Houston-area emergency rooms are packed and the taxpayer price tag is climbing. But one doctor's idea could not only shorten ER waits and save money, but could dramatically improve the health of Houston's most vulnerable patients.
"Our system is broken," said Dr. David Buck, executive director of the nonprofit Primary Care Innovation Center in Houston. "It's all costing us more in terms of money and in terms of quality of care."
A visit to the emergency room at Harris Health's LBJ Hospital on a Thursday night highlights the problem.
"How long is the wait to see the doctor?" a Local 2 Investigates producer asked.
"About 10 hours," said the triage nurse. "There are 70 people waiting."
LBJ is just one of the many emergency rooms across Houston flooded with patients who are waiting hours to see a doctor. Many patients, especially those going to ERs in county-funded hospitals, don't have a true emergency, just nowhere else they think they can go.
Numbers show the dramatic impact those patients are having on all of us.
Buck's research found 6,000 patients in Harris County went to the emergency room at least 10 times in just one year. The total one-year cost was $806 million; the price tag per patient -- $134,000. Taxpayers picked up almost all of those costs. Buck calls the repeat patients "super-utilizers."
"Super-utilizers are your costliest person and they're not getting the health care they need," Buck explained. "We don't have any way of identifying these people."
Right now if a patient goes to one emergency room one week and another ER the next, hospitals have no idea that same patient keeps showing up at different hospitals. That's because hospitals are not sharing patient information.
"Nowhere are we putting together the whole puzzle," Buck said. "Each of us has one little piece of the puzzle and we're going around thinking we have that whole picture of the person. There's a whole puzzle and we've not solved it because hospitals need to cooperate to get it done."
Buck said the end result is dramatically higher costs and the patient doesn't get any better. He said most super-utilizers go to the ER for chronic conditions like diabetes or mental health problems, not a real emergency. Then the emergency room treats just the symptom of the day, not the patient's overall health problem.
"We can't continue like this and the root cause is lack of any kind of coordination," said Buck.
That's why Buck founded the Primary Care Innovation Center. The hope is that hospitals, clinics, mental health centers and the Harris County Jail will all begin to share patient information. That way a super-utilizer can be identified. Then Buck's group will help the sickest patients by coordinating their care.
The team will introduce patients to a regular doctor, get them substance abuse help, or do whatever else is needed to treat their health concerns outside of the emergency room.
"Studies show when you coordinate their care not only were they're dying less frequently, they were healthier and had higher quality of life," said Buck. "Those people need a little extra care. If we begin to coordinate their care and get them plugged into primary care homes, then they can really build a health home there. They haven't had that kind of health care before."
So far several hospitals, clinics and nonprofit groups like Healthcare for the Homeless-Houston have signed onto Buck's plan. Buck hopes to start the process by identifying and helping 15 super-utilizer patients, then expanding the program.