ER Usage Drops when Uninsured Get Primary Doc
An internet-based primary care referral program developed by a consortium of Central New Mexico primary care safety net providers and being used in the UNM Hospital Emergency Department to provide uninsured patients with follow-up appointments with primary care givers, resulted in a 31 percent drop in subsequent Emergency Room visits within the first 17 months of operation.
The program was developed by Coordinated Systems of Care Community Access Program of New Mexico (CSC-CAPNM), a consortium of primary care safety net provider organizations that includes the UNM Health Sciences Center School of Medicine's Family and Community Medicine. The consortium partnered with the UNM Hospital Emergency Department to createPrimary Care Dispatch, a HIPPA-compliant Internet referral program that allows ER technicians to schedule uninsured patients with primary care follow-up visits 24 hours a day, seven days a week.
Nationally, there are now some 46 million uninsured patients and the growth in this population has been a key factor in contributing to overcrowding in hospital ERs. In central New Mexico , it is estimated there are some 140,000 medically uninsured patients within the four county region served by CSC-CAPNM.
"There are a number of barriers both for providers and for patients in receiving the primary care they need," said Art Kaufman, M.D., chair of the Department of Family and Community Medicine in the UNM School of Medicine and chair of CSC-CAPNM. "For patients who must use public transportation, it can be confusing to find a safety-net clinic, and it can be hard for them to access a phone to make an appointment during business hours. In the past, incompatible scheduling and appointment software has made it hard for providers to collaborate in providing a seamless provider system. All this has meant that, traditionally, only 25 percent of ER patients referred to a physician for follow-up care ever receive it."
ThePrimary Care Dispatchsystem addresses a number of those barriers. The Internet based system operates 24 hours a day, seven days a week. Patients receive a referral to a primary care provider appointment as well as a map to the provider's office and a list of other services provided at that site.
Four provider systems within the consortium, First Choice, First Nations, Healthcare for the Homeless and UNM, redesigned their clinical operations and streamlined their services and increased capacity at each clinic site. Additionally, the consortium engaged in cooperative hiring and support of health professional staff at all facilities. Technical barriers such as incompatible billing and appointment software were also addressed. "The system is internet based, which allows disconnected medical systems to share a limited patient record among members of the consortium," said Fornessa Randal, Executive Director for CSC-CAPNM and lead inventor of the software product. UNM provided support to the other organizations through sharing grants, assisting in professional recruitment, providing technical support and referring to their systems Medicaid and Medicare patients for whom they were able to receive cost-based reimbursement.
During the first 17 months of the program, some 756 patients were tracked for additional ER usage after being entered into thePrimary Care Dispatchsystem. The group found that patients referred via the CAP program to a family provider were less likely to return to the Emergency Department. The decrease was most significant among those who did not utilize the Emergency Department frequently prior to their CAP program referral.
Michael Murnik, M.D., was the principal investigator in the study that tracked subsequent ER usage. The group is also investigating a number of other factors and impact that an internet-based referral system can play in impacting the quality of care for uninsured patients.
The Primary Care Dispatch is now being incorporated selectively into the new, statewide, 24-hour nurseline so callers without medical homes can be assigned to them.
Consortium Members of CSC-CAPNM:
UNM Family and Community Medicine
First Choice Community Health
Indian Health Services, Albuquerque Service Unit
Albuquerque Healthcare for the Homeless
First Nations Community Health Source
Peanut Butter and Jelly Family Services
New Mexico Department of Health
Contact: Cindy Foster, 272-3322