Hospital admissions and readmissions are a hot topic in the healthcare community. Reducing hospital utilization can result in a leaner, more efficient system with lower costs and greater health outcomes. The opportunities to save money and improve care are extraordinary.
Accordingly, Medicare, state Medicaid agencies, health plans, and patient organizations have joined the discussion to address preventable hospital utilization. The first step is understanding patterns and trends in hospital utilization.
A primary diagnosis is the principal reason for a patient’s admission to a hospital, regardless of any other simultaneous conditions they may have. A fascinating statistical brief by the Healthcare Cost and Utilization Project (HCUP) analyzed admissions trends over the past decade and revealed several interesting trends.
Overall hospitalization numbers remained relatively constant between 1997 and 2010. However, certain conditions had a rapidly growing admission rate. Below is a list of the largest increase in hospital admissions by condition between 1997 and 2010:
- Acute and unspecified renal failure (264% increase).
- Prolonged pregnancy (136% increase).
- Pulmonary heart disease (112% increase).
- Osteoarthritis (106% increase).
- Deficiency and other anemia (103% increase).
Between 1997 and 2010 there were also shifts in the number of hospital stays by payor. The largest increases were seen in Medicaid and the uninsured.
- Medicaid was the primary payor for 8.3 million stays in 2010, a 47% increase since 1997. (Medicaid’s share of national hospital spending will, of course, increase dramatically starting in 2014 under the Affordable Care Act (ACT), both through state optional eligibility expansion and the woodwork effect of new federally-mandated, highly streamlined approach to Medicaid eligibility and enrollment.)
- Stays by the uninsured increased by 40%.
- Medicare paid for 14.5 million stays in 2010, a 12% increase since 1997.
- Primary insurance accounted for 12.5 million stays in 2010, a decrease of 7% since 1997.
Reducing Preventable Hospital Admissions and Readmissions
There have been many proposed approaches to reduce hospital admissions. Many of these include improving access and the quality of primary care, utilizing technology to create efficient alternatives to utilizing hospitals, and addressing inefficiencies in payment and care delivery models. A report from the America’s Health Insurance Plans (AHIP) Center for Policy and Research recommends five key steps to address hospital utilization and reduce potentially preventable events (PPEs):
- Create innovative payment and care delivery models.
- Help patients transition from hospital to home based care.
- Focus on and improve conditions for high risk patients.
- Care for frail patients at home.
- Reduce preventable utilization of emergency rooms.
Similarly, a interesting white paper by The Common Wealth Fund attributes fragmentation within the healthcare system and poor care management for unnecessary hospital use. The report details specific examples of organizations that have taken broad and sweeping steps to improve coordination and reduce hospital admissions.