You've heard about "superbugs" causing infections in hospitals. Meet the "super-users" contributing to the crisis in emergency rooms.

The Newark Star-Ledger has an interesting, detailed article about repeat visitors to ERs, the so-called "super-users." Repeat users doesn't mean eight or ten visits a year. It means 100 visits, even 200 visits, or in at least one case in Camden, N.J. 314 visits.

Camden is a very poor city, with high rates of people who are uninsured or on Medicaid. But it is shaping up as a laboratory to study ways of fixing the costly national problem of emergency care. "Researchers say a seemingly intractable problem could be solved, in large part, by focusing on just the top one percent of emergency room users, who in Camden alone cost $46 million over five years," the article by Carol Ann Campbell says.

She writes about Dr Jeffrey Brenner, one of Camden's rare family doctors, who has been studying five years of ER records from the city's three hospitals. He found that about one percent of ER and hospital users accounted for about 10 percent of total admissions. Putting it another way, about 1,000 super-users showed up at Camden hospitals more than 39,000 times from 2002–2007. The most expensive patient cost $3.5 million over five years. Overall, the city's three hospitals were paid $46 million to care for these top users, most of it from government insurance and New Jersey charity care. She writes:

As the data rolled in, Brenner looked at the money and shuddered. He reasoned that for the same money he could hire 50 doctors and provide a concierge level of medical care. Or he could hire 100 nurse practitioners who could provide one-on-one care for 10 patients each.

That's more or less what he did—creating a roving medical home that brings care to people who need it, managing their chronic diseases, helping them with their addictions. Keeping them out of the E.R. It's one of several programs detailed in the article, worth a look.

We've written before about why emergency rooms are so overcrowded—and the fact that it isn't just the uninsured who come. Studies have shown that the uninsured were no more likely to come to ERs for regular care than anyone else and less likely to come than Medicaid patients. (Although given the poverty levels in Camden and the local health infrastructure, it's not typical of every U.S. city).

Emergency room doctors and the medical literature, however, tell us that overcrowding is as much of a downstream problem as anything else. That is, about 13 percent of all patients admitted to an ER are so ill that they require admission to the hospital. But there are often not enough beds, both because existing beds are used inefficiently and hospitals limit capacity in order to avoid uninsured patients. In places like Camden, too much capacity for admission of emergency patients endangers hospital financing because the money the hospital brings in from insured patients doesn't offset the losses from the uninsured emergency patients. Overcrowding is less common in hospitals in affluent areas.

The people this article addresses are sick, poor and often uninsured. They lack a source of regular medical care. By creating a way to give them care outside the ER, the doctors in Camden are taking a good first step in solving a big problem in U.S. medicine.