Room for Improvement in Preventing Hospital Admissions

The Agency for Healthcare Research and Quality’s (“AHRQ”) Healthcare Cost and Utilization Project released a report in April 2009 outlining hospitalizations that might have been preventable had the patients been receiving appropriate ambulatory care.  The report, based on 2006 data, states that about 4.4 million hospital admissions, with an estimated cost of $30.8 billion, could have been avoided.  About 67% of the cost related to Medicare patients, 16% to private insurers and the rest to other payers.  The most common conditions leading to the hospitalizations were congestive heart failure and bacterial pneumonia, which is to be expected given the prevalence of Medicare patients identified as the subject of the unneeded admissions.

Patients living in the poorest communities were far more likely to be hospitalized than those in wealthier areas; and this effect was particularly marked for patients with chronic diseases.  Likely explanations include less health care coverage among the poor; less convenient access to primary care and other physicians in their communities; and less understanding of how to utilize the outpatient care system and the importance of adhering to medical visit schedules.

Assuming that these hospitalizations had not occurred, the entire $30 billion would not been saved, as the ambulatory care necessary to prevent the need for hospitalization would have had a cost associated with it.  But it is reasonable to believe that a very large portion of the cost would have been avoided.  The report is another reminder that there are some significant opportunities for savings in the current system and of the importance of good primary care delivery and coordination of care, particularly for patients with chronic diseases.