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.
very good suggestion! pitch it to CMS & perhaps you can qualify for a multi-million $$$ grant to test it!
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.
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.
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.
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”
Ahh….that is why I would pay these patients $50 to make their scheduled visits.