Study: Preventing Hospitalizations May Have Limited Effect on Costs

Curbing preventable hospitalizations and emergency department visits among high-cost Medicare patients may reduce healthcare costs only minimally, according to a study in the Journal of the American Medical Association.

Researchers examined the proportion and costs of preventable hospitalizations and ED visits among Medicare patients in the top 10 percent of Medicare spending in 2010.

The high-cost Medicare patients incurred 73 percent of acute-care spending in 2010. Overall, only 10 percent of these costs were considered potentially preventable, while 19.1 percent of non-high-cost patients' costs were considered potentially preventable. Here are some other key data points:

•    High-cost patients accounted for 79 percent of inpatient costs, 9.6 percent of which were due to preventable hospitalizations. In contrast, 16.8 percent of non-high-cost patients' inpatient costs were due to preventable hospitalizations, according to the study.

•    In 2010, high-cost patients accounted for 32.9 percent of total ED costs. Forty-one percent of high-cost patients' ED costs were potentially preventable. For non-high-cost patients, 42.6 percent of ED costs were potentially preventable.

•    Catastrophic events such as sepsis, stroke and myocardial infarction, cancer and expensive orthopedic procedures such as spine surgery and hip replacement were the biggest drivers of inpatient spending among high-cost patients, according to the study.

•    Annual preventable costs per capita were higher in hospital referral regions with more primary care or specialist physicians.

These data suggest that focusing on chronic disease management and preventing inpatient visits alone will not lower healthcare costs substantially, according to the study. In addition, only increasing access to primary care physicians for high-cost patients may not reduce costs. "The ability to lower costs for these patients through better outpatient care may be limited," the authors wrote.

The authors suggested combining disease management strategies with clinical redesign to lower the per-episode costs of high-cost diseases.

More Articles on Preventable Acute-Care Visits:

Study: People With Health Insurance Hospitalized Less, Incur Lower Costs
3 Ways to Make Readmission Rates a More Useful Quality Measure
10 Statistics on Hospital Admissions From the ED

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