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CMS Offers Advice to States to Help Curb ED Crowding

The Centers for Medicare and Medicaid Services (CMS) recently released an Informational Bulletin describing their efforts to reduce non-urgent emergency department (ED) use and improve on delivering appropriate care in the most appropriate settings. CMS has collaborated with states in order to reduce costs and improve patient experience.

The Informational Bulletin summarizes three strategies that aim to deliver appropriate care in the appropriate setting. This will help curb the problem of patients overcrowding EDs with non-urgent visits. The three strategies are:

  • Broaden access to primary care services;
  • Focus on frequent ED users; and
  • Target needs of people with behavioral health problems.

The strategies provided by CMS are excellent starting points for states and communities. With each strategy, CMS provides an example of where the practice is taking place as well as the results from the program. The programs in place have shown positive results so far, leading us to think that perhaps if these programs were implemented on a larger scale, the success would be much greater. 

Of course comes the question of whether or not state legislation needs to be passed in order for some of these programs to be implemented. The second part of the Bulletin describes the statute and regulatory issues involved in distinguishing non-emergent from emergent use of the ED.

With Medicaid beneficiaries using the ED more frequently than the privately insured, it is no question that something needs to be done to stave off the increased ED utilization among those newly insured Medicaid patients under the Affordable Care Act (ACA). Striving to provide the appropriate care in the most appropriate setting should be the ultimate goal as it creates efficiency.

View the release here.

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Tags: CMS, Medicaid, emergency department, ACA, Health Reform

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