When people routinely visit the emergency room for nonemergencies, it's not only costly to the health care system but a stress on hospitals, especially one such as Sinai Hospital, which is among several in the state that care for the worst traumas.
So the hospital announced Wednesday that it is partnering with a nonprofit health care advocacy group to target so-called "frequent fliers" or "super utilizers," about 200 patients who visit the emergency department four or more times in a four-month period, some as many as 20 times.
Federal regulators consider four or more times a year to be a problem.
"Our goal is to improve care and help Sinai with reducing their number of repeat ER visits," said Kathleen Westcoat, president and CEO of HealthCare Access Maryland, which along with Sinai applied for an $800,000 grant from the Maryland Community Health Resources Commission to fund the program over three years.
"Some fairly simple interventions can help keep people from using high-cost services," she said.
The program will help the targeted patients get primary and preventive care in their communities, Dr. William Jaquis, Sinai's chief of emergency medicine and a commissioner, said in prepared remarks.
Care coordinators will also link patients to services that support their general health, including drug and mental health treatment, housing, transportation and prescriptions, Westcoat said.
"Sinai's partnership with HealthCare Access Maryland to pilot this unique program is in step with our commitment to population health — connecting resources, outreach and links to health-promoting care," said Amy Perry, president of Sinai and executive vice president of LifeBridge Health.
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The idea isn't new, and others around the state and nation are experimenting with ways to cut unnecessary emergency department visits, as well as hospital admissions and readmissions. The federal office that oversees Medicare and Medicaid, for example, is working to reduce hospital readmissions by financially penalizing hospitals that have too many within a 30-day period.
In Maryland the issue has a special urgency. The state has federal permission to operate under a unique system to control hospital rates, and it is in the process of capping hospital revenue as part of that structure. That is pushing the facilities to control unnecessary spending in emergency departments and elsewhere.
The Community Health Resources Commission, created by state law in 2005 to expand access to health care in underserved communities, has handed out about 20 grants this year totaling $2.85 million, including this one. It received 65 applications.
Officials chose the Sinai project because it seemed that, if successful, it could "help guide and inform other projects in the state," said Mark Luckner, the commission's executive director. He noted that the General Assembly approved funding this year that could pay for similar programs.
Other commission grants will help boost access not only to primary care, but to dental services and behavior-health services, Luckner said. They also will help boost capacity at safety-net providers and address childhood obesity.
For example, Planned Parenthood of Maryland plans to reduce infant mortality rates by increasing access to women's health services, the Allegany County Health Department aims to address workforce shortages by training and assisting behavioral health providers, and the University of Maryland School of Medicine's department of pediatrics wants to reduce childhood obesity by promoting healthy eating and exercise in three public schools.