Curbing Emergency-Room "Frequent Fliers"

Emergency-room crowding is one of the most visible problems hospital administrators face, and it's also a fairly expensive one. Yet most hospitals have been hesitant to address it, in part because federal law requires doctors to treat anyone who turns up at the ER.

As is true of healthcare in general, a small fraction of people account for a huge percentage of the costs in ER care. Known colloquially as "frequent fliers," these individuals visit the ER repeatedly throughout the year, often because they're chronically ill, uninsured or alone -- or some combination of all three. A recent study in Camden, N.J., by Jeffrey Brenner, a professor at the University of Medicine and Dentistry of New Jersey, concluded that just one percent of ER patients at the city's three hospitals accounted for 10 percent of all admissions -- and $46 million in costs over five years. (The New Jersey Star-Ledger story doesn't say what percentage of total ER costs these patients accounted for, but I'd bet it's far more than 10 percent.)

Brenner is unusual in that he's spearheaded an effort to reduce both costs and unnecessary ER visits with a small team consisting of a nurse practitioner, a social worker and a community-health worker. That group seeks out ER frequent fliers -- which they formally call "super users" -- and tries to help people manage conditions like diabetes or liver cirrhosis and to sign up for insurance when it's available. Results are difficult to gauge at this point, although a similar program in San Francisco claims to save $1.44 in direct hospital costs for every dollar spent.

Other hospitals are taking similar piecemeal measures. A recent study by the Center for Studying Health Systems Change found that many hospitals are now trying to proactively screen out non-urgent ER patients by hiring nurse practitioners to refer them to outpatient clinics.

(Hat tip: Fierce HealthcareFinance)

Image of frequent-flyer cards by Flickr user caterina, CC 2.0