Healthcare News & Insights

Coordinated care keeps frequent fliers from landing in ER

Emergency departments (ED) have become the family doctor of the chronically ill. 

EmergencySignDespite the availability of affordable care insurance, the ED is ground zero for  “frequent flyers” —  patients with manageable chronic conditions who regularly show up in the hospital to receive emergency care.

Frequent fliers are generally uninsured, or Medicare or Medicaid recipients. They go to hospital EDs because they don’t have access to any source of care. They can’t afford to pay for an appointment with a primary-care doctor who can help them manage their condition — and they have no where else to go when their condition flares-up.

They suffer from a variety of chronic conditions such as congestive heart failure, diabetes, skin infections, chronic obstructive pulmonary disease (COPD), drug addiction and mental illness.

Last year, Halifax Health Medical Center in Daytona Beach provided $39.2 million in uncompensated care, said Arvin Lewis, chief revenue officer for the Florida public hospital system. Most of the cost is passed on to insurance providers that jack up premiums to subsidize care provided to the uninsured, he said.

Chronic conditions need to be managed

To off-set the high costs of frequent flier visits, Halifax and other Florida hospitals have opened hospital-based clinics to help reduce ED costs, the Daytona Beach News-Journal reported.

By connecting patients to primary care doctors that can provide patients with a comprehensive treatment plan, monitor their use of medication, provide nutritional and psychological counseling, and provide follow-up care, they can better manage their condition and reduce their need for multiple ED visits.

Halifax opened up a congestive heart failure clinic to provide follow-up care to patients who once sought treatment in the emergency room. The ED also directs patients to the clinic who show up suffering from a variety of other chronic illnesses. Some patients are eligible to participate in a patient assistance program and receive medication for a copay of only $7.

Frequent fliers make up 4.5% to 8% of all ED patients, but account for 21% to 28% of visits, according to a study published in the Annals of Emergency Medicine in 2010.

A Florida Hospital in Daytona Beach also is combating ED super-users. The hospital has assembled a team of clinicians, including a registered nurse, social worker, dietitian and counselor to coordinate post-discharge care for low-income patients.

More primary care and urgent care clinics are scheduled to be opened in the Florida panhandle, the newspaper reported.

Program reduces costs from ED super-users

Care One Clinic at the University of Florida Health Hospital in Gainesville saw a reduction of ED visits from 4.9 to 3.8 per patient and a drop in hospitalizations from 3 to 2.1 after assembling a multidisciplinary team at its hospital-based clinic, Med Page Today reported.

The intervention led to a savings of $4,000 per patient a year. Researchers at Care One mined their healthcare system’s electronic health records (EHR) system for all patients who had more than eight ED visits in the past year. They found 4,873 patients accounted for 5,728 ED visits, 147 of which were selected to participate in the study.

Clinic staff examined the patients, assigned them a social worker who connected them with healthcare resources in the community. Patients then met with a doctor, a pain and addiction psychiatrist, and a pharmacist for medication assessment and patient education.

In some cases, the clinic achieved 70% and higher hospital reductions through this pilot program that could be adapted to other hospitals.

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