Austin ER's got 2,678 visits from 9 people over 6 years

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Austin ER's got 2,678 visits from 9 people over 6 years Task force seeking

ways to divert non-emergencies away from emergency rooms.

By Ann Roser

AMERICAN-STATESMAN STAFF

Wednesday, April 01, 2009

In the past six years, eight people from Austin and one from Luling racked

up 2,678 emergency room visits in Central Texas, costing hospitals,

taxpayers and others $3 million, according to a report from a nonprofit made

up of hospitals and other providers that care for the uninsured and

low-income Central Texans.

One of the nine spent more than a third of last year in the ER: 145 days.

That same patient totaled 554 ER visits from 2003 through 2008.

" We looked at frequent users of emergency departments ... and that's the

extreme, " said Ann Kitchen, executive director of the Integrated Care

Collaboration, the group that presented the report last week to the

County Healthcare District board. " What we're really trying to do is find

out who's using our emergency rooms ... and find solutions. "

The health district, one of 26 members of the ICC, has long been concerned

about overuse and crowding of ERs, a problem that has hit hospitals around

the country.

The district is seeking ways to reduce the load on ERs by better managing

where patients who don't have a real emergency go for care, CEO and

President Young Brown said. In the past couple of years, the

district has expanded hours at public clinics it oversees and has financed

an urgent care center, where patients who don't have real emergencies can

receive after-hours medical treatment at a lower cost to taxpayers than in

an ER.

The ICC staff, meanwhile, has been gathering data so its members could learn

more about the kinds of patients who use the ER.

The report that mentioned the nine high-frequency patients didn't include

reasons for all of those ER visits and didn't identify the patients because

of privacy laws. But Kitchen, a former state legislator from Austin, gave a

sketch: All nine speak English; three are homeless; five are women whose

average age is 40, and four are men whose average age is 50. Seven have a

mental health diagnosis and eight have a drug abuse diagnosis. Kitchen said

she did not know their citizenship status.

Kitchen estimated that each ER visit averaged about $1,000. The cost

represents a national average for all ER patients, said Anjum Khurshid, the

ICC's director of clinical research and evaluation and co-author of the

report.

The ICC, whose mission is to work with safety-net providers to improve

access to and quality of care, has a database of 750,000 uninsured and

underinsured Central Texas patients collected from its members. That

database is confidential because of patient privacy laws. It found that 900

frequent users - people who visited an ER six or more times in three months

- had 2,123 preventable visits in 2007, or 18 percent of 11,600 total visits

to Central Texas ERs, which cost more than $2 million. Among those picking

up the bill were hospitals and taxpayers, including government programs such

as Medicare and Medicaid, Kitchen said.

She defined a preventable visit as one in which the patient could have been

treated earlier in a different setting, such as a clinic, avoiding the trip

to the ER.

" It's a pretty significant issue, " said Dr. Ziebell, chief of

the emergency department at University Medical Center at Brackenridge, which

has the area's busiest ER.

Ziebell is a member of a task force that includes representatives of the

health district, hospitals and other medical providers studying ways to

reduce inappropriate ER use. Solutions might include referring some frequent

users to mental health programs or primary care doctors so they would go

there first in the future, Ziebell said.

When frequent users come to the ER now, Ziebell said, his first obligation

is to stabilize them if they are having a medical problem. If not, he tries

to assess their problem and determine where they should go for care, such as

a community clinic, the local mental health center or a doctor who might be

treating their asthma, for example.

" They have a variety of complaints, " Ziebell said. With mental illness, " a

lot of anxiety manifests as chest pain, " he said.

In a report last year, Austin- County Emergency Medical Services said

that 10 patients made up more than 1 percent of the system's 130,000

contacts with patients in two years. The patients' most common ailments were

stomach or chest pains, injuries or respiratory problems.