Cornelius Buie is a regular patient at Progressive Community Clinics in Milwaukee, and that's a good thing — the 42-year-old needs regular treatment to keep his diabetes under control. However, getting such routine care wasn't something Buie was inclined to do after he was first diagnosed with the disease about seven years ago.
"I was insured but I didn't have a doctor," he said. "And at the time, I didn't want to accept that I was diabetic."
Despite Buie's denial, the disease caught up with him: His vision became blurry, he had to urinate frequently, and he began losing weight. So he turned to the emergency room — the only place he'd ever gotten care. In four years, he visited the ER a dozen times.
The number of people going to the emergency room has been on the rise in the years following the rollout of the Affordable Care Act, both across the country and in Wisconsin. When Medicaid was partially expanded in Wisconsin, ERs in Milwaukee County saw a nearly 10 percent spike in patients between 2013 and 2015. What's more, many of those patients — Buie among them — didn't necessarily need high-level emergency care.
Luckily, the city of Milwaukee was ready for those kinds of visits: It had a system to get patients the care they needed in a place many hadn't thought to look.
Emergency Room Visits In Milwaukee County Over Time
Providing "A Primary Medical Home"
In 2012, nearly half of ER visits in Milwaukee County could be considered non-emergency. It's a high rate compared to the rest of the state: A recent survey by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that 23 percent of Wisconsin residents say they've gone to the ER in the last two years for minor health problems.
Those ailments can be treated more cheaply and often better in a doctor's office. That's why in 2009, all the hospitals in Milwaukee teamed up with nearby community clinics to create the Milwaukee Health Care Partnership, a system in which patients in need of non-emergency care could get referrals to clinics.
Dr. Chris Decker, who directs emergency medicine at Froedtert Hospital, said that Milwaukee's emergency rooms use a citywide database to connect patients with the clinics.
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"If a patient needs care, we're able to get on that database, make an appointment for them, give them a time and a place and give them bus route lines and recommendations for transportation. And then a few days before their clinic appointment, they actually get a phone call from that clinic," he said.
Last year, nearly 6,000 people who visited Milwaukee ERs with minor or chronic health issues were given an appointement with a clinic for subsequent care. "We are in a fortunate enough position in this city, that we are able to … provide a primary medical home for any patient that comes to the emergency department," said Decker.
Dr. Chris Decker says once patients get connected with a primary care doctor, their use of the emergency room drops 44 percent. Shamane Mills/WPR
Barriers To Getting Routine Care
Just under half of the patients referred to clinics through the partnership showed up for their doctor's appointment. Partnership officials say that's a reputable rate, considering the barriers this group of patients faces, like transportation. Many are poor — 34 percent of those living in Milwaukee County are on Medicaid, and 44 percent of patients are at the federal poverty level or below it.
Among the patients who do get connected to a regular doctor, emergency room visits have dropped 44 percent.
As for Buie, diabetes has certainly left its mark. At one point, his income went up and he lost Medicaid coverage.
"I couldn't afford to go to the doctor and have my medications," he said. "Then I got sick again recently where I caught an infection in my toe, so it had to be amputated because of the diabetes."
But now, the disease is under better control. Buie is no longer turning to ER doctors — instead he's getting regular care from doctors he can call his own.