FOX 31 Investigates: Super Utilizers
Mon, 12 May 2014 20:46:45 GMT —
There's a problem brewing in the health care system. Thousands of dollars are spent every single month on patients, who health care professionals say shouldn't be there.
Clair Byrnes with Tift Regional Medical Center says, "In an effort to control those costs and not have those added expenses we are working on ways to prevent those re-admissions."
They're called "super utilizers," people who don't typically have a primary care doctor and over-use the emergency room for minor issues.
Byrnes says, "when they're here it may only be three or six a week but they may be back next week it may be those same patients that are back the following week."
According to a study by the Camden Coalition of Healthcare Providers, these super utilizers can cost a hospital on average up to $33,000 per month.
"If a patient is admitted within a certain time frame and within the next 30 days if they're admitted again Medicare will not pay the health system for that," says Byrnes.
Kaine Brown with the Tift Regional Medical Center Transition Clinic says, "basically if we can catch things as they happen sooner maybe we're able to keep them out of the hospital and enhance their care overall."
At Tift Regional Medical Center a lack of coordination for super-utilizers, can lead to repeating really expensive diagnostic tests such as CT scans. FOX 31 news reached out to local 911 centers to get their take on how the cost is affecting them due to transport. All declined an interview. They felt revealing information would be a HIPAA violation but after checking with a local lawyer, we found that to be untrue.
Brown says, "we've essentially taken a Band-aid approach to medicine in the sense that we don't worry about something until it starts to affect us and so you're starting to see more of an emphasis on preventative care, we've seen more of an emphasis on routine visits with your physicians so you can make sure that whatever medical problems that you have are kept in check so you won't have to go to the emergency room."
But what they've found is a way to help control those costs. The goal is not to drive patients away from the hospital, but to give them other options. They call it a transition clinic.
"What we do here is we provide that initial visit after discharge, we provide as many follow ups as we need to until those patients are able to get in to their primary doctors so that transition is as smooth as possible," says Brown.
The clinic helps recently discharged patients who don't have a doctor or won't be able to see them in a reasonable time span.
"If the period between discharge and the follow up with their physician is longer than two to three weeks, they have a higher chance of coming back to the emergency department," says Brown.
Hospital officials say by cutting down the time, they're able to help stabilize the cost.