Nearly 80 percent of the roughly $92 billion in acute care Medicare costs in 2010 were wracked up by the 10 percent of patients who comprise the high-cost cohort, and 9.6 percent of those costs were for potentially preventable hospitalizations, researchers found.
Among Medicare patients who fell short of the highest expenditures, 16.8 percent of costs were spent on preventable hospitalizations, Dr. Karen Joynt of Brigham and Women’s Hospital in Boston, and colleagues wrote online in the Journal of the American Medical Association.
Preventable hospitalizations were “those related to conditions, such as heart failure, diabetes, hypertension, and asthma, for which good outpatient care can likely prevent the need for hospitalization.” Preventable emergency department visits were those that were categorized as nonemergent, emergent/primary care treatable, or emergent/emergency department care needed/preventable or avoidable.
The authors noted that emergency department visits and inpatient hospitalizations represent the majority of Medicare healthcare spending among those in the top 10 percent of expenditures, who themselves represent more than half of all Medicare costs. They added that little data existed on which of these costs are preventable.
Joynt and co-authors attempted to quantify “the profitability of high-cost patients’ acute care spending” through healthcare data from 1,114,469 Medicare beneficiaries ages 65 and older. Specifically, they looked at the proportion of acute care episodes and spending associated with high-cost Medicare patients, the proportion of that spending used on preventable hospitalizations, as well as what supply-side factors may be associated with preventable spending.
High-cost patients were identified through standardized care costs through Medicare payments for each hospitalization minus duplicate costs “and adjusted for Medicare Wage Index, graduate medical education, and disproportionate-share payments.” Those in the highest cost were considered to be in the top decile of total costs for years 2009 and 2010.
Of the more than one-million patients included in the sample, 113,341 were considered to be “high-cost” patients, who were more likely to be older (median age 78 versus 77 in the total sample), male (44.5 percent vs. 41.7 percent), and black (8.5 percent vs. 7.1 percent ). Those in the top decile of costs also had a greater prevalence of comorbid illnesses, including heart failure, diabetes, and cancer, as well as mental illness and substance abuse.
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