Hospitalizations, deaths and costs decline in Medicare population: 5 study findings

The Medicare fee-for-service population experienced a considerable decline in hospitalizations, deaths and costs between 1999 and 2013, according to a new study published in JAMA.

Researchers examined trends in all-cause hospitalizations and mortality, as well as hospitalization-associated outcomes and expenditures, for more than 68 million unique fee-for-service Medicare and Medicare Advantage beneficiaries.

They found:

1. All-cause mortality for all Medicare beneficiaries declined roughly 16 percent, from 5.3 percent in 1999 to 4.45 percent in 2013. The decline in the mortality rate is equivalent to more than 300,000 fewer deaths a year in 2013 than in 1999.

2. Among fee-for-service beneficiaries (roughly 60 million people), the total number of hospitalizations per 100,000 person-years decreased 24 percent, from 35,274 to 26,930. That's approximately 3 million fewer hospitalizations in 2013 than 1999.

3. When patients were admitted to hospitals in 2013, they were 45 percent less likely to die during their stay and 24 percent less likely to die within a month of admission compared to 1999. Additionally, among fee-for-service beneficiaries in the last six months of life, the number of hospitalizations decreased from 131.1 to 102.9 per 100 deaths, meaning patients were 22 percent less likely to die.

4. The average inflation-adjusted inpatient expenditures per Medicare fee-for-service beneficiary declined from $3,290 to $2,801 over the time period studied.

5. Meanwhile, among fee-for-service beneficiaries in the last six months of life, the inflation-adjusted inpatient expenditure per death increased from $15,312 in 1999 to $17,423 in 2009 and then decreased dramatically to $13,388 in 2013.

Lead author of the study Harlan Krumholz, MD, a cardiologist and professor at the Yale School of Medicine in New Haven, Conn., spoke with USA Today about the results of the study.

"It's a jaw-dropping finding," Dr. Krumholz told USA Today. "We didn't expect to see such a remarkable improvement over time."

He went on to describe some possible driving factors behind the trends, including an increased focus on quality and safety, pubic health improvements (i.e. cleaner air, fewer smokers, etc.) and new drugs for common and chronic conditions.

Despite the study findings, Dr. Krumholz warns against the dangers of becoming complacent.

"The things we're trying to do to make things better are working," Dr. Krumholz told USA Today. "Rather than wave the victory flag, we want to see that trend continue. There's no reason to take our foot off the pedal."



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