One patient visited a Renown Health emergency department 412 times. Another was admitted 112 times in a single year. Those numbers, Jason Knight, MD, said, present the case for rebuilding how the Reno, Nev.-based system manages its highest utilizers.
Renown now runs panels of case managers and social workers — with physician oversight and backup — that manage 300 to 500 of these patients each, coordinating dialysis and other recurring care before it becomes an emergency.
“A small percentage of the patients use 50% of the health system resources,” Dr. Knight, CMO of Renown Regional Medical Center in Reno, said on a Becker’s virtual panel. “If you’re looking to develop a program, [a high utilization program is] probably one of the best areas to start.”
The approach is spreading. At Cleveland Clinic, one community hospital stopped admitting a patient who came to the emergency department for chronic transfusions and instead fast-tracked them to an ambulatory clinic on a set cadence, said Meredith Foxx, MSN, senior vice president and chief nursing officer. The system’s Connected Care program sends advanced practice providers and paramedics to homes and nursing facilities to head off avoidable admissions.
“OK, I tighten up their discharge, I sent them home, I got their durable medical equipment, I have their medications, they have a plan for home care. You know, check, check, check, but what happens after that to make sure, did they get all that stuff?” Ms. Foxx said.
“I’m sure all of us have examples of where patients have come back because oxygen didn’t get delivered in a timely fashion or medications weren’t being able to be picked up,” she added. “That follow up after the traditional discharge [is important] versus just checking a box and one patient’s out the door and the next one’s coming.”
The common thread: when it is appropriate, moving care off the most expensive real estate in the system. “It is a resource of bricks and mortar,” Ms. Foxx said — one better reserved for patients who truly need it.
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