Effects of the emergency medical services-based Resource Access Program on frequent users of health services

Background: It is recognized that a small number of individuals disproportionately use healthcare resources. We sought to measure the impact of the Resource Access Program (RAP) on the use of, and charges for Emergency Medical Services (EMS), outpatient and inpatient services by frequent healthcare users. Methods: A retrospective analysis of EMS and hospital billing records from one urban hospital from December 2006 – June 2009. Data from 51 individuals enrolled in the RAP with ≥ 10 EMS transports within 12 months or those reported to the RAP Coordinator for significant increases in EMS transports were collected. Inpatient services were defined to include outpatient or ED visits that resulted in admission. Data were collected for equal pre and post enrollment time periods and comparisons were made using Wilcoxon signed–rank test. Results: EMS encounters decreased from 736 to 459 (p = 0.005) from pre to post periods, resulting in a decrease of EMS charges from $689,743 to $468,394. Reductions in EMS transport time and mileage were approximately 263 (p=0.002) hours and 1,939 (p=0.002) miles, respectively. Outpatient and inpatient services showed no significant differences. Across all services, charges declined by an estimated $314,306. Conclusions: Our study suggests that the RAP is an effective means of decreasing EMS transports by frequent users but has a limited impact on use of hospital services. This may be due to the fact that the RAP focuses primarily on reducing inappropriate use of EMS rather than the actual treatment of chronic underlying conditions that lead to admission.