How Coordinated Care Can Ground Frequent Fliers

Waller tries not to dwell on the reasons why a fellow physician might fire a patient. There's a bigger problem after the patient is dismissed, he says. "Once (the patients) get fired, where do they go? The ED."

Being "released" isn't the only problem for these patients, Waller adds. From his vantage point, "a large portion of mental health diagnosis is inaccurate (for) these patients. They'll come up with being labeled for five to seven mental health disorders," Waller says.

"If you look at the definition of some of these illnesses, they simply can't co-exist, but these people keep getting labeled every time they show up (at their physicians' offices). You have them with a diagnosis of bipolar, but when you talk to them, yes, they have their ups and downs, but they just haven't been taught coping skills and they are angry."

Waller says the Spectrum clinic works to catch those patients before they keep going back to the ED. The doctor was instrumental in establishing the clinic after he led a study in 2008 about the "frequent fliers" at the hospital.  Waller found that 950 patients visited the EDs of two hospitals in the Spectrum system more than 10 times in a year. He extrapolated that these patients were responsible for as much of 20,000 total visits, and nearly $50 million in costs.