As an ER nurse, one of the toughest things about working in such a high demand and high flow environment is prioritizing patients and seeing the most critical patients in a timely manner. I come across many different personalities and situations. One of which is the most frustrating, as an ER nurse is the type of patient that we lovingly refer to as a “frequent flier”. These patients (aka frequent fliers) are the patients who come in several times in a day/week/month/year with or without emergent health needs. Sometimes the problems stem from social or economic factors, lack of knowledge on their disease process, lack of access to timely primary care doctors, or lack of affordable care other than an ER visit. Often times, these patients are faced with tough situations because they are known throughout the hospital and providers have compassion fatigue from treating them for the same issue each day/week/month. On top of that issue is the concern of cost, many of these patients are on Medicaid or Medicare and are in situations that could have been preventable with better outpatient/primary care. This issue is one that every hospital faces in the United States and the long-standing question has been how or if the hospital can even tackle the issue.
Recently I stumbled across an article on NPR about these types of patients, also known as “hot spotters”, who cost the hospital, Medicaid & Medicare, and the health care system large amounts of money each year. It highlights a special initiative, the Comprehensive Primary Care Initiative, which allows primary care practices more resources in order to invest in their workforce. With the right approach, like Dr. Brenner’s clinic in New Jersey, the practices can hire an extra nurse or social worker in order to follow patients or make house calls in order to decrease the social, economic, or other barriers in their care. The general idea is that if there are people who can intercept these patients’ problems before they have to go to the Emergency Department and become admitted to the hospital than they will be making a significant impact on costs. In the fall of 2012 the Center for Medicaid and Medicare services launched this initiative in 500 primary care practices to gauge the affect. Already there are similar programs that have shown promising results.
If the results from the initial Primary Care Initiative prove successful I think then the real work will begin. It will be an uphill battle to then go to hospitals and convince them to invest in these types of initiatives in order to reduce their costs. Although, I am confident that it would provide better, safer patient centered care I think there will need to be significant and dramatic decreases in order to convince more investors that it is a good financial investment for the future.