Care coordination, targeting chronic conditions key to reducing ED super-users

As hospitals across the country work to reduce costs from emergency department (ED) "frequent flyers," some Florida hospitals tackle the problem by coordinating care and targeting patients with chronic conditions, the Daytona Beach News-Journal reported.

Halifax Health Medical Center, in Daytona Beach, Florida, last year provided more than $39 million in uncompensated care, according to the News-Journal. To help offset the cost of frequent flyers, many with chronic conditions, the hospital employs caseworkers to help connect patients with primary care doctors.

Halifax Health also opened up a congestive heart failure clinic to provide follow-up care to those who once sought treatment in the emergency room. The ED also now directs patients suffering from diabetes, substance abuse, skin infections, mental illness and chronic obstructive pulmonary disease to the hospital's clinic, according to the article.

Florida Hospital in Daytona Beach partnered with Bethune-Cookman University to create a team of nurses, social workers, dieticians, counselors, student health coaches coordinate post-discharge care for patients with limited resources, the News-Journal reported. Both hospitals also have or plan to open primary care and urgent care clinics to improve access, according to the article.

Other hospitals in Florida are doing the same. University of Florida Health Hospital's Care One Clinic in Gainesville implemented a clinic-based multidisciplinary team, after which ED visits fell from 4.9 to 3.8 per Care One "frequent flyer" patient, hospitalizations dropped from 3 to 2.1 and days spent in the hospital fell from 3.8 to 2.9, compared to the six months before the program, FierceHealthcare previously reported.

In Oregon, coordinated care organizations have targeted super-users in EDs since July 2012, and St. Charles Medical Center saw ED visits by 144 frequent users in the Bend area drop by 49 percent during the first six months of 2013. That resulted in 541 fewer ED visits by that group alone, reducing costs by an average of more than $3,100 per patient, FierceHealthcare previously reported.

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