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City looks at 911 system

The Baltimore Sun

Baltimore's busy public ambulance service went out on more than 150,000 calls last year, responding to everything from car accidents to heart attacks. About 2,000 of those calls were from the same 91 people.

The breakdown: 38 people called between 15 and 20 times each, 37 called between 21 and 40 times, 13 rang up between 41 and 60 times, and two connected over 60 times. The high scorer called 107 times.

Officials fear the high frequency of calls from a small number of people means this group is using 911 because they lack transportation or insurance - and the result is worse care for them and higher costs for the city.

"A lot of them are using the fire department as the doctor," said Kathleen Westcoat, President of Baltimore Healthcare Access, Inc. "They call 911 and they know the ambulance will come, because it has to."

Yesterday, the city announced a program to cut down on the repeat calls and provide the callers with better health care. Called Operation Care, the approach will help the patients get health insurance, and will also connect them with a range of other services, including disease management programs and homeless shelters, that officials hope will improve patients' health.

"We want to get these people better healthcare so they don't call 911 so much," said Dr. Joshua M. Sharfstein, Baltimore's Commissioner of Health.

Sharfstein said that many of the calls are probably related to chronic health conditions, such as diabetes, hypertension and asthma. People without insurance, or overwhelmed by a byzantine healthcare system, often end up neglecting routine treatment of these ailments, and using otherwise expensive emergency care that could have been avoided.

The program will be run by Baltimore Healthcare Access, a nonprofit. The group will assign each patient a case manager, who will help patients navigate various healthcare options to better deal with their conditions.

Operation Care is a pilot program, and will last for three months. It costs around $20,000 - half from the city health department, and half from Healthcare Access.

"We're gonna see if this makes a difference," said Sharfstein.

The program may not make a significant dent in the overall number of emergency calls in the city. Baltimore's 26 ambulances make about 150,000 runs a year, according to Baltimore City Fire Department spokesman Kevin Cartwright.

Westcoat said that even reducing the load by a few percent would ease the stress on the system. "I think it would be easy to save a bunch of money," she said.

In any case, Sharfstein said, the main focus was not on lowering call numbers, but on helping repeat callers.

Westcoat said health insurance was often a key problem for the high-volume callers. She said about half of the repeat callers were not insured; most of these were probably eligible for some coverage, she said. Most of the repeat callers are between 40 and 60 years old.

Westcoat estimated that perhaps 120,000 of the city's 600,000 residents lack health insurance. "That's very high," she said. "That's completely unacceptable."

The program will begin Monday. Baltimore Healthcare Access will devote one nurse and five case managers to the work, Westcoat said.

In March, Washington began a similar program. The District of Columbia health department identified 30 people who made a total of 2,400 calls. The top dialer phoned in 243 times.

In response, the D.C. government set up a program known as Street Calls. City workers regularly visit the callers to educate them about 911, and to help them with medical issues.

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