Hospitals' Strategies For Managing Frequent Flyer Patients

Frequent flyers, also known as super-utilizers, are patients who repeatedly visit hospital emergency departments. They are a growing problem for hospitals and can be driven by substance abuse, chronic illness, or attention-seeking. Hospitals are developing strategies to manage these patients and reduce readmissions, such as referring them to primary care doctors, social services, and mental health programs. This approach has been successful in reducing emergency department visits and costs. The use of stigmatizing labels and icons for frequent flyers in health IT systems has been criticized for potentially contributing to harmful biases and diagnostic overshadowing. Building long-term relationships with frequent flyers and understanding their unique psychosocial needs can help improve their care and reduce emergency department usage.

Hospitals refer frequent flyers to primary care doctors, social services, and mental health services

Hospitals have started to notice an increase in "frequent flyers", also known as "super utilizers", who visit the emergency department repeatedly, often for non-emergency reasons. To address this issue, some hospitals have implemented strategies such as referring these patients to primary care doctors, social services, mental health services, and substance abuse programs.

For example, Sinai Hospital in Maryland identified 318 people who had visited the emergency department four or more times in four months. They referred these patients to the services listed above, as well as insurance providers. One patient, who had made eight trips to the emergency department in four months, was assigned a care coordinator. This coordinator worked with the patient to arrange medical care and address nutritional, social, and economic problems. This program cost the state $800,000 over three years but resulted in 1,000 fewer emergency department visits, making it a cost-effective solution.

Norwalk Hospital in Connecticut has also implemented a similar program with weekly meetings to review cases and connect frequent flyers to community health resources. By discussing patients' social determinants of health, such as transportation or childcare issues, they can create individualized care plans to reduce unnecessary hospital usage. These meetings have led to a significant reduction in frequent flyer visits, with a 50% reduction in patients coming in six or more times in a six-month period.

These referral programs aim to address the underlying causes of frequent flyer behavior, such as substance abuse, chronic illness, or attention-seeking, and provide better care for these patients outside of the emergency department.

Frequent flyers are often stigmatised as problem patients or drug seekers

"Frequent flyers", also known as "super utilizers", are patients who repeatedly show up at hospital emergency departments. These patients are often stigmatised as being "problem patients" or attention seekers, sometimes referred to with the slang term "GOMER" (get out of my emergency room). This negative perception implies that these patients are misusing the emergency department.

However, frequent flyers often have unique psychosocial needs that present challenges for healthcare providers. For example, some frequent flyers are chronically ill individuals who experience regular flare-ups from their condition, while others suffer from substance abuse issues, such as drug or alcohol withdrawal, overdose, or intoxication. In some cases, frequent flyers are simply seeking attention or primary care that could be provided by a non-emergency physician.

To address the issue of frequent flyers, hospitals have implemented various strategies. One approach is to identify and refer these patients to primary care doctors, social services, mental health and substance abuse programs, and insurance providers. For instance, Sinai Hospital in Maryland identified 318 people who visited the emergency department four or more times in four months and referred them to appropriate services. This strategy proved successful, resulting in 1000 fewer emergency department visits and paying for itself.

Another strategy is to hold weekly meetings to review cases and connect frequent flyers with community health resources. Norwalk Hospital in Connecticut implemented such a program, resulting in a significant reduction in frequent flyer visits. By discussing patients' social determinants of health and creating individualised care plans, hospitals can reduce unnecessary hospital usage and improve patient care.

Hospitals are incentivised to reduce frequent flyer visits due to fixed revenue

Hospitals are facing increasing pressure to reduce the number of "frequent flyers", or "super utilizers", who attend emergency departments for non-emergency reasons. These patients often have complex social and health needs, and their frequent attendance at hospitals incurs significant costs to the healthcare system. In the case of Anne Arundel Medical Center in Maryland, the CFO stated that their revenue remains fixed regardless of the number of patients they treat. Therefore, they are incentivized to reduce frequent flyer visits and redirect these patients to more appropriate care settings.

One strategy employed by hospitals is to identify and address the underlying causes of frequent flyer behavior. For example, Sinai Hospital in Maryland identified 318 "super utilizers" and referred them to primary care doctors, social services, mental health and substance abuse programs, and insurance providers. This approach has proven successful, resulting in a significant reduction in emergency department visits and overall cost savings.

Another strategy is to implement targeted population health management initiatives. Anne Arundel Medical Center has focused on developing methods to reduce readmissions and avoidable utilization. They aim to provide structures and support for patients to stay healthy and on the path to recovery, reducing the likelihood of readmission. While this may not reduce readmissions to zero, it can help address health concerns without requiring hospital admissions.

Furthermore, hospitals can establish outpatient clinics or community-based programs to provide alternative care options for frequent flyers. The HEZ Initiative, for instance, received a grant of $900,000 over three years to fund a clinic aimed at improving healthcare access and health outcomes in underserved communities. While the clinic incurred additional costs, it successfully reduced emergency department visits and medical 911 calls, demonstrating a positive return on investment in terms of improved community health.

By implementing these strategies, hospitals can address the challenge of frequent flyers while also improving patient care and reducing costs. These initiatives help redirect patients to the most appropriate care settings, ensuring efficient utilization of healthcare resources and enhancing overall population health outcomes.

Frequent flyers may be chronically ill or have substance abuse issues

Hospitals are increasingly encountering "frequent flyers", or "super-utilizers", patients who repeatedly visit the emergency department. These patients may be chronically ill or have substance abuse issues. For instance, a man with elbow pain was treated and discharged from the emergency department of Mutsu City General Hospital, only to return a few hours later with abdominal pain. He was examined and discharged again, but returned for a third time that night. An investigation revealed that the patient had been seen in the emergency department eighteen times in the first eight months of 2015 and was often intoxicated and belligerent with staff.

Chronic illnesses can cause regular flare-ups that require frequent emergency room visits. However, some frequent flyers are not actually in need of emergency care. They may be attention seekers or have a dysfunctional social relationship with the hospital staff. In some cases, frequent flyers may be dealing with substance abuse issues, such as drug or alcohol withdrawal, overdose, or intoxication. These individuals may also have co-occurring mental health issues.

Hospitals have implemented various strategies to manage frequent flyers. One approach is to refer them to primary care doctors, social services, mental health and substance abuse programs, and insurance providers. For example, Sinai Hospital in Maryland identified 318 people who visited the emergency department four or more times in four months and referred them to appropriate services. This initiative resulted in 1000 fewer emergency department visits and paid for itself. Another strategy is to hold weekly meetings to review cases and connect frequent flyers with community health resources. Norwalk Hospital in Connecticut has implemented such a program, resulting in a significant reduction in frequent flyer visits. By discussing patients' social determinants of health and creating individualized care plans, hospitals can reduce unnecessary hospital usage and improve patient care.

It is important to identify why patients are frequently visiting the emergency department and direct them to better care. This may involve addressing social and economic problems, as well as coordinating medical care. By working with patients and providing them with the necessary support, hospitals can reduce the number of frequent flyers and improve overall patient outcomes.

Frequent flyers can be directed to outpatient care or primary care

Hospitals are increasingly encountering "frequent flyer" patients, who make repeated visits to emergency departments. These patients are also referred to as "super-utilizers". They may be chronically ill, attention seekers, or simply prefer the convenience of emergency rooms over seeing their own doctor.

One approach to managing frequent flyers is to direct them to outpatient or primary care. For example, a hospital in Maryland identified 318 patients who had visited the emergency department four or more times in four months. These patients were then referred to primary care doctors, social services, mental health services, substance abuse programs, and insurance providers. Each patient was also assigned a care coordinator to help manage their medical and social needs. This program resulted in 1000 fewer emergency department visits, saving the state $800,000 over three years.

Norwalk Hospital in Connecticut has implemented a similar program, holding weekly meetings to review cases of frequent flyers and connect them to community health resources. By clearly defining the target population and tracking patients in real time, Norwalk has achieved a significant reduction in frequent ED visits. During the meetings, members discuss brief overviews of cases and create individualized care plans to reduce unnecessary hospital usage. Social determinants of health, such as transportation or childcare issues, are also addressed to remove barriers to accessing primary care.

By directing frequent flyers to outpatient or primary care, hospitals can reduce the burden on emergency departments and improve patient care. These programs have been shown to be effective in reducing frequent ED visits and saving costs. Additionally, they provide a more appropriate setting for managing chronic illnesses and addressing social and mental health needs.

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