Here's the thing, they are not getting the help they need when they come to the emergency room. They are handled in one of two ways:
1) They are quickly discharged. Its a been there, done that situation for the doc.
2) They are worked up by the OCD/CYA docs, wasting everyones time.
I would venture to guess that the vast majority of these people are on medicaid or have no insurance at all. The reimbursement for their bills are nonexistent or very low. They cost the hospital money.
If you added up all the frequent flyers in our ER, I think it would come to at least 10-15%. Lots of people. Lets say we have 60,000 visits a year - thats 6-9,000 unnecessary, money wasting visits. In this day and age of hospitals just trying to make ends meet, its really ridiculous.
It seems like most ERs just ignore the problem. Like mine does. We let it go on and on. Some ERs hire case managers who work with these people. They try to hook them up with community resources, direct them somewhere else, try to figure out what they really need so they can stop coming to the ER. Does it work? I have seen articles saying that it does.
Does your ER use them? What do you think about how well they work?
Case management in any area of medicine has a huge future. It has been proven to save money. Its an alternative for nurses who don't want to do bedside nursing anymore
7 comments:
According to our psych consultant, a task force was actually formed among the ERs and inpatient psych hospitals in my area to deal specifically with ONE of our frequent flyers. It never helped- the only times we would get a break from him was when he would cut up enough to get thrown in jail for a couple of months.
Our hospital policy years and years ago was to chip in a buy a bus ticket for the person to their home town. Legal? I doubt it. And, sad to say, they always returned.
Our ER uses case managers, but their main job is to review admissions and see if they are appropriate for observation or inpatient status as to not make us get over-paid or under-paid/make Medicare/Medicaid happy.
Generally, when I hear the term "case manager" in the ER, it has to do with this this and not the "case managers" that work with insurance companies or clinics to try to reduce hospital admissions and things of that nature.
The way to reduce repeat visits to the ER is to really avoid handing out narcotics unless there is an acute injury or similar. Then, you work on curing anxiety.
Cure you ask ?
saves_millions
Excerpt "The 98 street drunks whom the study tracked had cost the public $4,066 a month prior to entering 1811 and afterwards they cost $1,492 a month after six months in the facility and $958 a month after 12 months. That's a pretty big savings and, oddly enough, some of the residents began to drink less. Some even got sober. (Some also died.)"
Addressing this can save the typical ER $1million-2million/yr. Addressing fraud (usually related to drug seeking in states with prescription drug monitoring programs) can save the typical ER $1million to $4million/yr. Pretty simple math if management gets the message.
Tell me about it!
My hospital's Psyche ED is filled day in and day out with these guys: folks just looking for drugs or for a "vacation" (free shelter and food on the hospital's dime).
Our ER uses case managers, but their main job is to review admissions and see if they are appropriate for observation or inpatient status as to not make us get over-paid or under-paid/make Medicare/Medicaid happy. Generally, when I hear the term "case manager" in the ER, it has to do with this this and not the "case managers" that work with insurance companies or clinics to try to reduce hospital admissions and things of that nature. The way to reduce repeat visits to the ER is to really avoid handing out narcotics unless there is an acute injury or similar. Then, you work on curing anxiety.
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