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AH: Most Acute Care Costs Not Avoidable for High-Cost Patients

Only small percentage of costs related to preventable ER visits, hospitalizations

MONDAY, June 24 (HealthDay News) -- For high-cost Medicare beneficiaries, only a small percentage of costs are related to preventable emergency department visits and hospitalizations, according to a study published online June 24 in the Journal of the American Medical Association to coincide with presentation at the Annual Research Meeting of AcademyHealth, held from June 23 to 25 in Baltimore.

Karen E. Joynt, M.D., M.P.H., from the Harvard School of Public Health in Boston, and colleagues quantified potentially preventable emergency department visits and acute care inpatient hospitalizations among high-cost Medicare patients using data from Medicare files for 1,114,469 Medicare fee-for-service beneficiaries aged 65 years or older.

The researchers found that patients in the top 10 percent of Medicare spending in 2010 were older, more often male and black, and had more comorbid illnesses. In 2010, these patients incurred 32.9 percent of total emergency department costs. Forty-one percent of these costs were potentially preventable, versus 42.6 percent of costs among non-high-cost patients. Seventy-nine percent of inpatient costs were incurred by high-cost patients; preventable hospitalizations accounted for 9.6 percent of costs, compared with 16.8 percent of costs for non-high-cost patients. Among persistently high-cost patients, comparable proportions of emergency department costs (43.3 percent) and inpatient costs (13.5 percent) were preventable. For high-cost patients, there was higher preventable spending in regions with high primary care physician supply.

"Among a sample of patients in the top decile of Medicare spending in 2010, only a small percentage of costs appeared to be related to preventable emergency department visits and hospitalizations," the authors write. "The ability to lower costs for these patients through better outpatient care may be limited."

Full Text (http://jama.jamanetwork.com/article.aspx?articleid=1699911 )More Information (http://academyhealth.org/events/content.cfm?ItemNumber=882&navItemNumber=529 )