A Bridge To Health — And Away From ER Overuse


pie chart of causes of traumatic brain injury

pie chart of causes of traumatic brain injury (Photo credit: Wikipedia)

By Nancy Wang, North Carolina Health News

March 27th, 2013, 6:01 AM

There are patients in almost every hospital emergency room who do not need urgent care. They are there because they don’t have health insurance or a regular physician, or they didn’t know what else to do. Often, they are repeat visitors. It’s a problem that leads to emergency department overuse and contributes to spiraling health care costs.

Nationally, between 13.7 percent and 27.1 percent of all emergency department visits are non-urgent, according to a 2010 Health Affairs study, leading to about $4.4 billion in health care costs.

North Carolina’s Pardee Memorial Hospital, located in Hendersonville, has joined forces with local physicians in an attempt to reverse this cycle – and program data suggest the plan is working.

In 2009, Pardee’s emergency department treated approximately 45,000 patients. Among them the hospital identified 255 as “frequent flyers” – meaning they used the emergency room six or more times and racked up more than $3 million in unpaid medical bills. They were all uninsured, low-income patients, many with a history of substance abuse or mental health issues.

The next year, 44 of these patients agreed to participate in Bridges to Health – an integrated approach that Dr. Steve Crane, a family physician who started the program, calls a “patient-centered medical home on steroids.” It aims to decrease ER expenses by providing this patient population with primary care, behavioral health services and a nurse case manager through bi-weekly health clinic visits.

The program’s free clinic is part medical check-up, part group therapy. While the doctors treat rashes, abdominal pains and other symptoms, the patients also help one another, suggesting where to seek legal assistance or where to eat or sleep inexpensively. As such, the program sets out to address the two main problems seen in these patients: the lack of social support and access to regular primary care.

Advocates of this type of approach believe targeting ER over-users, who generally have limited experience with the health system, will buttress the Affordable Care Act’s provisions designed to expand insurance coverage and access to care.

A 2011 Centers for Disease Control and Prevention survey reported that 46.3 percent of respondent ER patients were in the ER because they had nowhere else to go. The report also found that uninsured adults were more likely than insured adults to go to the ER for this reason.

“Many of these people just went to the ER because they were in pain or scared,” Crane said. “You see them going back so many times because their real issues are not supposed to be treated in the ER and are not taken care of.”

A Targeted Approach

Unlike most free health clinics, where a wide variety of people are seen individually and most people rarely come more than once, Bridges to Health works exclusively with this specific group of ER over-users and each visit is conducted as one large group appointment.

Crane’s program offers these patients a better alternative with long-reaching benefits.

Before enrolling in the program, participants were averaging seven ER visits a year, costing an average of $14, 004 per person . At the end of the first year, participants averaged three visits a year, costing an average of $2,760 per person. This amounted to $404,784 in savings for the Pardee Hospital ER that year.

Additionally, 10 participants found employment and six previously homeless members found stable housing by the end of the first year.

Data for the second year is still being analyzed.

While the results of the program are very promising, Crane cautions that the patient group is small, and that the program only works for participants who come to the clinic meetings.

He and his team, however, are hopeful that programs like Bridges to Health will gain more support because they offer a way to hold down health costs, while improving care. A Bridges to Health pilot is on track to be replicated in Charlotte sometime this year, with a few other North Carolina and Virginia counties hoping to also get on board.

This entry was posted on Wednesday, March 27th, 2013 at 6:01 am.

5 Responses to “A Bridge To Health — And Away From ER Overuse”

  1. Lori says:

    This is a great outcome. We need more programs like this. Finding an additional reason for overuse in the population is lack of competency and inability and/or unwillingness for hospitals to address this in the emergency room. Deeper assessment of our frequent fliers re needed on many levels.

  2. Big issue great article. When the estimates are posted:

    “Before enrolling in the program, participants were averaging seven ER visits a year, costing an average of $14, 004 per person . At the end of the first year, participants averaged three visits a year, costing an average of $2,760 per person. This amounted to $404,784 in savings for the Pardee Hospital ER that year.”

    Are these dollar amounts what the hospital charges or what Medicare Allows? For instance the hospital may charge $2,000 for a CT of the brain but Medicare will pay $220 which is the Medicare Allowable.

  3. walter says:

    As a Republican, I don’t think this idea has even a remote chance of ever going prime time. Like Obamacare, ideas like this are a complete waste of time. We need to repeal Obamacare and we need to repeal stupid ideas like this. We need to return complete control of our healthcare system to the private insurance companies. America’s healthcare system was doing just fine prior to March of 2010. We need to trust the private insurance companies to do what is best for America’s healthcare system. The private insurers have had decades of experience. The private insurers should be allowed to do as they wish and not be regulated by the federal government. The private insurers can be trusted. We need to let the free enterprise system work. We need to let the free market system work. We need to stop federal government interference. In my opinion, emergency room overuse does not exist. In my opinion, nobody is abusing the emergency rooms in America. How can these statistics be accurate? In my view, it’s impossible!

  4. Lynn in SC says:

    In comparing cost you should also include the cost of the “free clinic”. Some entity is carrying that cost.

    Isn’t interesting that it took so long to identify the frequent flyers and most had mental health or substance abuse issues. These folks have been around for years.

    There are institution by institutions with creative solutions if only someone will look at the patients, recognize the patterns, and lead the solution. As long as providers have their vision limited by what is reimbursed and what is not reimbursed they won’t see solutions that are right under their noses because they only see the lack of revenue tied to these patients. .

  5. Evelyn says:

    Walter, ask anybody who works in any field remotely related to health care and they will tell you that you are dead wrong in your stance on emergency room overuse/abuse. My job involves working with only a small fraction of emergency room patients (only those who receive medical equipment while visiting the ED), and it is alarming how many of these people are “frequent flyers,” coming in monthly, sometimes weekly, for every little thing. (I can only imagine how many more patients I don’t look at that are in the same situation.) But a trend quickly becomes apparent: a strong majority of these patients are unemployed, uninsured or on state assistance, and have mental health and/or substance abuse issues. You cannot just ignore these issues. Private insurers will have nothing to do with these issues. And so we all pay, financially and morally.

    Why on earth would somebody lambast a program actually looking for solutions to these very real problems? I’m so sick of the complainers and naysayers. And it’s a little frightening how much faith you put into for-profit corporations. I sincerely hope that you don’t incur some horrible disease or injury that your insurance won’t cover a lick of, because that is another thing I see constantly in the hospital where I work. Then again, thanks to the Affordable Care Act (or “Obamacare”), you might never have to endure that tragedy.

    You do have one saving grace; at least you acknowledge your rant as opinion and not fact.

    Kudos to innovative thinkers like Bridges to Health.

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