Behavioral health organizations working on better way to help those who repeatedly seek assistance, county’s director of homeless services says
The city of Sarasota continues to be the primary location from which the Sarasota County Fired Department’s EMS units transport homeless individuals with medical issues to a hospital, the department’s September report shows.
Of the 187 calls for assistance last month from individuals who identified themselves as homeless, 162 resulted in transports to hospitals and 147 of those were from the city, the report says. The number of calls was a 24.6% increase from the same month in 2015, the report notes.
Of the 33 individuals who requested EMS services more than once, the report says, 28 were in the city of Sarasota.
The total number of requests for medical aid from homeless individuals in the city during the 2016 fiscal year — which ended Sept. 30 — was 1,067, the report notes.
During September, “One patient was transported 10 times,” the report continues, while another was taken to the hospital seven times; a third, five times. Four patients were taken to hospitals on four occasions, the report adds.
The latest information raised questions from Sarasota City Manager Tom Barwin about the expense to the Fire Department for its services to the homeless population. Using figures from his previous experience as a city manager in the Midwest, Barwin wrote in an Oct. 11 email to county staff, the seven homeless people with multiple transports to the hospital “could have stayed out of the elements in a place the quality of the [Sarasota Ritz-Carlton] for that amount,” if his estimates were correct.
In response, Wayne Applebee, the county’s director of services for the homeless, explained in an Oct. 12 email that representatives of the community’s behavioral health organizations have been collaborating on a better way to address the needs of homeless individuals who frequently call for medical assistance. On Oct. 26, he noted, the County Commission will discuss an analysis prepared by the county’s Health and Human Services staff related to that issue.
Nonetheless, Applebee wrote, even if a person is homeless, if he or she has Medicaid or Medicare, billing companies representing the Fire Department/EMS and the hospitals will submit invoices to those agencies. However, Applebee added, “both Medicare & Medicaid have fixed amounts that they will pay for these services,” and those “are a fraction of what the actual charges are. Medicaid patients cannot be billed for the balance [his emphasis].”
When patients with Medicare have supplemental insurance, he continued, that is billed as well, “and the patient is responsible for [the] balance. All billing agencies have programs and will work on a payment plan with patients.”
Other facets of the report
Along with calls for help in the city, the September report notes that 31 came from homeless people in the unincorporated areas of the county — a 29.5% decline for September, year-over-year; 93.5% of those incidents resulted in transport to a hospital.
Another nine calls originated in the city of Venice, with 66.7% of them resulting in transport to a hospital, a 30.8% decrease from the September 2015 figure.
The City of North Port’s Fire Rescue service reported one homeless incident in September, the report adds, while the Town of Longboat Key Fire Rescue had no such calls.
Altogether, for the 2016 fiscal year, EMS units responded to 1,437 calls for medical assistance, the report says.
Overall, the report continues, the number of calls for assistance from homeless individuals was up 6.9% from September 2015 to September 2016.
The total for September of this year represents “3.8% of our total transport numbers,” the report says.
Addressing the needs of the repeat callers
In his Oct. 11 email — which went directly to Rich Collins, Sarasota County’s director of emergency services — Barwin noted that in his review of the latest data, “what jumped out at me, as you noted in the narrative, is that 7 individuals were responsible for 23.4% of the total transports, or 38 of the 162 transports.”
Barwin continued, “I suspect a short visit to the emergency room averages at least $1,000 but obviously can vary greatly when a transport is admitted.”
He wrote, “What I am trying to get at is the cost of the chronically homeless/frequent EMS users? … If their 38 EMS transports in September say averaged $1,000 in costs for each transport and their 38 emergency rooms averaged a very conservative $1,000 in costs for each emergency room visit, these 7 individuals utilized $ 76,000 in costs …. or about $10,800 each.”
Applebee did not provide any figures. However, regarding the so-called “frequent flyers,” as Barwin characterized patients who made multiple calls for help, Applebee wrote that the Florida Department of Health uses grant funds to keep staff members in emergency rooms “for the primary purpose of identifying individuals who utilize the ER for primary care services,” to ensure those persons know about the help they can receive at the Health Department.
Applebee then referenced the Health and Human Services analysis of individuals “repeatedly utilizing behavioral health, law enforcement, jail and transportation services” under the voluntary and involuntary commitment acts provided by Florida law. “While the data is focused on behavioral health clients,” he continued, “a large percentage of those individuals have a homeless status and anecdotally [are] believed to be many of the same clients Fire/EMS is also transporting at times.”
Furthermore, Applebee continued, representatives of organizations in the community that handle behavioral health clients — the stakeholders, as he termed them — “meet on a regular basis to focus on the opportunities identified in the report with the goal of addressing those High Need High Utilizers clients in a more cost effective way and to provide better outcomes for the clients.”
Still, Applebee explained, if a program were developed to divert individuals from repeated EMS transports and ER admissions, a client could refuse to participate in it. “There would be no legal mechanism to force [that],” he added.
Finally, Applebee noted that, as with any service such as EMS, fixed costs are always a factor to be considered. Therefore, it would not be possible, he wrote, to achieve a dollar-for-dollar savings if a new program were to be implemented to try to deal with the “frequent flyers.”
Nonetheless, he pointed out, the hospitals “may realize a portion of savings from reduced services performed and clients would be more effectively served.”