Picture this; a not-for-profit hospital in an urban area tracks it’s cost to provide care for ONE uninsured, homeless individual for a period of between 18 months and 2 years. At the heart of this exercise lies the impetus for the creation and execution of the Patient Protection and Affordable Care Act. Making healthcare coverage available to every American. Note an important distinction, making healthcare COVERAGE available, NOT HEALTHCARE! The subtle difference in the two is about following the money. Indigent care (i.e. care for patients that cannot pay) is a line item on every acute care providers’ fiscal budget.

Now back to that one uninsured homeless individual that was tracked for nearly two years. After discovering the cost of treating the individual, the hospital pro-actively found the man a primary care physician, a neurologist, a substance abuse treatment plan, and assisted with finding a place to live.  According to the article, this was accomplished for around $6,000.  With no insurance, and no way to pay, that seems like a lot of money for the hospital to “front”, that is, until you dig deeper, and realize that for this same patient, in the prior two year period had racked up $626,143 in charges! Although it’s probably not fair to compare the $6,000 in pro-active costs to the $626,143 billable charges, it is fair to ask where these common sense solutions were prior to the passage of the Affordable Care Act.

A couple of notable articles have appeared that support some of these common sense approaches to the escalating cost of indigent care. In Camden New Jersey, Jeffrey Brenner, MD, has identified “superusers” by a process called “hotspotting” to reduce overall costs by as much as 50%.  According to this article, the sickest 5% account for more than half of U.S. healthcare costs.

This “hotspotting” technique was the premise upon which the urban hospital in Louisville KY delivered it’s results.