Patients » Pouring resources into the neediest, Utah clinic tries “hot spotting” to keep homeless out of hospital ERs.

By Kirsten Stewart

| The Salt Lake Tribune

Editor’s note: Details about Joseph Koch — a pseudonym — were obtained from court documents, other records and interviews, including Koch. But The Salt Lake Tribune chose to use a pseudonym to protect his medical privacy.

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At a glance

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About this series

Growing concern about the nation’s health costs is spawning innovation among Utah’s hospitals, clinics and insurance companies. This is the second in a series of occasional stories spotlighting those efforts. For an earlier look at concierge medicine in Utah, visit http://bit.ly/sWUp9I.

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Editor’s note

Details about Joseph Koch — a pseudonym — were obtained from court documents, other records and interviews, including Koch. But The Salt Lake Tribune chose to use a pseudonym to protect his medical privacy.

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Joseph Koch was weathered and muscular for a man in his 60s.

The career tile layer was never seen panhandling, had only minor run-ins with the law and was agreeable when he wasn’t drinking. On the streets he usually kept to himself, unnoticed by most except the cops and fire crews who lost count of the times they picked him up, intoxicated, unconscious and soaked in urine and feces.

Like many of the homeless and uninsured, Koch - a pseudonym - frequently surfaced in emergency rooms. His record, though, was unparalleled: over 16 months, between January 2010 and April 2011, he racked up 93 ER visits, hitting every major hospital in the Salt Lake Valley.

Some days, after being discharged, he’d make it only as far as the closest convenience store, where he’d down a bottle of mouthwash, pass out and get picked up again, said Ed Snoddy, a medical outreach worker for the homeless. At Pioneer Valley Hospital, where one day he showed up six times, Snoddy said, staff called him "Minty Fresh."

His estimated ER bill: $418,000. And that doesn’t include ambulance rides, X-rays, tests, treatments and several stays in intensive care.

If Koch embodies what’s broken in health care, he’s also a catalyst for change, compelling Utah’s fragmented system to rally behind a new strategy of caring for the sickest and costliest patients.

Called "hot spotting," it’s taking root in cities across America and, some say, points the way to lowering the nation’s health costs.