A survey to improve urgent primary care access for HealthPoint patients
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Introduction
In the fall of 2011, Washington State Health Care Authority approved legislation to stop covering non-urgent care for Medicaid patients at the Emergency Department (ED).(1) Justified by a dire fiscal deficit in the state, the new legislation off-loads Medicaid patient ED costs on to hospital charity care. While this will achieve the state’s goal of lowering Medicaid dollars spent, it does not provide education on appropriate uses of primary care resources, or improve or expand access to urgent care for the Medicaid community.
Our project’s goal in response to this new legislation was twofold:
- Assess and understand the reasons that HealthPoint’s Medicaid patients chose to use the ED for non-urgent care instead of their medical home at HealthPoint
- Compile patient feedback and propose suggestions on ways HealthPoint can improve their urgent care services and more effectively address and prevent future inappropriate ED use.
Materials and Methods
A list of patients was extracted from the Community Health Plan of Washington (CHPW), the Medicaid Insurance carrier for Washington, via HealthPoint staff.
Patients from this list were chosen according to the following criteria:
- Medicaid patients assigned to Auburn Health Point Clinic as their medical home
- ED visit with a date of service between June 1, 2011 and December 31, 2011
- ICD9 Diagnosis code determined “non-urgent” according to CHPW for that ED visit
Each patient was phoned by ATSU students and asked a survey of standardized questions. Survey results were complied by ATSU students into principal findings and results.
Main Challenges and Limitations of the Study
Out of 115 patients called, only 20 were available to answer our survey. This was due to:
- 36 phone numbers - wrong or disconnected
- 19 phone numbers - not called due to non-English speaking patients
- 40 numbers - called twice with no answer or patient declined to participate in the survey
Conclusion
The three major reasons cited for ED use by patients were :
- Hours of operation
- Ease of access
- Appointment availability.
Although the HealthPoint Urgent Care Clinic has expanded hours to include evenings and weekends, most patients found themselves in need of care at times outside of those hours. For those that did call the Urgent Care Clinic, many were told there were no available appointments. Other patients found that it was easier to go to the ED solely based on location.
In order to help Medicaid patients avoid non-emergent ED visits HealthPoint could make a significant improvement by increasing their patient education. Many patients would have used HealthPoint urgent care resources if they had known about them. However, increased patient awareness would likely result in increased use, which would mean consideration of expanding appointment availability, and increasing hours of operation in order to accommodate these patients. (2)
The benefits of a functioning medical home model is the sustained and established relationship between the healthcare provider and the patients. (3) HealthPoint can effectively address inappropriate ED usage by educating their patients on the availability and appropriate usage of the HealthPoint Urgent Care Clinic and 24 hr Nurseline.