Jacobs Journal of Emergency Medicine

Homeless Frequent Flyers: The Impact of Homelessness on Frequent Use of the Emergency Department

Published on: 2014-11-14


 Frequent users of the emergency department (ED) are a diverse group of patients with a wide variation in demographics and socioeconomic status. Three-point-six percent of Medicaid enrollees account for 48.8% of total program spending and each “frequent flyer” has an average cost of above $25,000 per patient per year. This group is in general sicker, older and in need of medical intervention, however, there are frequent users who repeatedly present to the ED for low acuity issues. A study from the Washington University Department of Emergency Medicine in St. Louis demonstrated that while patients with between 3-20 ED visits per year had a higher acuity rate than the general ED population, that users presenting more than 20 times had lower acuity scores, were hospitalized for shorter periods and had longer stays in the ED. The demographics of the group of high utilizers presenting more than 20 times a year, or ultra-high utilizers, is not well established, however, homelessness has been shown to be a predictor of increased ED utilization. Case management based interventions with a primary focus on housing have been shown to decrease health care utilization among the subset of frequent users who are homeless, and while these results are encouraging they have also been subject to criticism.