A new pilot program aiming to link non-urgent emergency department (ED) patients, such as a toothache or cold, with a more appropriate community-based medical home is kicking off at Methodist University Hospital on May 29.  The joint effort between Methodist, University of Tennessee Health Science Center’s Preventive Medicine Department, and a number of the local community clinics, will focus on the uninsured and TennCare patients.  The ideas behind the program are to have extra support to reduce non-urgent emergency room visits, one of the causes of overcrowding and financial strain for an emergency department, and to connect patients with a primary care medical home to provide continuity of care.

If the patient indicates they do not have a primary care physician (PCP), or they have difficulty getting in to see a PCP due to their type or lack of insurance, the ED staff will work with the patient to develop a connection with a medical home.  

“The emergency department is not the appropriate place for patients to receive care for non-urgent conditions,” said Marianne Fournie, Corporate Director of Emergency Services at Methodist Le Bonheur Healthcare. 

After patients receive a medical screening exam and treatment, patients will be asked to follow up with a PCP.  If they do not have one, and they are uninsured or have TennCare, the ED staff will help arrange a follow up appointment at one of the low-cost clinics.  The clinics include The Health Loop (Ayres site), operated by the Memphis and Shelby County Health Department, Church Health Center, Memphis Health Center, and Christ Community Health Services (4 sites).  A tracking system will be in place to ensure patients go for their clinic visit and continue to go.  The clinics are providing open access hours just for these patients so that appointments can be expedited.

“Our expectation is that once the patient establishes a relationship with a clinic and PCP, they will go there instead of the emergency department for their next non-urgent illness,” said Fournie.

“Our goal with this project is to help people get the health care they need in the most appropriate place,” said Church Health Center Director Ann Langston. “By moving patients who rely on the ED for non-urgent care to a primary care physician and a dependable medical home, we make better use of the resources of our healthcare system. The high cost of ED care will be replaced with more affordable primary care. Our hope is that this will allow us to redirect resources to build a system to care for more uninsured people in a primary care setting.”

The idea for this pilot came from regular meetings throughout the past year of hospital chief financial officers and management of the community clinics who are working together to better utilize existing resources to serve the uninsured and underinsured in our community. UT surveyed patients in emergency departments across Memphis who were there for less urgent care to determine the reasons. 

“Sixty-four percent of the patients surveyed at Methodist University Hospital said they did not know of any other place they could have gone for the care they needed.  Many, however, said that if they had a primary care physician close to home, they would go there,” said Fournie.

Other hospitals in Tennessee and across the nation are employing similar tactics to combat the problem, including South Side Health in Chicago, Middle Tennessee Medical Center in Murfreesboro and Vanderbilt and Saint Thomas in Nashville.

“There has been a great increase in people seeking primary care in the ER,” said Craig Becker, president of the Tennessee Hospital Association (THA).  “If ERs keep getting flooded, they aren’t going to be able to care for those who truly need them.”

THA reports that from 2004 to 2006 the number of uninsured visits to emergency rooms around the state jumped to 62 percent.  The cost to hospitals for this care grew from $43.8 million to $116.2 million in that period.  Nationwide about 40 percent of emergency room visits are for non-emergencies.  Becker says Tennessee’s number may be even higher.

“It is a nationwide trend, but in Tennessee it’s a bigger trend because of TennCare cuts,” Becker said.

With nearly 100 patients a day, Methodist University Hospital expects to refer 25-30 patients a day to clinics.  The program’s success will be measured by tracking how many patients went to the clinic for initial and repeat visits.

After the pilot, the intent is to replicate the program at other area hospitals. “It will take a little time to see if the program is successful, but we are very optimistic,” said Fournie.  “We have identified specific outcome measures, and we are going to drill down to find out what the real issues are.  We will do whatever it takes to be successfully, even if it means assisting with transportation by offering bus passes.  The long-term “win” is to keep people healthy with continued medical supervision and decrease emergency department overcrowding”