The emergency department (ED) is not only the most inappropriate and expensive place to deliver primary healthcare, it’s a gateway to unnecessary hospital admissions for people who could be better served in the community. For people with chronic conditions—such as diabetes, asthma, and hypertension—proactive monitoring and management of medication regimens and physical exams is especially important to prevent both avoidable crises and ED visits.
That’s the challenge. The good news is that innovative programs around the country are targeting and culling the herds of ED “super-users,” cutting costs and trying to fix a piece of our broken healthcare system—which means there are opportunities for reporters to tell local stories that highlight care models addressing a vexing systemic problem.
Sandy Hausman, Charlottesville, VA bureau chief for WVTF/RADIO IQ, described one of these programs in her spot about a local medical home program that aired April 30 on NPR’s All Things Considered. (The report was part of a partnership between NPR, Virginia Public Radio, and Kaiser Health News.) Hausman profiled the work of the multi-disciplinary staff at St. Francis Family Medicine near Richmond, VA—affiliated with the Bon Secours Health System—who work to keep people with chronic conditions such as blood pressure and diabetes out of the hospital.
She also drew on the successes of similar programs—like Virginia Commonwealth Care for the Uninsured, which saw reduced ED usage, fewer inpatient admissions, and reductions in the overall cost of care; and Healthy San Francisco, which cut healthcare costs sharply even with uninsured people included in the mix. (Disclosure: I work for a New York-based division of the Bon Secours Health System, which has no connection to the Richmond facility.)
Another recent example of this type of coverage comes from the Louisville Courier-Journal’s Laura Ungar, who put a face on the ED “super-user” in her profile of an innovative program underway in Louisville’s University Hospital. The program is modeled after Camden, NJ’s “hot spotters” program, founded by Dr. Jeff Brenner, and described in Atul Gawande’s acclaimed New Yorker article back in 2011.
Ungar’s piece, accompanied online by a compelling video, told the story of Dennis Manners, who came to University Hospital’s ED 337 times within a two-year period for non-emergency conditions—making him a so-called “super-user.” Both a chronic substance abuser and a sympathetic character, Manners racked up more than $620,000 in costs from his ED visits—a striking story that mirrors those of thousands of others around the country.
What’s different about Manners is that he benefited from a program built by an extraordinary group of hospital staff, who went to extraordinary lengths without a dedicated budget to build a support network that has reduced his reliance on the ED for primary care and also saved the hospital hundreds of thousands of dollars. They found him housing, connected him with a host of community health services and transportation to get there, and re-connected him with his family, who help care for him. Within the first eight months of the program, he visited the ED only three times, each for a legitimate medical emergency.
Brenner’s work continues in the Camden Coalition of Healthcare Providers. And just as University Hospital in Louisville found a way to emulate its ED “super-user” reduction strategies, so have other organizations. Now, it’s up to journalists to continue to go out and find them.