Hospitals in New York State are targeting so called “super users” who may end up in the ER as much as a dozen times a month. Such patients frequently lack coordinated primary care, and intervening in these cases can both help improve health and save money.
While a few hospitals have done this in the past and greatly reduced their costs, New York State is in its second year of an official coordinated program to deal with repeat ER patients. Two Buffalo hospitals have begun to implement the $8 billion “Delivery System Reform Incentive Payment Program.”
The Program is designed to identify and contact frequent ER users who are either enrolled in a Medicaid HMO or on Medicaid. “Health Connection” employees make follow-up calls to patients and document whether they have a primary care physician. If they do have a PCP, the employees will ask why they visited the ER and also track whether the visit was an issue of transportation or convenience.
Both Mercy Hospital and Sisters of Charity Hospital of Buffalo are aggressively pursuing this approach under the auspices of the Community Partners of WNY. Their two ERs alone see about 100 patients a day who are part of the targeted population. More than half do not need to be in the hospital, because a PCP could provide the care that they need.
Between May and October 2016, roughly 13,000 different patients who met the criteria of the program visited just 5 ERs within the Community Partners of WNY Performing Provider System.
One goal of the program is to partner these super users with a doctor associated with a patient-centered medical home structure to help them manage their healthcare problem(s). By doing so, New York State hopes to reduce avoidable hospitalizations by 25% by 2020.
Additional hospitals in New Jersey also implemented similar programs. It is highly likely that these efforts will significantly reduce costs to the taxpayers and provide better care to these patients.