Contribution of Preventable Acute Care Spending to Total Spending for High-Cost Medicare Patients

JAMA: June 24, 2013

Importance  A small proportion of patients account for the majority of US health care spending, and understanding patterns of spending among this cohort is critical to reducing health care costs. The degree to which preventable acute care services account for spending among these patients is largely unknown.

Objective  To quantify preventable acute care services among high-cost Medicare patients.

Design, Setting, and Participants  We summed standardized costs for each inpatient and outpatient service contained in standard 5% Medicare files from 2009 and 2010 across the year for each patient in our sample, and defined those in the top decile of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. We used standard algorithms to identify potentially preventable emergency department (ED) visits and acute care inpatient hospitalizations. A total of 1 114 469 Medicare fee-for-service beneficiaries aged 65 years or older were included.

Main Outcomes and Measures  Proportion of acute care hospital and ED costs deemed preventable among high-cost patients.  Read more