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Old April 2nd, 2009, 04:32 AM   #1
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Austin ER's got 2,678 visits from 9 people over 6 years

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 Mary Ann Roser
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 Travis 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 Patricia 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. Christopher 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-Travis 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.

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Old April 2nd, 2009, 04:34 AM   #2
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?It?s a pretty significant issue,? said Dr. Christopher Ziebel
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