Extended hospital stays and not frequent visits to hospital emergency rooms constitute the greatest cost in caring for homeless Medicaid patients, a new analysis has found.

A review of 1100 homeless people served by the Boston Health Care for the Homeless Program found that while repeated visits to the ER do constitute a problem for caregivers, the cost of those visits is dwarfed by costs associated with the same patients spending long periods of time in the hospital.

According to the review, 30 percent of the group’s Medicaid costs were for hospital stays while only four percent were for ER services. The homeless frequently spend more time in the hospital because they are in such poor overall health.

In recent years, providers have focused much of their attention on frequent ER visitors – so-called “frequent flyers” or “super-utilizers” – but the experience of the Boston program suggests that conditions that lead to long periods of hospitalization among the homeless may need more attention as well.

Because of where they are located, private safety-net hospitals serve far more homeless patients than the typical hospital.

For a closer look at the Boston program and what its leaders learned, see this Boston Herald article.