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A patient talks with nurse in the Emergency Room at Central Montgomery Medical Center December 10, 2004 in Lansdale, Pennsylvania.
This week a joint venture between the San Diego Union-Tribune and USC’s Center for Health Reporting gives us a new use of the term “frequent flyers” – this time as a name for the .08 percent of San Diego’s population that produces 17 percent of the city’s 911 calls and relies largely on emergency room visits for their health care.
The group is mostly homeless, and at an average of six visits a piece per year, costs taxpayers close to $20 million in ambulance and paramedic charges. The issue is neither unique to San Diego nor purely financial – emergency room doctors, paramedics, and firemen spend an extraordinary amount of energy, time, and resources on such patients, who often don’t even have the support to follow through with aftercare instructions.
"These folks are very very hard to reach. Its cheaper to provide these folks coordinated care and housing than it is to leave them free on the street to call 911 over and over again," said John Gonzales, senior writer for USC Annenberg's Center for Health Reporting. "The trick is to get these people in those programs and get them to stay."
One solution is programs like Project 25, started with a $1.5 million United Way of San Diego County grant, which aims to get these frequent users off the streets altogether and into housing. However, keeping people in the program is proving to be difficult, and there are other competing interests when it comes to medical care.
"Hospitals do get reimbursed by the federal government for taking care of these types of patients, and although that's warranted, it has become a bit of a crutch," said Gonzales. "Systematically there has to be more endurance with these people. If you buy into the notion that providing them coordinated care is going to save you money in the long run, you've got to resist the tendency to dismiss them."
Could there be other solutions to this problem? Is enough being done?
John Gonzales, senior writer, Center for Health Reporting, USC Annenberg
Dr. Jim Dunford, City Medical Director, Emergency Medical Services, San Diego