Super Utilizers

It amazes me that we actually have a label for “frequent flyers” to the emergency room.   Oh, wait a minute, that’s a label too.   Hmmmm.  Anyway,  a small blurb in the Family Practice News states that “two Cincinnati-based research and advocacy groups seek to identify and address the issues behind super-utilizers of emergency departments”. They intend to:

  • Identify super-utilizers (Easy.  The ER staff knows them all by name.)
  • Determine the individual problems leading to ED overutilization (Easy.  They have no primary care docs.)
  • Transition them into more regular sources of care (Yeah, right.)

Here is what I would do.   I recommend they buy a small building or park a nice trailer next to the ER.   Get a few family docs and pay them a ton and I mean a ton (these are the toughest patients in the world).  Give them adequate staff to call these patients, visit these patients, etc.  Lastly, pay each of these patients $50 to show up to their regular visits.  Sorry, and one more thing, remove the EMTALA law for these patients and have a staff member (runner) literally walk them over from the ER to this new clinic when they show up.   The hospital and government would save millions of dollars each year.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Super Utilizers

  1. Judy
    March 20, 2013 at 2:54 pm

    very good suggestion! pitch it to CMS & perhaps you can qualify for a multi-million $$$ grant to test it!

  2. Dave Hoffman
    March 20, 2013 at 12:52 pm

    I think you’re onto something, Doug. The only disincentive for patients without high ER copays is the long wait times in the ER. I work in a hospital-owned practice where all ambulatory and hospital visits show up on my EMR, and I’m shocked at how often my patients go to the ER for colds, sore throats, and rashes.

    I get really busy doing well child visits whenever Indiana Medicaid runs its program that rewards patients with a $25 Walmart gift card for showing up in my office.

  3. Marsha McKay DO
    March 20, 2013 at 10:27 am

    I think your idea is too brilliant for anyone connected with hospital administration to consider. And even if they did, some public assistance administrator would find a way to shoot it down. I realize this is cynical but after 24 years in medicine I have earned the right to be. If anyone asked physicians how to solve some of these huge problems we have with health care it would be a good start. We should have been involved years ago but it’s probably too late now. Even if someone asked us, we would probably be too busy to respond. And unfortunately, that is how things will continue to be.

  4. Pat
    March 16, 2013 at 7:25 pm

    One cannot work an ER shift without rolling in frequent fliers. Our come-on-in comglomerate of lawyer threats and federal mandates has perverted ER’s. Instead of simply being a place to heal the sick and injured, we are the enabling mechanism for growing numbers to continue in their cycles of sloth, over-procreation, apathy, gluttony, substance addiction, and any other manner of dependency. I’d write more, but there’s yet another laughing, squealing Medicaid baby whose long-term, frequent flier teenage mom just popped in because she could, and I’d better go blow some more of your tax dollars on a well-baby. Yeah, I’m proud.

  5. Private doc
    March 15, 2013 at 7:48 pm

    That still wouldn’t work. I witnessed this first hand in medical school. One of the PCP’s had his office literally across the ER parking lot not more than 30 yards from the ER door. The patient came into the ER with a cold. He was on TenCare and on his card the official PCP for the patient was the one across from the ER. When asked why he didn’t just go over to him he said “because if I go over there I have to pay five bucks, I can come here for free”. Oh he had more than five bucks worth of cigs and other things on his person at the time but he wasn’t about to pay five bucks for his care when he could walk into the ER and get treated for “free”

    • Doug Farrago
      March 16, 2013 at 6:52 am

      Ahh….that is why I would pay these patients $50 to make their scheduled visits.

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