Hospitals aim to take patients from ER to medical home

jholleman@thestate.comOctober 27, 2013 

About 8,500 uninsured people who have shown up routinely at South Carolina hospitals for emergency care will get free comprehensive care designed to keep them out of emergency rooms.

The effort is tied to the S.C. Department of Health and Human Service’s new Healthy Outcomes program, spelled out in a state budget proviso this year. In order to be eligible for its full portion of the state’s pot of $474 million of Medicaid funds allocated for treating the uninsured, each hospital must put together a plan designed to keep frequent emergency room patients out of the hospital.

Large hospitals that didn’t participate in the Healthy Outcomes program would lose 10 percent of their share of the uninsured funding. Not surprisingly, each hospital came up with a plan. The goal is to save money by improving the health of a select group that runs up extreme costs with no means of paying for their care.

At Palmetto Health Baptist and Palmetto Health Richland, 1,268 uninsured patients made at least four visits to the emergency room in a recent 12-month period. Those 1,268 patients accounted for about 7,500 emergency room visits — nearly 10 percent of the hospitals’ total emergency visits — and almost 600 admissions for hospital care.

Those visits generated $38 million in charges that the patients couldn’t pay. It would be much less expensive for patients with chronic ailments to control those ailments by seeing a primary care physician, getting medication and making lifestyle changes.

Palmetto Health is reaching out to those 1,238 frequent users now rather than wait for them to return to the emergency room. The goal is to get 662 of those patients free care at teaching clinics, health centers and primary care sites affiliated with Palmetto Health. To do that, Palmetto Health will add about 30 employees to expand two programs started in recent years to reduce hospital readmissions.

Dr. Tripp Jennings, an emergency room physician at Palmetto Health Richland and a consulting medical director with HHS, said it’s common to have emergency patients that don’t meet standards for admission to the hospital “but they just need a little help. It’s very exciting to me to be able to discharge patients who don’t have insurance with more than just hope.”

Abbeville County Memorial Hospital had one of the more unusual plans, using paramedics to check on former emergency room patients at home. They’ll take standard health measurements, make sure the patients have their prescribed medications and get them in touch with physicians when necessary.

Lexington Medical Center is focusing specifically on patients who show up frequently at its emergency room with diabetes complications. Those cases clog an already busy emergency room, which handled 108,000 cases from April 2012 to March 2013. More than one-quarter of those visits — 28,227 — were by people without insurance, and 1,345 of those involved a diabetes-related problem.

The hospital set up Lexington Medical Associates in 2001 to provide a medical home for patients without insurance or the means to pay for care. Lexington Medical Associates has about 1,500 patients. The hospital plans to assign Lexington Medical Associates 280 more patients — chosen from those who visit the emergency room frequently. Those patients will have free access to a primary care physician, a diabetes educator and social workers.

Providence Hospitals has identified 457 uninsured frequent emergency room users with chronic illnesses. It will recruit 180 of them for free care at Providence Internal Medicine Downtown, which was set up in 2011 specifically as a medical home for its frequent uninsured users. Providence Internal has 196 uninsured patients now. Providence plans to focus on patients with diabetes, hypertension and cardiovascular disease, as well as behavioral health patients.

The Census Bureau estimates that 50,613 people in Richland County and 46,417 in Lexington County were uninsured in 2011. The Healthy Outcomes programs will pay for medical homes for about 1,100 of them.

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