The cost of hospitalizations, particularly hospital readmissions, is increasingly a concern for Medicare, Medicaid, and private health plans. The Centers for Medicare and Medicaid Services (CMS) in particular has emphasized reducing hospitalizations and readmissions. Results from the CMS Medicare Coordinated Care Demonstration pilot project show coordinated care for Medicare patients reduces hospitalizations and is cost-neutral, according to two recent studies sponsored by the Robert Wood Johnson Foundation (RWJF). Click here and here for the studies.

CMS also intends to make hospitalizations an important metric in determining the quality and value of qualified health plans (QHP) offered through Health Insurance Exchanges (HIX), part of the Affordable Care Act (ACA) health reform law.

AHRQ Statistical Brief Details Hospital Admissions for the Elderly:

CMS has reason to be concerned with hospitalizations: The elderly, and thus Medicare beneficiaries, are far more likely to end up in hospitals than younger people are. People ages 65 and older accounted for 34.3 percent of all hopsitalizations in 2009, yet made up only 12.5 percent of the U.S. population.

Those interested in specifics should look at a recent statistical brief from the Agency for Healthcare Research and Quality (AHRQ). The agency publishes a series of briefs based on data from its Medical Expenditure Panel Survey (MEPS), which offer helpful insights into health costs and spending.

The brief looks at hospitalizations in 22 states for people in nursing homes, and compares the figures to those for elderly people who are not in nursing homes. Findings included:

  • 97.6 of hospital stays for the elderly in 2009 were for those not in nursing homes
  • Stays for people from nursing homes lasted 6.4 days on average, compared to stays of 5.2 days on average for people not in nursing homes
  • 29.8 percent of hospitalizations from nursing homes were for an infection, compared to 16.2 percent from the community
  • 28.6 percent of hospitalizations for people not in nursing homes were for circulatory disorders, such as heart disease or a stroke. 20.6 percent of admissions from nursing homes were for those conditions.
  • The average cost for admissions from nursing homes was $10,935, compared to $11,132 for admissions from the community.
CMS Initiative to Reduce Hospitalizations from Nursing Homes:

Such statistics were troubling enough that CMS recently launched an initiative to reduce avoidable hospitalizations among nursing home residents. The program focuses on Medicare-Medicaid dual eligibles, who account for a large chunk of both nursing home residents and hospitalizations. Almost half of hospital admissions are avoidable for patients using Medicare or Medicaid nursing facility services, according to CMS. Seven organizations across the country will participate in the program, with the goal of reducing hospital readmissions for nursing home residents by 20 percent before the end of 2013.