Inpatient care--not the ER--drives homeless patient costs

Homeless patients' hospital stays for chronic conditions cost organizations more than those patients' emergency room visits, according to the Boston Herald.

Living on the streets takes a toll on patients in myriad ways, Jessie Gaeta, M.D., chief medical officer of the Boston Health Care for the Homeless Program, told the Herald. Such patients often suffer from premature aging of everything from the brain to the kidneys, she said. "You can't discharge people as quickly when they live on the street as opposed to going back to a home where they may have someone to take care of them," she said.

Indeed, of 1,100 patients the program treated in 2015, its Medicaid expenditures for inpatient visits, at 30 percent, were more than quadruple the 4 percent that went to emergency services. This flies in the face of much of healthcare's conventional wisdom on homeless patients; up to this point, healthcare providers targeting the homeless have focused largely on ER "super-users," who comprise 17 percent of emergency visits at Massachusetts General Hospital despite representing only 4 percent of patients.

Healthcare providers have long targeted improved outcomes and readmissions for vulnerable homeless patients, with more than 70 cities establishing respite care facilities for recently-discharged homeless patients who may not have anywhere else to go, FierceHealthcare previously reported.

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