Forging Aligned Partnerships Between Value Based Care Organization & Geriatric Emergency Departments

Executive Summary

Hospital emergency departments hold the key to preventing avoidable hospital admissions for older adults, addressing a costly and widespread problem with serious ramifications for Medicare and health systems at large. Potentially avoidable readmissions cost Medicare $17 billion a year, in large part because they’re so common. Seventy-three percent of hospital readmissions from skilled nursing facilities are rated as potentially avoidable₁₇, as are 63% of hospital readmissions from long-term care settings₁₈. Emergency departments play a central role in the trend; a recent study found that hospital EDs account for nearly 60% of hospital admissions for older adults and, increasingly, also serve as an advanced diagnostic center for primary care physicians₅. As a result, reducing potentially preventable ED visits and subsequent hospitalizations or readmissions has become a priority for Medicare and Value Based Care Organizations (VBCOs)₁₉. Despite these efforts, Medicare beneficiaries continue to seek care in EDs for non-emergent, primary-care treatable, and preventable or avoidable issues.

As the primary point of admission, EDs can be a part of the solution to reduce avoidable hospitalizations and connect older adults to the most appropriate level of care. Recognizing the need to address the unique health concerns of older adults, in 2014 the American College of Emergency Physicians (ACEP) in collaboration with the Society for Academic Emergency Medicine, the American Geriatric Society, and the Emergency Nurses Association published Geriatric Emergency Department Guidelines. Per these guidelines, a primary goal is to help EDs recognize those older patients who could benefit from inpatient care, and to effectively implement outpatient care for those who do not require inpatient resources. To be most effective, a senior-focused ED would utilize the resources of the hospital, as well as outpatient resources₂₀. In 2018, ACEP in collaboration with West Health created a Geriatric Emergency Department (GED) Accreditation Program (GEDA). The GEDA program was developed to ensure that older patients receive well-coordinated, quality care at the appropriate level at every ED encounter.

We believe that VBCOs are incentivized to forge aligned partnerships with GEDs to connect their outpatient resources to the clinical operations within a GED. Such partnerships could reduce unnecessary admissions and improve transitions of care back to the VBCOs and beneficiary’s primary care physician – two central VBCO “must haves” for success. Like VBCOs, GEDs are motivated to ensure patients receive care in the setting best matched to the patient’s needs. Due to the influx of patients going to the ED in recent years, EDs are also driven to reduce time spent in the ED and get patients back home if possible. Emergency physicians currently have limited disposition options (admission, discharge, or observation). VBCOs may be able to provide additional disposition options or outpatient resources that ED clinicians are not aware of or do not know how to easily access, which is why partnering could be so valuable.

This toolkit and the resources that follow lay out an approach for VBCOs to forge aligned partnerships with their local GED. The toolkit proposes a framework for VBCOs to understand their local GED capabilities and key GED stakeholders, mobilize action, move towards partnership, remove barriers to partnerships, and launch collaborative projects.