Program looks to re-direct non-critical ER visits

The reasons for the alarming volume of emergency room visits run the gamut. Some people work too late to make regular clinic hours, or they can’t get transportation or child care until the evening or weekend. Some avoid seeking care because of the potential cost, until there’s a crisis. And of course, illness often strikes at odd hours.
The vast majority of these patients end up in emergency rooms, even though, according to the R.I. Department of Health, 38.6 percent of the 382,247 ER visits in the state in 2005 that did not lead to an inpatient stay were for a problem that could have been handled elsewhere.
Another 5.4 percent of those visits, the state analysis shows, could have been avoided with adequate primary care. But a 2007 study estimated that 25.4 percent of the state’s population, or more than 273,000 people, lacked access to regular care, with low-income residents of the urban cores, especially Providence, Pawtucket and Central Falls, forming a large proportion of that group.
The issue has been on local health providers’ and policymakers’ radar screen for years. Now, using a $750,000 grant from the Rhode Island Foundation, two community health centers and a mental health provider are teaming up to try to address it.
Starting this fall, Providence Community Health Centers and Blackstone Valley Community Health Care will each have one clinic open in the evenings and on weekends. Walk-ins will be welcome, even if they are not regular patients. Mental health services also will be offered.
The project is called Rapid Access Rhode Island, and it’s the largest of several initiatives supported by grants from the foundation’s new Fund for a Healthy Rhode Island.
“We’re not going to be open 24/7, but extend hours so [people] can get care,” said Dr. Jerry Fingerut, medical director of Blackstone Valley.
Through the program, Providence’s Chafee Health Center and Blackstone’s clinic in Pawtucket will be open until 8 p.m. on weeknights, and on Saturdays and Sundays, they will be open from 9 a.m. to 5 p.m. – though Fingerut said the extended hours will be phased in.
Altogether, the centers estimated, the program will allow for 9,500 extra visits from patients in the first year, and 10,100 by the third year. And with electronic medical records, Fingerut said, the care increasingly will be seamless, even for patients who normally go to another provider. The benefits are expected to be substantial: convenience, for starters, with no long waits in the ER; better-coordinated care; and big savings for patients, government and insurers alike.
“This might be a $100 visit, as opposed to a $600 visit to the ER,” Fingerut noted. “The burden on the system is much heavier if you have to go to an emergency room.”
The community health centers already play a major role in caring for low-income patients. In fiscal 2008, the Providence centers served 34,400 adults and children, while Blackstone served nearly 9,900, including RIte Care beneficiaries, uninsured and some insured people.
In recent years, recognizing the close ties between mind and body, both centers have added mental-health and substance-abuse services. Last year, about 2,000 Providence patients and more than 300 Blackstone patients had a behavioral health issue as their primary diagnosis.
The third partner in the program, The Providence Center, devotes itself entirely to behavioral health care, serving more than 11,000 adults and children each year, 80 percent of whom have an annual family income of less than $10,000. The nonprofit will staff the behavioral-health side of the walk-in clinics, helping to screen patients for mental health and substance abuse issues, providing care on site, and making referrals to services in the community.
In an interview, Dale K. Klatzker, president and CEO of The Providence Center, said mental issues and substance abuse are a particularly serious problem in ERs, because during off hours, there is nowhere else for people to turn when they are having a crisis.
The bad economy has increased the need, too, Klatzker said, because a lot more people are now unemployed and uninsured, struggling not to become homeless, stressed out and less able to keep a handle on any behavioral problems they already had.
Treating these people in ERs is costly and not very effective, Klatzker said, so the hope is that Rapid Access will improve outcomes even as it saves money.
“We’ve always been stretched thin,” he said. “This partnership will allow us to extend our resources. … I’m hopeful that this will work, and that it will be a model that others can use.” &#8226