Study: High Rate of Avoidable Hospitalizations Among Medicaid Home and Community-Based Services Users

Users of Medicaid home and community-based services are particularly vulnerable to avoidable hospital admissions, generating a significant cost to Medicaid and Medicare, according to a study in Health Affairs.

Researchers studied data on the national 2005 Medicaid population from the Medicaid Analytic eXtract data set. They defined avoidable hospital admissions using composite measures from a larger set of indicators developed by the Agency for Healthcare Research and Quality. The measures included admissions associated with chronic conditions, such as diabetes and congestive heart failure, and admissions associated with acute conditions, such as bacterial pneumonia and urinary tract infection.

The researchers found 2.2 million people used Medicaid home and community-based services in 2005, accounting for nearly 4 percent of the total Medicaid population. Two-thirds of the users were dually eligible for Medicare and Medicaid. There were more than 19,000 avoidable admissions per 100,000 Medicaid home and community-based services users, a rate which is nearly twice the number of avoidable admissions for the entire Medicaid population.

Based on an estimated average cost per avoidable hospitalization for dual eligibles of $6,740, these avoidable hospitalizations cost nearly $3 billion in annual Medicare and Medicaid expenditures, according to the study. Medicare pays most of the costs for dual eligibles.

More Articles on Avoidable Hospitalizations:

6 Care Coordination Approaches to Reduce Hospitalizations
Rehospitalizations Due to SSIs Add Up to $65M in Healthcare Costs

What Hospitals are Doing to Prepare for Medicare Readmission Penalties

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