Catholic Charities program seeks to reduce unnecessary ER visits _lowres

Advocate staff photo by MATTHEW HINTON--Elliott Major is a client of the archdiocese's Health Guardians program, represented by Ben Wortham, left, which provides health care and housing services to individuals with low incomes who previously frequented the emergency room seen here in New Orleans, La. Tuesday, Nov. 25, 2014.

After Elliott Major’s wife, son and grandson were killed in a car accident in 2003, he stopped working, gave away most of his money and eventually ended up sleeping on the streets.

He also got sick.

Major, 54, would have painful episodes of labored breathing. “I felt like I was going to die. Sometimes I would have to crawl to get help,” he said.

This spring, he started going to the emergency room — sometimes twice a week — to get treatment for a bacterial infection in his lungs, racking up huge medical bills.

He became what is sometimes referred to in the medical world as a “frequent flier,” a patient who habitually arrives at the emergency room for management of a condition that could be better and more cheaply dealt with by a primary care physician.

Now, he’s enrolled in a program of the Archdiocese of New Orleans called Health Guardians, which aims to cut down on preventable hospitalizations by helping patients like Major manage their condition with primary care.

One recent study found the 3-year-old program has demonstrably reduced hospital visits. And now, it has received a two-year, $500,000 grant from the Louisiana Public Health Institute that will help it expand.

Elmore Rigamer, the medical director for Catholic Charities who oversees Health Guardians, said about 140 people a year have been treated since the program began.

Rigamer said about one-third of those patients are uninsured, one-third have Medicaid or Medicare and the rest have insurance through the Greater New Orleans Community Health Connection.

Anyone with three or more visits to the emergency room or two hospital admissions within the past six months is eligible.

The program links patients with health care “navigators,” who accompany them to doctors’ appointments, arrange transportation and assist them with obtaining and taking medications.

Starting this summer, Health Guardians will partner with 10 federally qualified health centers, expanding its capacity to 250 people a year.

Rigamer hopes the expansion will put a small dent in a large problem.

Overuse of the emergency room is estimated to cost $38 billion a year nationwide, according to a 2010 report by the New England Healthcare Institute. The report also found that 56 percent of ER visits are preventable.

The issue is especially acute in Louisiana, which, according to a report by United Healthcare Rankings, ranks third from the bottom among the states in preventable emergency room expenditures.

“It’s a huge cost to the hospital and the EMS system,” said Jennifer Avegno, a member of the emergency medicine faculty at Interim LSU Hospital.

Avegno said she and her colleagues often see the same faces in the emergency room time after time, frequently for controllable conditions such as diabetes or hypertension. She said many patients don’t know how to gain access to any other forms of healthcare.

Avegno and other doctors in the emergency room would refer those who were eligible to Health Guardians.

The program seemed to be working, so the hospital decided to conduct a study of 55 patients to measure its effectiveness. The study, completed last month, found that 72.7 percent of patients enrolled in the program reduced their hospital visits.

The average cost of the patients’ hospital expenses fell from about $38,000 during the six months before they entered the program to about $23,000 in the six months after they were enrolled.

Joseph Kanter, a former chief resident in the emergency room at Interim LSU Hospital and the current medical director of the city’s Health Department, said the savings are split among the hospital and the state and federal governments, all of which share in the expense of covering those who are indigent.

Kanter said one of the reasons Health Guardians is successful is that the health navigators spend extensive time talking to patients and individually tailoring plans to their needs.

“The results really have been incredible,” he said. “These are patients that many of the ER staff would know by name.”

According to Kanter, a typical patient who would benefit from the program would be someone with heart disease who was often coming to the emergency room for symptoms like swelling in the ankles and shortness of breath.

If treated regularly with diet and medicine, the patient could easily avoid the ER.

In addition to saving money, preventing unnecessary ER visits also frees up resources for those with emergency conditions. Kanter said many of the patients who use the program are homeless and often rely on ambulance rides to get to the hospital.

Major said he used to be one of those patients when he was living on the streets.

Five months ago, he entered the Health Guardians program, and now he has his health problems under control and avoids the emergency room.

He’s living in temporary housing provided by Catholic Charities while he looks for a job.

Rigamer said he’s hopeful that after they take care of their pressing health issues, patients in the Health Guardians program who are unemployed will then be able to find work.

Now that the program is expanding, patients will be referred to it not only by the hospital but also by clinics that notice certain patients on their rolls are frequently turning up at the emergency room.

The key, according to Rigamer, is the individual attention and step-by-step assistance provided by the four navigators and one social worker who interact with patients.

“This isn’t quantum physics,” he said. “You just sit down with the patient and ask them what they need.”