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Report focuses on ‘super-utilizers’ of health care

3 min read

While the number of people who require multiple admissions over the span of a year to general acute care hospitals represent a relatively small group, they place a sizeable financial burden on Medicare and Medicaid expenditures in Pennsylvania, according to a recent statewide study.

The Pennsylvania Health Care Cost Containment Council said in a report released Wednesday that “super-utilizers” – patients with five or more admissions to a hospital per year, often for chronic illnesses – accounted for $761 million of Medicare and Medicaid outlays for inpatient stays in Pennsylvania.

Super-utilizers are patients who make frequent trips to hospital emergency rooms or have repeated inpatient hospital stays.

According to PHC4, the high-volume user of medical services often moves between emergency departments and inpatient admissions and readmissions, and often across different hospitals or health systems.

The result is high health care costs that might have been prevented through early intervention and collaborative care, the PHC4 study states.

The study from the independent state agency, which collects, analyzes and reports information that can be used to improve the quality and restrain the cost of health care in Pennsylvania, found the following:

• Fourteen percent, or $545 million, of Medicare fee-for-service payments for inpatient stays were for super-utilizers.

• Seventeen percent, or $216 million, of Medicaid payments (including both fee for service and managed care) for inpatient stays were for super-utilizers.

“Having data on super-utilizers will help the commonwealth’s policy makers and health care professionals as they determine the best way to care for those with chronic care needs while containing costs,” said Joe Martin, executive director of PHC4, in a press release.

The PHC4 brief notes that while super-utilizers represent a relatively small percentage of patients, they tend to have longer hospital stays and account for a disproportionate amount of health care resources.

The report is based on hospital data from fiscal year 2014. Payment figures were based on 2012 data, the most recent year available to PHC4.

Across the state, super-utilizers represented 3 percent (21,308 patients) of all hospitalized patients, 11 percent (136,795 admissions) of hospital admissions and 14 percent (813,606 days) of hospital days.

The top reasons the multiple users of medical services were admitted, according to PHC4, were heart failure, septicemia, or blood poisoning, and mental health disorders.

Of the 3 percent of patients who had five or more admissions, 31 percent had seven or more admissions, and 12 percent had nine or more admissions.

In Washington County, super-utilizers accounted for 335 admissions for mental health disorders; 223 admissions for heart failure; and 178 for septicemia. According to the PHC4 report, there were 28 super-utilizers per 10,000 residents in Washington County.

Greene County had 39 admissions from super-utilizers for mental health disorders; 29 for heart failure; and 21 for chronic obstructive pulmonary disease. The count totaled 16.8 super-utilizers for each 10,000 residents in Greene County.

In counties contiguous to Washington and Greene, the counts of super-utilizers per 10,000 residents were similar.

Allegheny County’s average was 24.6 per 10,000; Beaver, 23; Fayette 30.8; and Westmoreland 27.6. With the exception of Greene County, all of the county-by-county tallies in the region were slightly above the statewide average of 21.2 super-utilizers per 10,000 residents.

PHC4 noted that higher rates for some counties might be a result on larger numbers of residents with high-risk characteristics such as age of 75 years or older (rate of 55.8); black(rate of 41.9); and living in high poverty areas (rate of 36.9). PHC4 said county rates were not adjusted for these population difference “so that important effects of these patients characteristics were not masked by such adjustment.”

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