Healthcare News & Insights

Study: One-quarter of Medicare hospital admissions are preventable

In terms of overall healthcare expenditures, hospital care has the largest piece of the pie. However, according to a new preliminary study, 25% of all Medicare beneficiary hospital admissions are “potentially preventable.”

When you think about that, hospital care costs could be a lot less, especially when you consider nearly 60% of Medicare beneficiary emergency department (ED) visits are preventable, too.

That’s about 94 hospital admissions and 158 ED visits per 1,000 beneficiaries per year, according to a study by the nonpartisan Medicare Payment Advisory Commission (MedPAC).

In the study, potentially preventable admissions (PPAs) were defined as “admissons  for conditions that could have been avoided with adequate ambulatory care.” Potentially preventable visits (PPV) were defined as “ED visits that might have been furnished in less costly ambulatory settings.”

MedPAC contracted with 3M Health Information Services to quantify the rates nationally and in different regions. It analyzed Medicare claims from 2006 to 2008 in six markets.

Results

The study found:

  • hospitals with lower occupancy rates had higher rates of potentially PPVs and PPAs, and
  • Medicare beneficiaries that also received Medicaid had higher rates.

When the study broke down the rates by region (Boston, Phoenix, Miami, Minneapolis, Greenville, SC, and Orange County, CA), it found a large difference between the highest and lowest performing regions:

  • PPA lowest rate was 52.9 per 1,000 and highest rate was 69.8 ,
  • PPV lowest rate was 23.7 per 1,000 and highest rate was 42.7.

Access to care

So what does this mean?

First of all, it doesn’t mean hospitals in the study acted inappropriately. Rather, it reflects patients’ access to care and the quality of care furnished in a region. Higher rates in a region may suggest there are opportunities for improvement.

The most common diagnosis for PPVs was upper respiratory infections. For PPAs, it was congestive heart failure.

While high admission rates for these potentially preventable conditions may indicate a need to improve access to quality care, it also reflects a need for patients to adopt healthy lifestyles and actively self-manage chronic conditions.

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