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Hospital Reduces Repeat ED Visits by Providing Social Workers

Milwaukee facility helps guide frequent ED visitors to appropriate primary care

Aurora Sinai Medical Center in downtown Milwaukee is trying a pilot project to reduce emergency department (ED) visits by providing social workers who can help patients develop relationships with primary care doctors.

According to National Public Radio, the pilot project at Aurora Sinai — the only hospital left in a mostly poor, black area of downtown Milwaukee — is labor intensive. But it is showing promise in getting patients connected with primary care doctors and in cutting ED costs.

Mark Huber, the hospital's senior vice president of social responsibility, says the hospital placed social workers in the ED full time. It then identified 313 so-called frequent fliers who visited Aurora Sinai's ED at least five times in four months. Those patients alone accounted for 1,827 ED visits in that time.

The social workers chose 39 people out of the 313 and spent the next eight months trying to change their habits so that when they get sick, they go to a primary care doctor or clinic rather than the ED. The social workers developed a plan for each patient that included finding transportation to a doctor and securing child care for the appointment. Then they helped the patient make a first appointment. Sometimes they even accompanied the patient to the visit. After the visit, the social workers ensured that the patient made at least two follow-up appointments.

In the first four months, visits by these 39 people to the Aurora Sinai ED fell by 68%, from 487 to 155. Compared to the four months before the program, the cost fell from $1.5 million to $440,000. The immediate savings of more than $1 million make the effort appear worthwhile if the patients continue to see their new doctors and don't return to their ED habits.

The efforts are aimed squarely at one of the biggest conundrums emerging from the passage and implementation of the Affordable Care Act (ACA). Policymakers thought that once people had health insurance, they would stop using EDs for basic health care. Instead, the opposite has happened. Study after study has shown that ED visits skyrocketed once the ACA was implemented. People newly covered, especially by Medicaid, the federal insurance program for the poor, are flocking to EDs for care.

Wisconsin did not extend Medicaid to as many poor residents as it could have under the ACA. Still, Governor Scott Walker did expand the program so that poor adults without children can now get the insurance. Huber says one of the challenges is that many of these patients have serious physical ailments but also suffer from underlying mental health issues, such as anxiety and depression. Those ailments make the prospect of finding a new doctor, making an appointment, and following up harder than it is for patients without such challenges.

One development that may aid Huber's efforts is that Aurora is going to open a community health clinic and an urgent care center within its walls. The new centers, set to open later this year, will allow ED staff and social workers to direct patients immediately away from the ED and into more appropriate care.

Source: National Public Radio, October 23, 2015.

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