By KEN KUSMER

Associated Press Writer

INDIANAPOLIS (AP) — The state hopes to divert Medicaid clients to health clinics and primary care doctors from unneeded, costly emergency room visits under a program in Indianapolis and Lafayette next year.

Indiana, which is receiving a $1.61 million grant, is one of 20 states that will share $50 million from the federal Centers for Medicaid and Medicare Services over the next two years to reduce ER visits by Medicaid beneficiaries for routine complaints such as headaches and ear infections.

The goal is not only to reduce non-emergency ER use by Medicaid patients, but also to increase their use of family physicians and to better diagnose mental health conditions such as depression and anxiety, said Dr. Jeff Wells, director of the state’s Office of Medicaid Policy and Planning.

“It’s really about improving value,” Wells said Wednesday.

For example, patients suffering from depression and anxiety often will show up in emergency rooms complaining of nonspecific symptoms such as headaches, but the Lafayette and Indianapolis clinics will have nurses trained in mental health who can direct the patients to psychiatrists.

“The goal is to do it (treat patients) in a setting where it makes more sense,” Wells said.

The clinics will be operated in Indianapolis by Wishard Hospital, drawing clients from Marion County and six surrounding counties, and in Lafayette by a partnership between St. Elizabeth’s Hospital and Tippecanoe Health Clinic, also drawing patients from seven counties.

The clinics will operate from 8 a.m. to 8 p.m. weekdays and six hours on Saturdays in retail areas, the Medicaid policy office said in a news release. The office estimates they will see a combined 1,300 Medicaid patients per month, plus 500 non-Medicaid patients.

Wells said Indiana’s approximately 880,000 Medicaid patients go to emergency rooms at a frequency that’s about 10 percent higher than the national rate.

Many patients go to ERs for non-emergencies. The private Robert Wood Johnson Foundation estimates as many as six in 10 adults going to ERs could have been treated in outpatient settings. That calculated to as many as 182,000 non-emergency ER visits by Medicaid patients in Indiana during 2006, said the Medicaid policy office.

Emergency room visits are more expensive than doctors’ offices and are more likely to lead to even more costly hospitalizations at rates of hundreds and even thousands of dollars per day, Wells said.

Dr. Jon Marhenke, an Indianapolis psychiatrist who’s president of the Indiana State Medical Association, welcomed the pilot project.

“We know that people use the emergency room as their family doctor, and that’s really inappropriate,” Marhenke said. Not only does it tie up more costly resources, but also inhibits Medicaid clients from finding medical homes. “Follow-up becomes a real issue.”

 Posted 4/24/2008