Better care for dual-eligible Medicare-Medicaid patients could reduce hospitalization rates

"The volume and costs related to these hospitalizations are substantial. Even a modest reduction would result in substantial savings in economic and human costs," Walsh said.

The authors identified five conditions - pneumonia, congestive heart failure, urinary tract infection, dehydration and chronic obstructive pulmonary disease or asthma - that were responsible for more than three-quarters of the potentially avoidable hospitalizations.

Individuals in Medicaid home and community-based services waiver programs had higher rates of total hospitalizations than Medicaid nursing home patients, which reflects the complex medical, functional and supportive service needs of this community-dwelling, long-term care population. The study also found that hospitalization rates varied widely from state to state. African Americans were hospitalized more frequently and at a higher cost than white patients from all settings, and Hispanics were hospitalized more frequently from nursing facility stays and less frequently from the community.

"The findings suggest that there is room for improvement in reducing potentially avoidable hospitalizations. However, necessary interventions, such as improving quality of care in long-term care settings and expanding home and community-based service programs, will require additional investments by state Medicaid programs to yield savings or Medicare policies that provide an incentive to reduce hospitalizations," Walsh said.

Source RTI International