Better care in outpatient settings could have prevented a quarter of hospital admissions by Medicare beneficiaries and 59% of emergency room (ER) visits, says a study recently released by a congressional advisory board.
Potentially preventable admissions and ER visits are defined as those that could have been avoided with “adequate ambulatory care” (outpatient care or services), says the Medicare Payment Advisory Committee (MedPAC) in an October presentation on the study’s preliminary results.
The study looked at health services provided to 5% of traditional Medicare program beneficiaries between 2006 and 2008, along with analyzing data of Medicare beneficiaries in six different markets. Upper respiratory infections are named as the most common reason for potentially preventable ER visits, while congestive heart failure is the most common diagnosis for potentially preventable hospital admissions.
In 2006, hospitals spent $30.8 billion on 4.4 million hospital admissions that may have been avoidable had the patient’s condition and outpatient care been better managed, according to a 2009 report by the Healthcare Cost and Utilization Project.
MedPAC recommends further research on how access to outpatient care impacts preventable admissions and ER visits. The advisory board notes that Medicare’s current fee-for-service reimbursement system rewards volume of health services given, with “little regard” to quality and value.
Written by Alyssa Gerace