Ensuring Appropriate Hospital ER Use: A Shared Responsibility
4/1/2024
This article first appeared as a column in the 2024 March issue of South Florida Hospital News
By Mary Mayhew, FHA President and CEO
In a stellar example of bipartisan leadership and support, Florida’s legislature completed its session last month with near-unanimous passage of a large omnibus health care package that will have a significant positive impact on Florida’s health care system for decades. The passage of Live Healthy with its provisions ranging from workforce investment to enhanced Medicaid reimbursement rates should be applauded and acknowledged as a major investment in the work hospitals and other health care providers do to make high-quality health care accessible for all Floridians.
One of the provisions, dealing with encouraging appropriate use of hospital ERs for emergencies only, was revised slightly during the legislative process as lawmakers incorporated hospital feedback. The laudable intent – to reduce avoidable ER use – respects hospitals’ legal obligation to comply with federal law governing emergency room access and treatment while maintaining a clear expectation that accessible non-hospital care options be more widely available so that ERs are not the only source of non-emergent care that is more appropriately provided in primary or specialty care sites in the community.
Nearly 60 percent of all ER visits are by individuals with a chronic condition, such as diabetes. An estimated 30 percent of these visits would be considered avoidable if ongoing care management were more available. Nationwide, Florida has the highest average chronic disease prevalence.
Additionally, many ER visits are considered nonemergent. Still, individuals, even those with Medicaid coverage, rely on the ER for health care because they do not have timely access to primary care or mental health services in the community. Unfortunately, some providers, often because of extremely low Medicaid reimbursement rates and significant administrative burdens, opt not to participate in Medicaid. And, of course, for those without any health insurance coverage, the ER is often their only point of entry for health care services.
Many hospitals of all sizes across the state have innovative programs, such as ER navigators, who work with patients to identify the variables and factors that lead them to rely on the hospital ER for care, as well as public education programs to advise patients on knowing where to go for care based on their condition or need. Still others have outpatient care sites with extended, non-traditional hours and operate urgent care centers so that needed care can be provided quickly without relying on an ER. Hospitals are focused on supporting individuals to get the right care at the right time and in the right setting.
With the support of Live Healthy, more hospitals can build on these diversion programs and initiatives to support the Legislature’s goal of even greater collaboration among hospitals and non-hospital care sites so that avoidable ER use is further reduced. Hospitals will continue to support expanded access through hospital-employed primary care providers and partnerships with FQHCs and other community providers. The state’s largest hospital association, the Florida Hospital Association, will continue to support efforts to improve Medicaid managed care reimbursement rates to support more robust networks of providers with their doors open to moms, dads, children, and other adults on Medicaid who need timely access to health care services.
Florida’s hospitals’ and lawmakers’ collaboration through Live Healthy to address these pressing health care challenges – and opportunities – is exemplary of what proactive, bipartisan health care policy can look like for better access to care and outcomes for all Floridians.