The plan for avoiding emergency rooms
It’s a common complaint- emergency rooms are often full of people that don’t need to be there. Unfortunately, the most expensive place to get medical care is also the default for a lot of people- folks without insurance, people with health concerns after hours, and Rhode Islanders with mental health or addiction struggles.
A special Senate commission is tackling how to better care for that last category of patients. They’ve been meeting since last November to sketch out a system that effectively treats mentally ill or addicted Rhode Islanders without throwing them into an expensive hospital bed. One physician participating in the group puts the problem this way-
We are providing an extremely expensive taxi through the use of municipal ambulances and RIH [Rhode Island Hospital] is the most expensive hotel in the City for this population with an average stay of $650 for a turkey sandwich and place to sleep.
The group released a rough draft of its final report today. It’s still a working document, testimony from a round table discussion today might change the contents slightly, but the broad strokes will stay the same.
The report first details the problem- a small sliver of Rhode Islanders use emergency rooms more than four times a year. Many get expensive and unnecessary ambulance rides. The report says-
EMS personnel estimate that 10% of ambulance transports were for actual medical emergencies.
As for the other 90% of the ambulance rides, they’re not only unnecessary, they’re often done for free. The report estimates that in Providence alone, city firefighters and police officers provide about $800,000 to $1.3 dollars in unpaid transportation services.
So what can we do about this? The commission proposes a few things-
1. Change protocols that make it difficult to take patients anywhere else.
Currently, state rules say medical technicians have to take “intoxicated persons and persons incapacitated by alcohol” to a place that provides “emergency treatment” and is affiliated with or connected to a hospital. That pretty much rules out community treatment centers.
The rules also say the patient must be assessed by a “licensed physician.” That leaves out other folks (nurse practitioners, licensed physician assistants, etc) who could easily do that job for less money in another setting.
To do something about this, the commission proposes a change to state’s alcohol statute to allow for a “pilot period” where intoxicated Rhode Islanders have the option of being evaluated in the community by other types of licensed health care providers.
2. Create a pilot program testing community options.
When I spoke with Senator Josh Miller, the co-chair of the commission, he said the group plans to propose legislation for a pilot program. The pilot would use non-emergency vehicles to transport intoxicated or mentally ill Rhode Islanders to the most appropriate treatment location.
The pilot would demonstrate whether this new approach actually saves money and improves results. It would be run by a community provider that already works with this community. Miller says the state would probably have a RFP (request for proposals) process to select one of them.
Those are the highlights for me, but here are the other proposals in the report-
- Create a state-wide care partnership
- Use special Medicaid funding to accomplish some of these goals
- Help health care providers and first responders use “suicide/mental health assessment tools.”
- Develop stable housing options for the homeless.
Miller says he’s hoping the General Assembly will approve the pilot program this year. If all goes well, the state would select a group to run it by the end of the year.
What do you think? Does this sound like a smart solution? Will it work?