Your hypothesis is born out by example.
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Monday, October 11, 2004, 01:38 P.M. Pacific
Taxpayers footing bill for excessive use of ERs
By Kyung M. Song
Seattle Times staff reporter
A 47-year-old Snohomish County woman made 131 trips to the hospital emergency room last year — more than once every three days, on average.
Her chief medical complaints: headaches, backache and migraines.
The cost of this emergency care, paid by taxpayers: more than $21,000. And that doesn't count her prescription-drug bill.
The woman topped the Washington Medicaid program's first list of emergency-room "frequent fliers" — patients who make an inordinate number of ER visits and often walk out with a prescription for narcotic painkillers.
The state compiled the list in an attempt to identify heavy emergency-room users on the federal-state insurance program for the poor and steer them to less costly forms of care, such as a doctor's office or community clinic. The heaviest users would be assigned to certain doctors to monitor their care.
The ER list surprised and alarmed Medicaid officials.
A 57-year-old Thurston County man, the No. 3 ER user on the list, traveled throughout Washington and even to Tillamook, Ore., seeking emergency care last year. He visited 59 hospitals for a total of 126 ER visits.
A 46-year-old Spokane County woman made 119 emergency-room visits and obtained 392 prescriptions during the year. Her drug bill alone topped $18,000.
Equally troubling to Medicaid officials, the most-frequent ER users also are big consumers of expensive narcotic painkillers, such as Oxycontin and Vicodin.
The state counted 198 Medicaid patients who made more than 30 visits each to hospital ERs in fiscal year 2002, most commonly complaining of migraines, backache and abdominal pain. They left with a prescription for painkillers 99 percent of the time, the records show.
That has Medicaid officials suspecting that some people are cruising emergency rooms to hunt for painkillers.
"If you were taking the number of drugs they're taking, you wouldn't be able to function," said Doug Porter, Washington's Medicaid director, who added that visiting emergency rooms is a "full-time job" for some patients.
Ken Stark, director of the Division of Alcohol and Substance Abuse of the Washington State Department of Social & Health Services, said drug users are adept at exploiting busy emergency rooms to finagle prescriptions.
"ER doctors err on the side of whatever they need to do to move on to the next patient," Stark said. "Drug seekers have become incredibly proficient at signs and symptoms of pain."
ER costs growing
Medicaid patients are using hospital emergency rooms more than ever. The state spent an average of $967 on emergency care for each Medicaid enrollee last year, a 12 percent increase over the previous year.
Medicaid pays emergency-room physicians $37.18 for each patient, compared with $35.25 for a doctor's office visit by an adult. But Medicaid also pays an additional $170 on average for use of the emergency room, making such visits much more expensive than seeing a regular physician.
The rise in emergency-room costs comes as Washington's Medicaid program is already facing financial strain. A tighter state budget last year prompted Medicaid to reduce adult dental benefits by 25 percent.
The state also was poised to start charging monthly premiums for low-income children for the first time this year before backing off amid protest by children's advocates.
But reining in emergency-room use won't be easy. Poor and disabled people rely on ERs for a host of reasons: trouble finding a doctor who accepts Medicaid; accidents resulting from mental illness or drug abuse; the ease of free transportation to the ER; and the emergency room's 24/7 hours of operation, a not inconsequential factor for low-wage workers who can ill afford time off to see a doctor.
The state wants to slap restrictions on top ER users by assigning each to a single gatekeeper physician to oversee all of their medical needs. The so-called "patients requiring regulation" program was started in the early 1990s but fell out of widespread use with the growth of managed care.
Medicaid officials are reviving the program to pair the top 200 ER users with doctors willing to act as medical traffic cops. But Medicaid officials have been unable to recruit enough doctors to take on all the high ER users, some of whom aren't easy to handle.
"These patients can be belligerent, and they can be demanding," said Porter, the Medicaid director. "These are very difficult patients."
Mental illness and substance-abuse problems compound the challenges of curbing excessive ER use. According to the state analysis, almost nine out of 10 heavy ER users suffer from either psychiatric conditions or alcohol or drug disorders, and more than half have both.
Porter said he plans to ask the Legislature next year for $50 million to expand substance-abuse treatment programs to help divert traffic from emergency rooms. He says the state expects to wring the $50 million out of Medicaid by clamping down on unneeded ER treatments.
Rest at: seattletimes.nwsource.com |
