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Austin ER's Got 2,678 Visits From 9 people Over 6 Years

Kitchen estimated that each ER visit averaged about $1,000. The cost represents a national average for all ER patients, said Anjum Khurshid, the ICC’s director of clinical research and evaluation and co-author of the report.

The ICC, whose mission is to work with safety-net providers to improve access to and quality of care, has a database of 750,000 uninsured and underinsured Central Texas patients collected from its members. That database is confidential because of patient privacy laws. It found that 900 frequent users — people who visited an ER six or more times in three months — had 2,123 preventable visits in 2007, or 18 percent of 11,600 total visits to Central Texas ERs, which cost more than $2 million. Among those picking up the bill were hospitals and taxpayers, including government programs such as Medicare and Medicaid, Kitchen said.

She defined a preventable visit as one in which the patient could have been treated earlier in a different setting, such as a clinic, avoiding the trip to the ER.

“It’s a pretty significant issue,” said Dr. Christopher Ziebell, chief of the emergency department at University Medical Center at Brackenridge, which has the area’s busiest ER.

Ziebell is a member of a task force that includes representatives of the health district, hospitals and other medical providers studying ways to reduce inappropriate ER use. Solutions might include referring some frequent users to mental health programs or primary care doctors so they would go there first in the future, Ziebell said.

When frequent users come to the ER now, Ziebell said, his first obligation is to stabilize them if they are having a medical problem. If not, he tries to assess their problem and determine where they should go for care, such as a community clinic, the local mental health center or a doctor who might be treating their asthma, for example.

“They have a variety of complaints,” Ziebell said. With mental illness, “a lot of anxiety manifests as chest pain,” he said.

In a report last year, Austin-Travis County Emergency Medical Services said that 10 patients made up more than 1 percent of the system’s 130,000 contacts with patients in two years. The patients’ most common ailments were stomach or chest pains, injuries or respiratory problems.

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