Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations

CMS.GOV: 1/15/14

Objective: Potentially avoidable hospitalizations have been identified by experts as leading to poor health outcomes and costly care. Potentially avoidable hospitalizations are particularly common among full-benefit dual eligible beneficiaries. This paper examines potentially avoidable hospitalizations rates by setting, state, and medical condition, and the average cost of these events.
Methods: This analysis identifies potentially avoidable hospitalizations using diagnosis codes identified by an expert panel. Settings of care are determined using a timeline file, which assigns an individual to a specific setting on a particular day.
Population/Data Source
: The analysis uses several different datasets from the Chronic Conditions Data Warehouse. The study population includes fee-for-service beneficiaries who were eligible for both Medicare and full Medicaid benefits for at least one month during the calendar year. The study years are 2007 to 2009. Read More