How often do you visit the Emergency Department or need to be admitted to the hospital? For most of us, probably not too much, if ever. However, the PA Health Care Cost Containment Council just released a report on “PA’s “super-Utilizers” of Inpatient Hospital Care” in a nice summary.
The thrust of the report is that a small percent of the population is admitted to the hospital over five times a year and is using up a lot of financial resources:
- “Patients admitted to a PA hospital five or more times during FY 2014 represent:
- 3% of hospitalized patients
- 11% of hospital admissions
- 14% of hospital days
- The top reasons “super-utilizers were admitted:
- Heart failure
- Septicemia (severe infection in bloodstream that can cause organ damage and/or death – LB)
- Mental Health Disorders
- Of the 3% of patients with five or more admission:
- 31% had seven or more admissions
- 12% had nine or more admissions
- Super utilizers by payer types:
- 10% of the Medicare admissions were for super-utilizers
- 18% of the Medicaid admissions were for super-utilizers
- 20% of the admissions where the payor was both Medicare and Medicaid were for super-utilizers
- 7% of commercial payor admissions were for super-utilizers
- Medicare and Medicaid Payments:
- $545 million (14%) of Medicare payments for inpatient stays were for super-utilizers.
- $216 million “17% of Medicaid payments for inpatient stays were for super-utilizers. “
This is sobering information and may upset some people. However it is important to know that often these populations do not have primary care providers and often are not plugged into the system so do not receive preventive care, routine check-ups, etc. Data demonstrate that those in poverty have lower ability to make and keep appointments. Why? First, trying to get through the day is a lot harder for the elderly and the impoverished and planning is more difficult. In addition, transportation is often a major barrier to getting lots of needed services. Many additional factors are in play as well.
This piece was an issues I was already aware of but thought it is important for more people to be aware of. Right here in Pottstown we have both a Community health and dental care center (Community Health & Dental Care, Inc) as well as a community behavioral health center (Creative Health Services) whose missions are to serve exactly these populations. Now we need to work on getting more people to them and out of the hospitals so it becomes a win-win for the entire community.