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Trenton’s Emergency Rooms Clogged by People Lacking Health Insurance, City Ranked Third Worst in University Study

TRENTON – Too many people lacking health insurance or who do not regularly visit doctors are clogging Trenton emergency rooms and hospitals, costing tens of millions of dollars a year that could be saved through more efficient health care, a Rutgers University study found.

The capital ranked third worst among New Jersey cities in the study by Rutgers’ Center for State Health Policy that found that between 2008 and 2010, avoidable emergency room visits alone cost $16.5 million a year. Avoidable hospitalizations cost another $23 million.

Dr. Ruth Perry, executive director of the Trenton Health Team, an organization created by the city and area health-care providers to improve delivery of care, said the study reflects the fact many Trenton residents do not see a primary-care doctor.

Instead, they go to the hospital when there are signs of trouble, even if a clinic or doctor’s office would be better suited to address their health needs, she said.

“The results of this study were not a surprise. We’ve been working on this issue for quite some time,” Perry said. “When you look at the cities listed, those are cities that have deep levels of poverty, so they have huge barriers to receiving health care and having good health outcomes.”

One example of the problem is Cliff, a 49-year-old Trenton resident with diabetes, kidney failure and a host of other illnesses, who needed dialysis several times a week. Unable to sit through the hours-long treatments, he often skipped out early.

That bad habit backfired in 2010, when he was hospitalized 66 times at St. Francis Medical Center and spent a month in intensive care at Robert Wood Johnson Hospital in Hamilton. The cost of his care during that period easily exceeded $1 million, according to physicians familiar with his case.

Patients like Cliff are why Trenton ranked the third-worst out of New Jersey’s 13 urban centers in the Rutgers study that measured how well medical and public health professionals kept the state’s poorest citizens healthy and out of the hospital from 2008 to 2010.

The study found the New Brunswick-Franklin Township region scored the highest among the 13 urban centers, while Atlantic City-Pleasantville ranked lowest. But the report said every region unnecessarily spent millions during the study period, including $284 million that could have been saved in 2010 alone.

Many low-income areas face high rates of avoidable emergency room visits due to factors outside hospitals’ control, Rutgers researcher Sujoy Chakravarty said. The study suggests there is room for improvement in the way communities approach health care, he said.

“Potential improvements could be trying to build up primary-care capacity in the community and care coordination,” Chakravarty said. “All these factors would provide better care, improve health and help outcomes.”

By improving to the level of hospitals in the state’s best-performing regions, Trenton’s hospitals could have saved about $11 million on avoidable emergency room visits, $9 million on avoidable hospitalizations, $28 million by reducing high use of inpatient services, $11.9 million by cutting high use of emergency rooms, and $7.8 million by reducing readmissions, the study found. The potential savings total $68 million a year.

The study said that Capital Health’s former Mercer campus had more than 1-in-3 avoidable emergency room visits and represented about a third of high emergency room use at Trenton hospitals.

During the study period, public health services such as vaccination clinics and prenatal services in Trenton were scarce because the city didn’t have the money to provide them, said Jim Brownlee, the city’s health officer. “People had no place to go. They ended up in the ER and on charity care.”

Then the city’s clinics, hospitals and medical professionals, who traditionally competed against each other, came together in 2010 to form the Trenton Health Team. Now, unnecessary emergency room visits are down 45 percent and avoidable hospital stays have declined 56 percent, said Perry.

Since the end of the period studied, Mercer County’s hospitals have seen major changes.

Two new hospitals have opened – Capital Health Medical Center-Hopewell in 2011 and the University Medical Center of Princeton at Plainsboro in 2012 – and the former Mercer campus on Bellevue Avenue in Trenton has been reduced to a satellite emergency services location. The city is now left with two full-service hospitals: Capital Health Regional Medical Center on Brunswick Avenue and St. Francis on Hamilton Avenue.

Perry said the Trenton Health Team has been making slow but steady progress in reducing avoidable hospitalizations. The organization has been working to coordinate care and link patients with primary-care physicians, and from 2011 to mid-2012, 30-day hospital readmission rates fell by 6.8 percent in Mercer County, she said.

Still, many patients who lack transportation and insurance face continued barriers to health care, she said.

“What we have to do is work together in the health-care community and work with our colleagues in behavioral health, education and the city to work on addressing these social barriers to health care,” Perry said. “We need increased opportunities for economic development, better education and increased opportunities for housing. These issues really need to be addressed if we’re going to rise to the top of these types of rankings.”

“We can’t quantify how much money we’ve saved, but we know we have,” said Robert Remstein, vice president at Capital Health and president of Trenton Health Team. “More importantly, we’ve improved the provision of care for the people of Trenton.”

And Trenton officials say the case of Cliff, the man hospitalized 66 times, provided an opportunity for them to tackle the problem.

A nurse at St. Francis, a member of the Trenton Health Team, asked Cliff what he’d like to do to take his mind off the tedious kidney treatment. He liked to draw, he replied.

“She gave him poster boards and pens, and he drew for six hours,” said Christy Stephenson, executive vice president for Catholic Health East, St. Francis’ parent company. Since that breakthrough in November 2010, Cliff has been hospitalized only once and he never misses dialysis.

“He’s on a (kidney) transplant list. He stopped smoking,” Stephenson said of Cliff. “It changed his life.”

The Star-Ledger contributed to this report.

About the Trenton Health Team
Trenton Health Team (THT) is an alliance of the city’s major providers of healthcare services including Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city’s Health Department. In collaboration with residents and the city’s active social services network, THT is developing an integrated healthcare delivery system to transform the city’s fragmented primary care system and restore health to the city. THT aims to make Trenton the healthiest city in the state. Support for the Trenton Health Team was provided in part by a grant from The Nicholson Foundation. For more information, visit