America faces a physician shortage that is only set to intensify when the Affordable Care Act takes full effect in January of 2014. A number of ongoing efforts are being made to streamline the care process for patients without compromising their level of care. In July of 2012, hospitals in Oregon began a program aimed at limiting the number of “frequent flier” visits to their ERs. Although the new initiative will take place over the course of five years, it shows early signs of success.

Oregon’s New ER Program

Approximately 80 percent of all healthcare expenditures in the United States are used to service only 20 percent of the population. Visits to the emergency room can be notoriously expensive. Officials in Oregon have taken these two factors into consideration and designed a new program aimed at lowering ER visits, especially by “frequent flyers.” Frequent flyers are defined by the program as patients who visit the ER ten times or more each year. Some of the patients who fall into this group annually visit the ER at a rate of once a week.

Oregon’s program is federally funded; as of 2012, the state began receiving almost $2 billion in federal funds to be spread out over the course of five years. The goal of the program is to reduce the medical inflation rate in Oregon by two percent over the course of this period. Promising early numbers suggest that this goal is reasonable to expect. In the first year, emergency room attendance rates by documented frequent flyers have dropped in many Oregon hospitals – in the case of at least one hospital, at a rate of 48 percent.

The Methods of the New Program

The main technique used in this new program is to isolate patient issues which do not directly demand a visit to the emergency room. Many patients end up in the emergency room with complaints that do not necessitate immediate care, and this number is especially high among frequent flyers. Additionally, frequent flyers may end up in the emergency room due to complications from relatively benign health issues.

Patients in Oregon are being walked through the care process by Coordinated Care Organizations, or CCOs. Employees in these organizations help patients navigate the medical system and encourage frequent flyers to make regular appointments with a primary care doctor instead of visiting the emergency room whenever a perceived problem arises. Additionally, these CCOs may provide basic shelter and hygiene support for individuals who run into emergency-level health issues on a regular basis as a result of their lifestyle. On a case-by-case and hospital-by-hospital basis, the numbers coming out of Oregon may help to set the precedent for more nuanced ER practices and less cluttered ERs moving forward.