Emergency room sign with ER is for Emergencies in text


January 28, 2015: Coalition of hospitals, physicians and Health Care Authority getting national attention (read the press release here)

ER is For Emergencies Results in Better Care Coordination and Cost Savings

A March 2014 report released by the Washington State Health Care Authority confirms a partnership of doctors, hospitals and state Medicaid representatives is making a big difference in utilization, quality of care and savings. The report also concludes The ER is for Emergencies initiative reached its targeted savings goal of $33.6 million in Medicaid fee-for-service emergency care costs.  The report showed that during Fiscal Year 2013:

  • The rate of emergency department visits declined by 9.9 percent.
  • The rate of “frequent visitors” (five or more visits annually) dropped by 10.7 percent.
  • The rate of visits resulting in a scheduled drug prescription fell by 24 percent.
  • The rate of visits with a low-acuity (less serious) diagnosis decreased by 14.2 percent.

“The ER is for Emergencies campaign demonstrates how public-private partnerships can benefit everyone,” said Scott Bond, President and CEO of the Washington State Hospital Association. “Hospitals are dedicated to working with our partners to do the right thing for patients, and sometimes that means seeking care that is not delivered in a hospital.”

View the Press Conference Recording 

View the press release

Download the Report

Download the Press Conference PowerPoint 


Emergency Department Information Exchange Resources

  • A group is available in EDIE that lists all patients that have visited your ED in the last month that have met or exceeded five ED visits in the last twelve months. The group is available in the Referrals & Groups section and is titled "5 in 12 Population."
  • A Care Guidelines template is also available in EDIE. The template was developed by clinicians from across the state and is located in the Care Guidelines section on each Patient Screen in EDIE.

Partnership to Reduce ER Visits Shows Initial Success!

The first report  from HCA to the legisalture on a collaborative effort of hospitals and physicians to reduce “unnecessary” emergency room visits and coordinate patient care also contains good news for the state budget. Preliminary data from the first six months of the initiative suggest the state is saving more than 10 percent in Medicaid fee-for-service emergency care costs.  Accumulated savings could reach $31 million for the fiscal year. Learn more by reading the press release or read the full report from the Washington State Health Care Authority.

Read the news coverage of the ER is for Emergencies program.

Seven Best Practices Program

The goal of the Seven Best Practices program is to redirect care to the most appropriate setting, reduce low acuity, and reduce preventable Medicaid emergency room visits. The plan, which attempts to address the root of the problem—chronic medical conditions, substance abuse issues, and lack of primary care access—focuses on high users and will:

  1. Track emergency department visits to reduce “ED shopping”;
  2. Implement patient education efforts to re-direct care to the most appropriate setting;
  3. Institute an extensive case management program to reduce inappropriate emergency department utilization by frequent users;
  4. Reduce inappropriate ED visits by collaborative use of prompt (72 hour) visits to primary care physicians and improving access to care;
  5. Implement narcotic guidelines that will discourage narcotic-seeking behavior;
  6. Track data on patients prescribed controlled substances by widespread participation in the state’s Prescription Monitoring Program (PMP); and
  7. Track progress of the plan to make sure steps are working.

See below for one-page document outlining Seven Best Practices. Our success will work to prevent the state from enacting payment cuts to both hospitals and physicians for emergency room services.

UPDATED Seven Best Practices [PDF]. (April 9, 2015)

ER is for Emergencies Kick-Off Safe Table (September 2012) 

Introduction - Carol Wagner

Seven Best Practices - Schlicher, Anderson, Neven

Managing Difficult Conversations - Anderson

How Payors can Contribute - Thompson

EDIE demonstration screen - Rudberg

Health Integration Project: Emergency Department Navigation in Oregon - Henderson

Department of Psychiatry Emergency Department Case Management Program in San Francisco - Kathy O'Brian

Kick-Off Documents:

DPA Naxolone Issue Brief

MMWR Naxonone Prescribing Info

Naxolone Instructions

Naxolone Blank Collaborative Drug Therapy Treatment Form

Washington Law allowing Narcan administrations

Prescribe to Prevent FAQs

Example Patient Follow Up Referral Form

Sample Patient Notification Letter

Additional Resources

ER is for Emergencies Overview


Best Practice Goal

A) Electronic Health Information

Exchange patient information among emergency departments

B) Patient Education (Translated into multiple languages.)

Help patients understand and use appropriate sources of care
C) Patient Review and Coordination (PRC) Information Ensure hospitals know when they are treating a PRC patient and treat accordingly
D) Patient Care Plans Assist clients with their care plans
E) Narcotic Guidelines Reduce drug-seeking and drug-dispensing to frequent ER users
F) Prescription Monitoring Ensure coordination of prescription drug prescribing practices
G) Use of Feedback Information Review reports, ensure interventions are working

Additional Resources:

List of HCA-defined low acuity visits

Policy: Care Management in the ED (Sample Policy)

Background information on Medicaid Emergency Department Use (April 2012) 

EMTALA Fact Sheet

Media Coverage

Coverage from the orginal three visit emergency room benefit limit

Judge Rules Against Emergency Room Benefit Limit

Read news coverage of the court ruling


Amber Theel

Partner Organizations

WSHA is partnering with the Washington State Medical Association and the Washington Chapter of the American College of Emergency Physicians. Visit WSMA's ER Page