San Diego Seeks Ways To Manage Frequent Users of Emergency Services

San Diego officials are looking into ways to reduce costs associated with emergency service "frequent fliers" -- a group of mostly homeless patients who use the 911 system and hospital emergency departments in rates disproportionate to their small numbers, U-T San Diego reports.

The San Diego Tribune article was produced by the California HealthCare Foundation's Center for Health Reporting. The center is supported by a grant from CHCF, which publishes California Healthline.

The article is part of a series on the city's push to manage frequent users of emergency services.


Frequent emergency service users represent eight-hundredths of a percent of San Diego's population, but they account for more than 17% of paramedic and ambulance calls in the city.

According to the city medical director's office,  1,136 frequent emergency service users in San Diego are on pace to use emergency medical services at least six times this year and generate more than $20 million in ambulance and paramedic charges.

Many health care procedures cost three times as much in the ED as they do in other hospital settings, according to U-T San Diego.

Frequent emergency service users typically are difficult to treat because they often have chronic conditions such as diabetes and high blood pressure, in addition to mental illnesses and substance misuse problems.

Meanwhile, hospitals across the U.S. rely on frequent users of emergency services to draw billions in federal reimbursements, according to San Diego Medical Director James Dunford.

He said, "There are no benchmarks or incentives to provide higher quality care" for frequent emergency service users, "only the idea that some hospitals take care of more people like this." Dunford added, "The cost is born by the taxpayers without ever taking a look at how that money could be better spent."

Addressing the Challenges

John Lozier -- executive director of the National Health Care for the Homeless Council -- said that frequent emergency service users who are homeless need "good, strong primary care that will prevent many emergencies from occurring in the first place."

Dunford said frequent emergency service users should have access to coordinated health care and housing programs. In addition, Dunford has been working to compile real-time electronic 911 records that can be used to identify frequent emergency service users by name, need and likely location (Gonzales, U-T San Diego, 3/31).

Additional Articles

Headlines and links to other articles in UT-San Diego’s series on San Diego’s efforts to manage frequent users of emergency services are provided below:



Tim Colling
I suppose that's a disgusting practice... unless the result is truly saving lives. Either way, if those "frequent flyers" can be gotten into a case management system with access to non-ED health services, research has shown that the outcome is better health for the patients and less strain on the ED resources.
robert alboney
Ambulance companies cruise the homeless areas of town looking for people to take the nearest emergency room both who profit at the highest rates for service.Are they saving lives or looking to profit from the system?
Tim Colling
This topic has already been studied. The "Frequent Flyers" in the hospital emergency departments generally decrease their ER visit frequency and their inpatient admission frequency when they are provided with social workers serving as case managers for them, helping them find access to community based non-ED services.

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