Long a niche, street medicine for homeless heads mainstream

Far from the sterile confines of a doctor's office or hospital, Brett Feldman looks for homeless people where they're most likely to be found — in wooded encampments, under bridges, along riverbanks, at soup kitchens — and treats them for ailments ranging from diabetes to trench foot, mental illness to substance abuse.

The 34-year-old physician assistant is one of the nation's few practitioners of "street medicine," a tiny health care niche that advocates predict will become more mainstream as hospitals and health care systems seek to cut costs, in part by reducing emergency-room visits among the homeless.

In cities scattered around the country and the world, they left the office and headed outside to care for the chronically homeless, a population that is generally sicker and dies far younger than people with homes.

[...] recently, though, relatively few of the 60 street medicine programs that operate nationwide have been affiliated with a hospital or health system.

Homeless people use the emergency room more often than the general population, stay longer and are readmitted at higher rates — a triple financial blow that's inflicting "open wounds, bleeding wounds for hospitals," says Dr. Jim Withers, a street medicine pioneer who launched Pittsburgh Mercy's Operation Safety Net program in 1992.

The street medicine program, which is funded by grant money including a $200,000 award from the Pennsylvania Department of Health, has reduced 30-day readmission rates to Lehigh Valley Hospital from 51 percent to 13 percent.

[...] Feldman and his team have been able to raise the rate of insured homeless from 24 percent to 73 percent, meaning the hospital gets paid more often for the care it provides.

Fleisch and three psychiatry residents conduct "street rounds" in Nashville, Tennessee, once a week, hiking to homeless camps and providing follow-up care to people who have been treated at the hospital for mental illness and substance abuse.