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Extra attention keeps frequent fliers from landing in ERs

A groundbreaking health care clinic in Grand Rapids expects to save millions of dollars a year by targeting a chronic cause of high medical costs: patients for whom the emergency room is a virtual revolving door.

Based on early results, the director of the Spectrum Health System clinic projects savings of $12 million to $15 million in annual Medicaid and Medicare costs by reducing emergency room visits among a group of  "high frequency" users.

"Ultimately this will save money for the taxpayers long-term," asserts Dr. Corey Waller, who designed and directs the clinic that aims to develop comprehensive treatment and support for each of these patients. Waller pegged the potential savings of a statewide system at near $300 million.

Opened in December, the clinic grew from a study of emergency room use at two Grand Rapids hospitals. It found that 950 patients visited the emergency rooms at Butterworth and Blodgett hospitals  more than 10 times a year, accounting for 20,000 visits and racking up annual costs of up to $50 million.

The clinic seeks to identify the constellation of factors driving each of these patients to the emergency room, whether they are physical, social, emotional, a product of mental illness or any combination of those. In many cases, Waller believes, no one in the health-care system has taken the time sort them all out.

"There is no social safety net. It's a farce. Everybody thinks that somebody else will do it," Waller said.

Grand Rapids resident Emily Boss, 34, had become a familiar sight at the emergency room with issues related to her withdrawal from methadone, an opiate substitute, and her prescription to an anxiety medication. She broke her jaw last year, when she passed out from withdrawal symptoms. It was one of some 10 emergency room visits she logged last year.

But Boss hasn't been there since December, stopping instead into the clinic, called the Center for Integrative Medicine. Most often, she sits down with social worker Shelly Virva to discuss anything and everything in her life.

"It really helps me to stop in there. She has been an amazing influence," Boss said.

Steve Fitton, Michigan's state Medicaid director, believes Spectrum's approach has potential to change the standard of care for these kinds of patients: "Historically I don't think the system has attacked this all that well. This seems like a very promising approach. We will be watching closely."

Waller estimates savings of $300 million if this approach were implemented across Michigan. While Fitton isn't sure of that, he believes it is a model that could be duplicated elsewhere -- if it proves out. There is plenty of potential for savings, since Michigan spends some $12 billion a year on Medicaid alone.

"It is something that is replicable," Fitton said.

Most of the high-use patients are low-income and enrolled in Medicaid or Medicare, Waller said, many between the ages of 25 and 40. Many have been diagnosed with a variety of mental health problems.

"They are people who have generally stable health with unstable social situations with generally undifferentiated mental health problems. Typically it's a lot of anxiety about the problem they have: chest pain, dizziness. They haven't been given a very good education about their disease.

"They (obsess) on that and every time they have a headache they end up in the emergency room."

Waller said the clinic has reinforced to him that factors influencing mental and physical health extend far beyond what shows up in an exam room.

"The more we look at these patients, the more I realized that medicine has to encompass everything. Do they have heat? Do they have enough money for food? Do they have transportation? Without these basic factors nothing I do as a doctor is going to make a difference."

Each patient is assessed at an initial, intensive, three-to four-hour visit to the clinic that includes interviews with a licensed medical social worker and other health care providers. After that, patients are  encouraged to make regular follow-up appointments to the clinic.

Thus far, more than 90 percent are showing up.

"It takes time and it takes honesty and a lot of times that is something that is not given by the medical establishment," Waller said.

Kent County resident Heather Mosher, 38, lost track of how many times she's been to the emergency room in recent years. She puts it at over 100.

"It's too many to count," Mosher said, who receives both Medicaid and Medicare disability coverage.

Mosher said she has been treated for fibromyalgia, a pain disorder, osteoarthritis, migraine headaches, chronic sinus infections, allergies and other disorders. She also has been diagnosed with depression, major depressive disorder, bipolar depression, post traumatic stress disorder and attention deficit disorder.

She was taking as many as 50 pills a day, she said. After her initial visit with the clinic and extensive discussions with Waller, that figure was cut to 10.

Mosher, who visits the clinic weekly, realizes she has options other than the emergency room thanks to the trust she has invested in Waller and others at the clinic.

"I've struggled to find a doctor that would listen and get to know me," she said.

Ted Roelofs worked for the Grand Rapids Press for 30 years, where he covered everything from politics to social services to military affairs. He has earned numerous awards, including for work in Albania during the 1999 Kosovo refugee crisis.

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