Efforts to keep chronically ill patients from going to the hospital as often seem to be making a difference in the Philadelphia area and throughout Pennsylvania, according to a new state report on hospital “super-utilizers.”
The number of these patients, defined as those admitted to a hospital at least five times in a year, has declined since 2012, dramatically so in Philadelphia. But they still ring up a big tab, according to the report by the Pennsylvania Health Care Cost Containment Council.
These super-users consist of just 3 percent of all hospital patients in the state, but they account for 15 percent of hospital days and 10 percent of payments to hospitals — or $1.25 billion in 2016, the agency’s report said.
Philadelphia remained tops in the state in its rate of residents who were admitted to a hospital at least five times in a year, with 33.4 frequent users per 10,000 residents in 2016.
But the city also marked one of the state’s biggest county-level declines, down 15.9 percent from 2012, according to the report.
Statewide, the number of people admitted to a hospital at least five times during the year declined 8.6 percent, from 24,045 frequent users in 2012 to 21,968 in 2016, the agency found.
The decline comes amid increasing pressure from insurers such as Medicare, which imposes financial penalties on hospitals with high rates of readmission — defined as the percentage of patients who end up back in a hospital within 30 days of discharge. Medicare’s readmission penalties were created under the Affordable Care Act in an effort to improve the quality of care. They have been controversial, however, as some hospitals have argued that they have only limited control over which patients must come back to the hospital.
Hospitals have explored a variety of programs to keep patients healthier, such as tasking nurses and pharmacists with checking on patients by phone and visiting them at home, said Robert Shipp III, vice president of population health strategies for the Hospital and Healthsystem Association of Pennsylvania.
For patients with heart failure, a leading cause of hospital admission in the elderly, caregivers encourage patients to reduce sodium intake and weigh themselves daily to guard against retaining too much fluid, Shipp said. Frequent hospital users also are encouraged to visit their primary care provider, he said.
“If somebody’s coming to the emergency department 10 times a month, it probably tells you there’s something going on with the patient,” Shipp said. “Maybe you can get them into the doctor’s office a little more often.”
The state report focused primarily on inpatient hospital stays, not emergency-room visits, but sometimes those can lead to admission, said Joe Martin, executive director of the state agency that did the analysis.
Among super-users covered by Medicare fee-for-service plans, 70 percent visited the emergency room at least once in 2016, according to the report. Nearly half had five or more emergency-room visits during the year.
Statewide, the agency counted 21.7 hospital super-users per 10,000 residents. The rate among low-income residents was measured at 38.3 super-users per 10,000.