In response to the growing utilization of EDs to treat non-emergency health care conditions, particularly among Medicaid enrollees, as well as the high cost of preventable hospital readmissions, CMS and state Medicaid agencies are incentivizing hospitals to establish linkages with primary care providers. Through such linkages, patient care is managed in a more appropriate outpatient setting, resulting in a reduction in unnecessary and costly hospital care. As health centers, by mission and design, exist to provide comprehensive primary and preventive care to patients, regardless of their ability to pay, they have been identified as essential partners in these endeavors. This brief is designed to assist health centers in exploring opportunities to collaborate with hospitals to reduce inappropriate ED utilization through linking individuals with the health center’s patient-centered medical home model of care. This brief outlines strategies to achieve ED care coordination, summarizes important legal and policy issues, and provides case studies of health centers that have implemented successful ED care coordination programs.
Important NACHC Library Content Note: This technical assistance resource was developed prior to the August 2017 release of the Health Center Compliance Manual by the Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care (BPHC). The BPHC Compliance Manual, issued August 2017, indicates where PINS, PALs and other program guidance are now superseded or subsumed by the BPHC Compliance Manual.