In the shadow of great hospitals, asthma reigns
BALTIMORE — Keyonta Parnell has had asthma most of his young life, but it wasn't until his family moved to the 140-year-old house here on Lemmon Street two years ago that he became one of the health-care system's frequent customers.
"I call 911 so much since I've been living here, they know my name," said the 9-yearold's mother, Darlene Summerville, who calls the emergency medical system her "best friend."
Summerville and her family live in the worst asthma hot spot in Baltimore: Zip code 21223, where decrepit houses, rodents and bugs trigger the disease and where few community doctors work to prevent asthma emergencies.
Residents of this area visit hospitals for asthma flare-ups at more than four times the rate of people from the city's wealthier neighborhoods, according to data analyzed by Kaiser Health News and the University of Maryland's Capital News Service.
Baltimore paramedic crews make more asthma-related visits per capita in 21223 than anywhere else in the city, according to fire department records. It is the second-mostcommon Zip code among patients hospitalized for asthma, which, when addressed properly, should never require emergency visits or hospitalization.
The supreme irony of the localized epidemic is that Keyonta's neighborhood in southwest Baltimore is in the shadow of prestigious medical centers – Johns Hopkins, whose researchers are international experts on asthma prevention, and the University of Maryland Medical Center (UMMC).
Both receive massive tax breaks in return for providing "community benefit," a poorly defined federal requirement that they serve their neighborhoods. Under Maryland's ambitious effort to control medical costs, both are supposed to try to improve residents' health outside the hospital and prevent admissions.
But like hospitals across the country, the institutions have done little to address the root causes of asthma. The perverse incentives of the health-care payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.
Hopkins, UMMC and other hospitals collected $84 million over the three years ending in 2015 to treat acutely ill Baltimore asthma patients as inpatients or in emergency rooms, according to the news organizations' analysis of statewide hospital data. Hopkins and a sister hospital received $31 million of that.
Executives at Hopkins and UMMC acknowledge that they should do more about asthma in the community but note that there are many competing problems: Diabetes, drug overdoses, infant mortality and mental illness among the homeless.
Science has shown it's relatively easy and inexpensive to reduce asthma attacks: Remove rodents, carpets, bugs, cigarette smoke and other triggers. Deploy community doctors to prescribe preventive medicine and health workers to teach patients to use it.
Ben Carson, secretary of the Department of Housing and Urban Development, who saw hundreds of asthmatic children from lowincome Baltimore during his decades as a Hopkins neurosurgeon, said that the research on asthma triggers is unequivocal. "It's the environment – the moist environments that encourage the mold, the ticks, the fleas, the mice, the roaches," he said in an interview.
As the leader of HUD, he says he favors reducing asthma risks in public housing as a way of cutting expensive hospital visits. The agency is discussing ways to finance pest removal, moisture control and other remediation in places asthma patients live, a spokesman for HUD said.
"The cost of not taking care of people is probably greater than the cost of taking care of them" by removing triggers, Carson said, adding, "It depends on whether you take the short-term view or the long-term view."
Asthma is the most common childhood medical condition, with rates 50 percent higher in families below the poverty line, who often live in run-down homes, than among kids in wealthier households. The disease causes nearly half a million hospital admissions in the United States a year, about 2 million visits to the emergency room and thousands of deaths annually.
That drives the total annual cost of asthma care, including medicine and office visits, well over $50 billion.
Keyonta lives in a two-bedroom rowhouse on the 1900 block of Lemmon Street, which some residents call the "Forgetabout Neighborhood," about a mile from UMMC and three miles from Hopkins.
Reporters spent months interviewing patients and parents and visiting homes in 21223, a multiracial community where the average household income of $38,911 is lower than in all but two other Zip codes in Maryland.
To uncover the impact of asthma, the news organizations analyzed every Maryland inpatient and emergency room case over more than three years through a special agreement with the state commission that sets hospital rates and collects such data. The records did not include identifying personal information.
For each emergency room visit to treat Baltimore residents for asthma, according to the data, hospitals were paid $871, on average. For each inpatient case, the average revenue was $8,698. In one recent three-year period, hospitals collected $6.1 million for treating just 50 inpatients, the ones most frequently ill with asthma, each of whom visited the hospital at least 10 times.
Hopkins' own research shows that shifting dollars from hospitals to Lemmon Street and other asthma hot spots could more than pay for itself. Half the cost of one admission – a few thousand dollars – could buy air purifiers, pest control, visits by community health workers and other measures proven to slash asthma attacks and hospital visits by frequent users.