals to evaluate those patients seeking prescription painkillers and who may be using ER visits for non-emergencies.
"According to emergency room statistics, our community has an alarming number of people who misuse our emergency departments," Marshall said. "Our ability to share patient care plans with the other hospitals should result in cost-savings for the hospitals and reduce unnecessary emergency room visits."
Research will be conducted by the Washington State University College of Nursing Program of Excellence in the Addictions on citywide ER care coordination for patients who make frequent ER visits.
Physicians at the three hospitals will be able to access the system and view a patient's history at each hospital. That information will allow the hospitals to develop individual care plans to help reduce the number of ER visits.
"The hospitals already are collaborating on a state program to reduce non-emergency visits," said Kadlec President Lane Savitch. "This is one more tool to allow us to provide better, more cost-effective treatment for our patients and the community."
The rising number of ER visits by uninsured and low-income patients covered by Medicaid is an area of concern for hospitals facing state budget cuts.
The state's 2011-13 operating budget continued a freeze on new enrollments into the state's Basic Health Plan for low-income people, and it lowers enrollments to 37,000 people in 2012 and 33,000 in 2013.
More than 100,000 people had insurance through the plan when cuts began in 2009.
The budget also freezes grants to federally qualified health centers, such as Tri-Cities Community Health, that pay health care for low-income patients. It also reduces reimbursements for those covered by Medicaid.
Hospital officials said if patients can't get care at community clinics such as Tri-Cities Community Health, then they likely will go to an ER for care.
And along with budget cuts comes a new state policy of paying for only three ER visits by Medicaid patients when they're deemed not in need of emergency care.
Because Medicaid patients tend to be high-volume users of emergency rooms and not use family doctors, hospital officials foresee spending more to treat those patients without getting paid.
However, a hospital often doesn't know if a case is an emergency until doctors and nurses have spent the time to evaluate and diagnose the patient.
Another issue is that low-income people on Medicaid typically don't have to pay co-pays when they go to an ER. They do for an urgent care or walk-in visit.
For someone in poverty or on the brink, paying a $25 co-pay can be a challenge. So they choose the ER.
Tri-City hospitals continue to teach patients when to use the ER and when it would be more appropriate to go to an urgent care or walk-in clinic. They also try to help patients find "medical homes" - primary care physicians who will manage their long-term care.
"This is another opportunity for us to work together for the safety of the patient," said Lourdes CEO John Serle. "This grant will allow us to coordinate care across our three hospitals giving us a chance to teach people how to find a medical home and when to use different types of medical care. We'd like to see less duplication of services and more collaboration with our partners."
