High-Cost Medicare Patients: What is the Contribution of Preventable Acute Care Spending to Total Spending?

Dr. Karen E. Joynt, MD MPH  Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public HealthMedicalResearch.com Interview with
Dr. Karen E. Joynt, MD MPH

Cardiovascular Division
Brigham and Women’s Hospital and VA Boston Healthcare System
Department of Health Policy and Management, Harvard School of Public Health

MedicalResearch.com: What are the main findings of the study?

Dr. Joynt:  The main findings of the study were two-fold.

First, high-cost patients in Medicare (the top decile of spenders) are responsible for about 80% of inpatient spending in the Medicare program, so understanding more about these patients’ patterns of care is really important.

Second, we found that only about 10% of acute-care spending for these high-cost Medicare patients were for causes that we generally think of as preventable in the short term, like uncontrolled diabetes, COPD, or heart failure.

The rest of the spending was for acute conditions that we generally don’t think of as preventable (at least in the short term), such as orthopedic procedures, sepsis, and cancer.

MedicalResearch.com: Where any of the findings unexpected?

Dr. Joynt:  When we set out to perform this study, we had actually anticipated that a much larger proportion of spending in this high-cost group would be for exacerbations of chronic conditions, with many repetitive admissions.  What we found is that a huge component of inpatient spending is on episodic, acute conditions.

MedicalResearch.com: What should patients and clinicians take away from this study?

Dr. Joynt:  Clinicians might find the study interesting because it points out the importance of a multi-pronged approach to reducing health care costs.  We don’t just need public health efforts and better outpatient care; we also need inpatient care redesign to make these acute, expensive episodes more efficient.  To the degree that patients worry about health care costs, they would likely be interested in the same take-away message.

MedicalResearch.com: What future research do you recommend as a result of this report?

Dr. Joynt:  I think future research should focus on understanding more about these inpatient costs.

  • What proportion are from cardiology versus orthopedics versus intensive care?
  • Where might there be the greatest opportunity for care redesign and improved efficiencies?
  • How can we best address these acute episodes of care?

Citation:

Joynt KE, Gawande AA, Orav E, Jha AK. Contribution of Preventable Acute Care Spending to Total Spending for High-Cost Medicare Patients. JAMA. 2013;309(24):2572-2578. doi:10.1001/jama.2013.7103.

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