By Alena Maschke
The Advocate
LAFAYETTE, La. 鈥� Acadian Health, a division of Acadian Companies that provides home-based health services, is launching a pilot program designed to keep patients out of hospital emergency departments if their condition can be treated in a home environment.
Approximately 20% of the state鈥檚 Medicaid patients visit local emergency rooms on average 17 times per year, making them 鈥渟uper-utilizers鈥� in the Louisiana Department of Health鈥檚 lingo, often for non-life-threatening situations or due to social factors, such as a lack of transportation, according to recent data gathered by LDH鈥檚 Bureau of Health Services Financing.
鈥淲e took a close look at emergency room use by 鈥榮uper-utilizers鈥� over a one-year period and found opportunities to meet patient needs more effectively,鈥� said LDH Secretary Michael Harrington. 鈥淭hrough this project, we will increase access and simplify care delivery while helping hospital emergency rooms to remain highly flexible and accessible.鈥�
Many patients are 鈥渆xcessively using the ER, almost as a primary care clinic,鈥� said Acadian Health Director of Business Development Rob Burnell. 鈥淲hich kind of lets us know that they probably don鈥檛 have a primary care physician.鈥� Or if they do, they don鈥檛 have a way of getting to their office.
鈥淥ftentimes, they have a lack of transportation. They have limited mobility. A lot of these patients simply don鈥檛 have a ride,鈥� he pointed out.
That鈥檚 why Acadian is hoping to bring care directly to them.
The pilot will focus on a cohort of 7,000 Medicaid beneficiaries in Southwest Louisiana, a majority of whom will be referred to Acadian by their managed care organization 鈥� the insurance company that administers their Medicaid benefits.
Those patients will then be scheduled for a visit from an Acadian Health community paramedic, with follow-up visits as needed to prevent unnecessary trips to the emergency room.
鈥淚f they don鈥檛 have a primary care physician, a lot of them have chronic conditions 鈥� diabetes, high blood pressure, congestive heart failure 鈥� that are left untreated,鈥� Burnell said of the target demographic. 鈥淪o what happens is those chronic conditions exacerbate.鈥�
Almost all of Louisiana is considered a Health Professional Shortage Area, a designation that includes a lack of primary care doctors. The Cicero Institute, a conservative Austin think tank, projects that by 2030, the state will be short almost 5,000 doctors, nearly 400 of them primary care physicians, to meet the medical needs of its residents.
For those who have a primary care physician, the program offers an acute care alternative that can provide urgent care services to patients at home within an hour, after being referred by their doctor.
Whether the program will have a noticeable impact on emergency departments鈥� workloads, which can lead to long wait times during peak hours, remains to be seen, said Zach Barnhill, director of emergency services at Our Lady of Lourdes. 鈥淚鈥檓 excited to see where this program is going to go and what it鈥檚 going to do for our area,鈥� Barnhill said. 鈥淚 think it鈥檚 going to have a positive impact on the patients it鈥檚 going to serve.鈥�
According to Barnhill, one of the most common non-emergent conditions patients visit the emergency room for is pain, such as back pain or pain caused by a variety of chronic conditions. Patients in pain will likely be a large portion of those served by the Acadian pilot, Burnell anticipates.
鈥淭he patient doesn鈥檛 really know what鈥檚 going on until we get there,鈥� he said. Should the source of the pain require treatment in a hospital, paramedics can still call an ambulance, but, according to Burnell, that is rare 鈥� only roughly 5% of patients, he estimates, actually need to be transported to an emergency room.
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