Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We must be committed to putting patients over politics

Alister Martin, MD
Policy
February 8, 2017
Share
Tweet
Share

It was 3 a.m. and 3 degrees outside, and I was about to discharge Mike from our emergency department for the third time in less than 24 hours.

“Doc, let me finish this episode,” he said, his eyes glued to the TV in the ER waiting room.

Mike was homeless, and this was our routine all winter last year, when it was too cold to sleep in shop doorways or the bridge under I-93. Many times he was drunk, and we monitored him until he was sober enough to be discharged. Other times he would fabricate medical issues that needed to be evaluated, excuses that kept him safe and warm, at least for a few hours.

That morning, he came in intoxicated. Another physician evaluated him for signs of injury. There were none. When he sobered up, he was discharged with a thick stack of papers detailing the dangers of alcohol abuse.

Later that day, Mike came back in complaining of pain in his foot. Another exam, another discharge.

About 30 minutes later, I saw Mike amble in and park himself back in the chair from which he had just been discharged.

This time it was pain in his knee. Mike didn’t need emergent evaluation. He came in because it was freezing outside, the T wasn’t running, and the shelters were too far away.

Last winter our emergency department saw hundreds of patients like Mike. Boston’s annual homeless count last January tallied 1,732 individuals in emergency shelters. Hundreds more slept on the street.

The truth is that for folks like Mike, we are their de facto shelter, a hotel with infinite vacancies.

But patients like Mike put a real financial strain on the system. One recent analysis that tracked 35 of Boston’s high utilizers like Mike found that they accounted for more than $3.6 million in costs at a major Boston hospital over just an eight-month period.

What should be the role of emergency departments in caring for homeless patients with no emergent medical needs? Emergency departments nationwide don’t have a good answer to this question. Nor do emergency physicians have either the time or the training to wrestle with this question on a busy shift. Instead, we grapple with the reality we’re handed.

How long can we keep him in this warm examining room until another patient needs it? How many shelters will I have to call until one tells me that they have room? How do we get him to that shelter four miles away in sub-freezing temperatures?

“Let me just rest here,” Mike said when I offered to get him into a shelter that night. “I ain’t gonna be back here for awhile, anyway.”

ADVERTISEMENT

“Why is that?” I asked.

“They’re getting me a place in Dorchester,” he said.

Surprised, I asked how.

“HUES program,” he responded, eyes not budging from the TV screen.

In 2011, Boston made a bold step to help patients like Mike. It created the High-Utilizers of Emergency Services (HUES) to Home program.

It supports homeless individuals who are habitual users of Boston’s emergency services by providing them with case management, links to substance abuse and mental health counseling, and, most importantly, it connects them to permanent housing.

HUES to Home is working. For example, after receiving housing, one patient who had visited the ER 50 times the year before didn’t go to the ER once in 10 months. Another patient suffering from alcohol abuse was housed in a single-room occupancy apartment for nine months; his ER visits dropped from 90 to 12.

But too many remain unserved.

Like many of the programs that care for the city’s poor, disabled and frail elderly, HUES to Home is in desperate need of expansion. It also, like many of the programs that serve these vulnerable populations, partly relies on a fragile funding source: Medicaid.

That’s why providers statewide rejoiced when, on Nov. 4, Massachusetts received permission from HHS, called a waiver, to overhaul the way it pays for health benefits through Medicaid. With that waiver was a promise of $52 billion in funding beginning in 2017 over five years.

For providers, this felt like the cavalry riding to our aid in our campaign to care for the vulnerable.

Four days later, on election day, it seemed that cavalry had been recalled.

President Trump and House Speaker Paul Ryan have proposed giving states a block grant for Medicaid, rather than using the current funding formula.

This could mean a cut of up to a third of current Medicaid funding.

That reduction would jeopardize programs that protect vulnerable patients — programs like HUES to Home, which gave Mike a way to escape the cold, and which also saves the system money.

Now more than ever, we must be committed to putting patients over politics. Protecting Medicaid funding is one place to start.

Alister Martin is an emergency physician.  This article originally appeared in WBUR’s CommonHealth.

Image credit: Shutterstock.com

Prev

5 health care IT tips for President Trump

February 8, 2017 Kevin 2
…
Next

How the government hiring freeze dishonors veterans

February 8, 2017 Kevin 1
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
5 health care IT tips for President Trump
Next Post >
How the government hiring freeze dishonors veterans

ADVERTISEMENT

More by Alister Martin, MD

  • Why don’t patients pick up their prescriptions?

    Alister Martin, MD

Related Posts

  • Patients made this doctor care about politics

    Chad Hayes, MD
  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • How Big Medicine is hurting patients and putting small practices out of business

    John Machata, MD
  • Fixing health care requires putting patients and their health teams on top

    Matthew Hahn, MD
  • You are abandoning your patients if you are not active on social media

    Pat Rich
  • Help hospitalized patients vote by requesting emergency ballots

    Priya Joshi

More in Policy

  • Unused IV catheters cost U.S. hospitals billions

    Piyush Pillarisetti
  • Why your health care dashboard isn’t working and how to fix it

    Dave Cummings, RN
  • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

    Robert E. White, Jr. & The Doctors Company
  • How new loan caps could destroy diversity in medical education

    Caleb Andrus-Gazyeva
  • Why transplant equity requires more than access

    Zamra Amjid, DHSc, MHA
  • Ideology, not evidence, fuels the anti-trans agenda

    Andie Riffer, PhD and Shawn E. Parra, LCSW, MSW
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast
    • A surgeon’s testimony, probation, and resignation from a professional society

      Stephen M. Cohen, MD, MBA | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast
    • A surgeon’s testimony, probation, and resignation from a professional society

      Stephen M. Cohen, MD, MBA | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We must be committed to putting patients over politics
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...