California Pilot Project Seeks To Reduce Repeat Use of Emergency Departments by Uninsured

Two Santa Clara County hospitals are beginning a 12-month pilot project designed to reduce the number of patients who repeatedly visit emergency rooms, a practice that costs hospitals millions of dollars each year, the Silicon Valley/San Jose Business Journal reports. Under the project, one case manager will work at each of the emergency departments at San Jose Medical Center and Valley Medical Center to identify repeat patients, then "work to deliver the health care services needed to keep them out of the emergency department." The project is sponsored by the Hospital Council of Northern and Central California. The Hospital Council received a $65,000 grant from the Health Trust, a public benefit organization that seeks to improve the health and wellness of at-risk, underserved county residents, to conduct a preliminary study of nine county ERs. The study found that 2,433 uninsured patients or Medicaid beneficiaries made at least four visits during a 12-month period, for a total of 14,585 visits. The study also found that most repeat patients were uninsured working poor -- whose care is uncompensated -- or individuals with substance abuse problems. Most were men between ages 30 and 50. Once the preliminary study was completed, the Health Trust awarded the council a separate $530,000 grant to conduct the pilot project, which will give hospital executives a "clearer idea of how much these repeat visitors are costing hospitals." A preliminary analysis of billing records of five local hospitals indicated that repeat patients cost hospitals $7 million every 12 months. Barbara Harrelson, regional vice president for the Hospital Council, said the organization would like to expand the pilot program to all Santa Clara hospitals if funding becomes available.

Repeat Performance
The Santa Clara pilot project is based on a similar program started at San Francisco General Hospital in 1995 that has reduced by 50% costs associated with repeat users of its ER. A study published in the American Journal of Emergency Medicine in 2000 reported that the hospital saved $132,726 on 53 patients who had used the ER at least five times in a 12-month period. Kathy O'Brien, a clinical social worker and program coordinator at San Francisco General, said the case manager system had worked so well with ER patients that the hospital was considering whether to offer a similar program for frequent users of inpatient services. "We are saving the hospital thousands of dollars," she said (May,Silicon Valley/San Jose Business Journal, 2/22).