High utilization by intensive users
Intensive users of medical services account for 21% of the Medicaid budget in Texas. Four patients used emergency rooms at 19 different Houston hospitals a total of 179 times last year, according to Primary Care Innovation Center, a Houston nonprofit. One patient had a total of 56 visits to 10 different emergency rooms. These intensive users of medical services - in the jargon, "super-utilizers" - account for 21 percent of the Medicaid budget in Texas, according to Primary Care Innovation Center.
One typical super-utilizer has no primary care physician and suffers from a variety of conditions such as diabetes, hypertension and gout, to give a few common examples. Some experience dementia. When faced with a health crisis, such as a high spike in temperature, the super-utilizer heads to the emergency room.
The super-utilizer may receive a MRI or CAT scan at an emergency room even though a similar expensive test was conducted at a different emergency room weeks earlier. Discontinuity of care - or overlap in care - can be harmful, as well as expensive. For example, the most recent emergency room physicians may not have a record of the patient's existing medications, and the patient may not be able to recall all of them. The patient may receive a prescription for new medication that conflicts with his existing medications.
The irony is that despite their many hospital visits, the super-utilizers receive poor care; their chronic conditions are not suited for treatment in emergency rooms. As an over-reliance on emergency centers is expensive, the taxpayer loses, too. A strategy to identify these patients and improve their care is essential to drive down health care costs.
The Primary Care Innovation Center has developed a pilot program, and its initial results working with such patients are encouraging. In the first three months, the costs of emergency room visits by the super-utilizers enrolled in the program and ambulance transport dropped 85 percent from the previous three months.
Although the nonprofit has not yet duplicated its results in a large population, its strategy makes sense. Nurses, social workers and other caregivers work with super-utilizers to solve the underlying problems that contribute to these patients' over-reliance on the emergency care system, such as lack of transportation, housing and education.
Other similar programs across the U.S. have shown dramatic decreases in the utilization and related cost of emergency room care. Texas needs this kind of cost-saving innovation, as the average Medicaid expense of its super-utilizers is 50 percent more than the rest of the U.S., according to Dr. David Buck, president of Primary Care Innovation Center and professor at Baylor College of Medicine's Department of Family and Community Medicine.
Our various hospital systems need to work together to identify these super-utilizers and coordinate their care. This will require overcoming barriers to the sharing of medical records and to standardizing databases. The Legislature should act to provide adequate sources of reimbursement for Medicaid services to maintain continuity of primary care. All state leaders should spend more time listening to physicians with innovative ideas - such as Dr. Buck - and less time lecturing federal officials. Texans would benefit from more efficient use of tax dollars, and Texans with chronic conditions would receive better care.
Published On: March 10 2015 in the Houston Chronicle. Read the complete article here.
