Improve health, lower health care costs by reducing emergency room visits
- on August 24, 2011
In Camden, NJ, physician Jeffrey Brenner dug into local hospital discharge data to find out that in a six-year period, 900 people in two buildings in Camden made more than 4,000 hospital visits that cost $200 million. In a captivating coverage by Dr. Atul Gawande -- an article that appeared in the New Yorker in January and a Frontline feature that aired last month -- he focused on the question: can we lower medical costs by giving the neediest patients better care. After Brenner discovered the hospital-use pattern, he wanted to do something about it, according to Gawande:
Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.
If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. And, if the stats approach to crime was right, targeting those with the highest health-care costs would help lower the entire city’s health-care costs. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients.
The article goes on to chronicle the change in approach that Brenner took to caring for people who had a revolving-door relationship with their local hospital, and who weren't getting preventive care. They were the most difficult cases, and the medical profession had pretty much given up on them. Brenner explored their history, got them back into church if they were religious, into Alcoholics Anonymous if they'd once attended, found them a social worker to assist with disability payments to get into long-term housing instead of living in motels. Hospital visits, including ER visits, and costs plummeted. If you haven't read it, it's worth checking out.
This post by Phil Galewitz on Kaiser Health News on Monday explores a similar approach that states are taking to reduce Medicaid costs. The post begins with a look at a program in Oregon that's trying to reduce unnecessary ER use by Medicaid patients. It looks at a 22-year-old unemployed mother who visited the ER 22 times for routine care because it was convenient and free. After participating in the program, she's used the ER only once the first six months of this year.
In the first half of this this year, ER visits by the 400 patients in this program have declined by more than half from the same period last year, saving Medicaid $1 million, officials say.
The post goes on to explain how, in some states, getting people to reduce ER use is a challenge, because hospitals are marketing their ERs as primary-care services and advertising wait times on electronic billboards. It's sometimes also difficult to determine if a visit to an ER is necessary or not -- is a headache just a headache or a symptom of a stroke?
However, with "frequent flyers", the term the post used to describe people who visit ERs frequently, they may need more than just medical care. The young woman who visited the ER 22 times last year is getting help from the ER diversion program to:
....get her high school equivalency diploma, search for a job and deal with her mental health issues. At the heart of the program is a community outreach worker who assists participants with getting to medical appointments and addressing other needs.