Spectrum Health is launching a new clinic in Grand Rapids to target people who visit its emergency rooms more than 10 times a year.
Doctor Corey Waller identified the problem while working in Spectrum Health's emergency rooms. The non-profit health system says there were 950 of these high-frequency visitors in 2008. That’s an average of 21 times per person. Combined, their visits cost at least $40 million a year.
"That prompted the next question, well so what do we do about this? And since what we're supposed to do is actually care for people and give them good medical care; the first thought was ‘well let's figure out what's wrong,” Waller said.
In a pilot study Waller found many patients had poorly managed medical conditions, like diabetes, because they couldn't get transportation to their primary care doctor. Others had underlying medical problems, including mental health and substance abuse issues, which were previously undiagnosed. Some of them admitted to getting pain medications so they could sell them to pay their bills or feed their family, Waller said. He visited their homes, went over their medical history; really tried to get at the root of the problem.
After one year in Waller's pilot study the 30 patients saw their trips to the emergency room drop by 85-percent. That's close to a million dollars in savings. Waller says he called around to other emergency rooms to make sure the patients in the pilot study weren’t just going somewhere else.
Waller says the method is the same that many doctors use for transplant or cancer patients. He’s just using it for people who end up in the emergency room a lot. “These are patients who really do need it; who are marginalized, who are really debilitated emotionally because of way that they're treated and the stereotypes that follow along with being a high frequency (emergency room visitor).”
Spectrum Health will open a new clinic next month to expand this pilot program to the entire hospital. The health system estimates the program could save more than $15 million in the first year. From a press release:
New Center patients undergo a series of in-depth evaluations through multiple visits. The visits include a:
• Full history and physical by a physician trained to care for these patients
• Mental health evaluation by a mental health professional
• Comprehensive addiction screening and planning
• Comprehensive medical social work – case management evaluation and intervention
The team will develop a care manual for each patient. Patients will be seen for a three to six month period to monitor how well they follow the plan. After success completion of this period, patients will be discharged to a permanent medical home under the care of a primary care physician.
For the first few months, the Center will be evaluating identified high-frequency visitors from Butterworth and Blodgett hospital EDs, then will accept referrals from other hospitals. Meanwhile, Waller will meet with ED directors from local hospitals to discuss high-frequency patients visiting multiple EDs who would benefit from being seen sooner.