Camden ER study documents the crisis but misses the full solution

$46 million to care for top 1% of users over 5 years!
Many live on the streets or in homeless shelters, or they are in and out of the homes of relatives or friends!
Housing First is the solution!

Dr. Jeffrey BrennerWe read with amazement tinged with frustration an article in Sunday’s Star-Ledger entitled “Repeat ‘Super Users’ are swamping the ER” by Carol Ann Campbell. The article highlights the work of “Jeffrey Brenner, a family doctor motivated to reduce costs, but also to improve health care for some of the city’s most difficult to treat patients.”

Dr Brenner “obtained five years of ER and hospital records from the city’s three hospitals: Our Lady of Lourdes Medical Center, Virtua Health Camden and Cooper University Hospital.”

The data documents the fact that “about 1 percent of ER and hospital users accounted for about 10 percent of total admissions. Those 1,000 or so super users showed up at Camden hospitals more than 39,000 times over the five year period.

“One Camden resident was admitted 113 times in one year, Brenner found. Another was admitted 324 times over the five-year period. The most expensive patient cost $3.5 million over five years. Overall, the city’s three hospitals were paid $46 million to care for these top users, most of it from government insurance and New Jersey charity care.

As the data rolled in, Brenner looked at the money and shuddered. He reasoned that for the same money he could hire 50 doctors and provide a concierge level of medical care. Or he could hire 100 nurse practitioners who could provide one-on-one care for 10 patients each.”

Robert L. Okin, a professor of clinical psychiatry at the University of San Francisco was quoted about how one program “which also involves nurses, social workers and doctors, has helped more than 1,000 people get places to live, alcohol and drug rehabilitation or government assistance. Each dollar put into the program saved $1.44 in hospital costs, according to a published study. He noted that this is “the tip of the iceberg. There are all kinds of other cost savings, such as jail costs. Court costs.”

We fully agree with Dr. Brenner’s data and even his point “no one benefits when people overuse the ER. Not the hospitals, not the taxpayers, and not the patients.” However, the long term solution is housing first. This has been documented in “Million Dollar Murray” by Malcolm Gladwell as well as numerous studies on housing first. Even the Wall Street Journal has documented that with permanent, supportive housing “homeless people that received housing and intensive follow-up by a case manager consumed fewer public resources” including emergency rooms.

Although, it is reassuring that our data is the same as found by Gladwell in Reno but it is depressing that we have our multiple million dollar Murrays in Camden. When will we understand that ending homelessness is not only a humane response but also one that will save tax payers money?

Now is the time to create a permanent solution that involves housing first with appropriate social and medical services. When will New Jersey wake up and stop spending money on band aids and instead use our public and private resources to create a long-term solution?

To read all of our reports on housing first click here.

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