Trend: ED 'super users' generating big expenses

Everyone in the hospital business knows about the emergency department's "frequent fliers"--folks who show up countless times, either because they're uninsured, fearful or maybe just lonely. While ED nurses and administrators may be used to such folks, they're a big problem, one that researchers are beginning to look at more closely. Researchers, who have named such people "super users," are trying to understand how to cope with the most extreme behavior--and by doing so, take significant costs out of the healthcare system as a whole.

One way to approach the problem is to look at one community's patterns, which professionals are doing in Camden, NJ. In the small, impoverished city, researchers estimate that that hospitals could save $46 million by reducing ED overuse. A Camden physician, family physician Dr. Jeffrey Brenner, began earlier this year to document how Camden residents used the area's EDs. Having analyzed five years of records from the city's three hospitals, he concluded that the top 1 percent of ED and hospital users (about 1,000 patients) between 2002 and 2007 accounted for about 10 percent of total admissions. These patients came to the city's EDs more than 39,000 times over the five year period, with one patient using a record $3.5 million in services.

When he saw these figures, Brenner took action, creating a "medical home without walls" with a $300,000 grant from the Robert Wood Johnson Foundation. With the money, he built a small team including a nurse practitioner, community health worker and social worker that goes to homes and homeless shelters to find super users and keep them well. Other cities--such as San Francisco--have developed similar programs.

To learn more about this trend:
- read this piece in The Star-Ledger

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