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Hospital starts new program for frequent emergency patients

A new plan to assess and treat patients who go to the hospital emergency more than 10 times a year could save millions of dollars in costs, as well as free up the emergency room.
Spectrum Health announced the formation of a multi-specialty clinic to assess and treat high-frequency patients at area emergency departments (EDs). The Spectrum Health Medical Group Center for Integrative Medicine began seeing patients December 5, and will employ a novel approach to assess the issues facing chronic ED users.
The Center will employ enhanced medical management, aggressive social services and intensive psychiatric evaluation and treatment. The Center’s mission is to help these patients integrate into primary care and other traditional outpatient medical settings as opposed to seeking care in EDs.
The Center is a response to an issue identified by emergency and addiction medicine specialist R. Corey Waller, MD, MS, in 2008. During that year, approximately 950 patients were identified as visiting Butterworth and Blodgett hospital EDs greater than 10 times. These patients were responsible for more than 20,000 total visits and 40-50 million dollars in costs.
These patients were mainly young, healthy people with hard to diagnose conditions, psychiatric illness, chronic pain and/or addiction as their major medical issues. A pilot study of 30 of these patients completed in 2008 showed an 85 percent decrease in ED visits and close to one million dollars in savings.
The central goal of the Center is to identify, accurately diagnose, and develop a care plan for each patient. When treatment is stable and the patient has successfully followed up with a primary care physician, the patient will be transferred into a primary care office.
This approach will result in better patient care, improved ED operations, and will help hospitals by reducing unreimbursed care in a higher-cost setting. It is estimated that the program could save commercial insurers plus Medicare and Medicaid more than $15 million in Spectrum Health ED reimbursements during the first year of operation.
“This model of care is a win for patients, providers and insurers,” said Waller, who will serve as medical director of the Center. “We’re dealing with patients who need an in-depth care plan and a continuum of care that can’t be delivered efficiently in an ED setting. It can also free up space in the ED and allow them to deliver care more efficiently. In addition, insurers are paying for primary care for these patients instead of more expensive emergency care.”
People visiting EDs more than 10 times a year will be identified as potential patients for the Center. 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.
The Center will employ approximately seven people and be located at a Spectrum Health owned building at 75 Sheldon, SE.  Staff from Network180 will provide behavioral health assessments and treatment plans.
“Many of the persons who are frequent users of emergency services are already involved with Network180. This project will improve the health of these patients, in a comprehensive way, by partnering with Dr. Waller and Spectrum Health to integrate our behavioral health services with this clinic,” said Mark Witte, planning director of Network 180.
“We’re always looking for ways to deliver health care more effectively and efficiently and the Center is an excellent example of that approach,” said Matt Van Vranken, executive vice president, Spectrum Health Delivery System. “Getting these patients into a clinic designed for their needs with follow up care by a primary care provider is the best way to serve these patients. Hospitals also benefit since care provided in an ED setting can be more expensive and those costs are not fully reimbursed through Medicaid and Medicare.”
Another benefit of this program is getting hard-to-place people into primary care settings, Waller said. “About 54 percent of this population are Medicaid patients and about 16 percent are Medicare patients. It’s historically been hard to get primary care physicians to accept these patients—partly because they have complex medical issues. Because of the Center, every one of these patients going to a primary care practice has a full diagnosis and care plan prepared. This approach doesn’t overly stress primary care groups’ resources. It lets physicians focus on working the plan with patients.”
Waller says the benefits of this approach are not limited to Grand Rapids patients, hospitals and insurers. “The Center’s approach could easily be replicated in other communities throughout Michigan. The pilot program showed we can reduce ED visits among this population by up to 85 percent. I estimate that Medicare and Medicaid could expect a savings of $12-15 million in charges from Spectrum Health patients alone, which mean $8 million would be saved in one year through Michigan’s Medicaid program. This could mean an estimated one-year savings of $150-250 million in actual state Medicaid expenditures for these patients if this clinical model was copied throughout the state. This estimation is based on the assumption that ED visits would decrease by 50 percent, like they did in our pilot program.”

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