Potentially Avoidable Hospitalizations of Dually Eligible Medicare and Medicaid Beneficiaries from Nursing Facility and Home- and Community-Based Services Waiver Programs
Objectives Beneficiaries dually eligible for Medicare and Medicaid are of increasing interest because of their clinical complexity and high costs. The objective of this study was to examine the incidence, costs, and factors associated with potentially avoidable hospitalizations (PAH) in this populat...
Saved in:
Published in | Journal of the American Geriatrics Society (JAGS) Vol. 60; no. 5; pp. 821 - 829 |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, NJ
Blackwell Publishing Ltd
01.05.2012
Wiley-Blackwell Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Objectives
Beneficiaries dually eligible for Medicare and Medicaid are of increasing interest because of their clinical complexity and high costs. The objective of this study was to examine the incidence, costs, and factors associated with potentially avoidable hospitalizations (PAH) in this population.
Design
Retrospective study of hospitalizations.
Setting
Hospitalizations from nursing facilities (NF) including Medicare and Medicaid‐covered stays, and Medicaid Home and Community‐Based Services (HCBS) waiver programs.
Participants
Dually eligible individuals who received Medicare skilled nursing facility (SNF) or Medicaid NF services or HCBS waiver services in 2005.
Interventions
None.
Measurements
Potentially avoidable hospitalizations were defined by an expert panel that identified conditions and associated Diagnostic Related Groups (DRGs) which can often be prevented or safely and effectively managed without hospitalization.
Results
More than one‐third of the population was hospitalized at least once, totaling almost 1 million hospitalizations. The admitting DRG for 382,846 (39%) admissions were identified as PAH. PAH rates varied considerably among states, and blacks had a higher rate and costs for PAH than whites. Five conditions (pneumonia, congestive heart failure, urinary tract infections, dehydration, and chronic obstructive pulmonary disease/asthma) were responsible for 78% of the PAH. The total Medicare costs for these hospitalizations were $3 billion, but only $463 million for Medicaid. A sensitivity analysis, assuming that 20%–60% of these hospitalizations could be prevented, revealed that between 77,000 and 260,000 hospitalizations and between $625 million and $1.9 billion in expenditures could be avoided annually in this population.
Conclusion
Potentially avoidable hospitalizations are common and costly in the dually eligible population. New initiatives are needed to reduce PAH in this population as they are costly and can adversely affect function and quality of life. |
---|---|
Bibliography: | ark:/67375/WNG-3W630HLQ-K ArticleID:JGS3920 istex:62EE9DAE9DD905633072B08FEF21D12896C8091D ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0002-8614 1532-5415 |
DOI: | 10.1111/j.1532-5415.2012.03920.x |