Khullar Dhruv, Zhang Yongkang, Kaushal Rainu
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
J Gen Intern Med. 2020 Oct;35(10):2845-2852. doi: 10.1007/s11606-020-05691-8. Epub 2020 Feb 26.
High-cost patients account for a disproportionate share of healthcare spending. The proportion and distribution of potentially preventable spending among subgroups of high-cost patients are largely unknown.
To examine the distribution of potentially preventable spending among high-cost Medicare patients overall and potentially preventable spending associated with each high-cost category.
A cross-sectional study. We merged Medicare claims and social determinants of health data to group patients into high-cost categories and quantify potentially preventable spending.
A total of 556,053 Medicare fee-for-service and dual-eligible beneficiaries with at least one healthcare encounter in the New York metropolitan area in 2014.
High-cost patients were mapped into 10 non-mutually exclusive categories. The primary outcome was episodic spending associated with preventable ED visits, preventable hospitalizations, and unplanned 30-day readmissions.
Overall, potentially preventable spending accounted for 10.4% of overall spending in 2014. Preventable spending accounted for 13.3% of total spending among high-cost patients and 4.9% among non-high-cost patients (P < 0.001). Among high-cost patients, 44.0% experienced at least one potentially preventable encounter compared with 11.4% of non-high-cost patients (P < 0.001), and high-cost patients accounted for 71.5% of total preventable spending. High-cost patients had on average $11,502 in potentially preventable spending-more than 20 times more than non-high-cost patients ($510). High-cost patients in the seriously ill, frail, or serious mental illness categories accounted for the highest proportion of potentially preventable spending overall, while end-stage renal disease, serious illness, and opioid use disorder were associated with the highest preventable spending per patient.
Potentially preventable spending was concentrated among high-cost patients who were seriously ill, frail, or had a serious mental illness. Interventions targeting these subgroups may be helpful for reducing preventable utilization.
高成本患者在医疗支出中所占比例过高。高成本患者亚组中潜在可预防支出的比例和分布情况在很大程度上尚不清楚。
研究高成本医疗保险患者总体中潜在可预防支出的分布情况以及与每个高成本类别相关的潜在可预防支出。
一项横断面研究。我们将医疗保险理赔数据和健康的社会决定因素数据合并，以便将患者分组至高成本类别并量化潜在可预防支出。
2014年在纽约大都市地区共有556,053名医疗保险按服务收费和符合双重资格的受益人，他们至少有一次医疗就诊经历。
高成本患者被划分为10个非相互排斥的类别。主要结果是与可预防的急诊就诊、可预防的住院治疗和计划外30天再入院相关的阶段性支出。
总体而言，2014年潜在可预防支出占总支出的10.4%。可预防支出在高成本患者总支出中占13.3%，在非高成本患者中占4.9%（P < 0.001）。在高成本患者中，44.0%经历过至少一次潜在可预防的就诊，而非高成本患者为11.4%（P < 0.001），高成本患者占可预防总支出的71.5%。高成本患者平均有11,502美元的潜在可预防支出，比非高成本患者（510美元）多20倍以上。患有重病、体弱或严重精神疾病的高成本患者在总体潜在可预防支出中占比最高，而终末期肾病、重病和阿片类药物使用障碍与每位患者的最高可预防支出相关。
潜在可预防支出集中在患有重病、体弱或严重精神疾病的高成本患者中。针对这些亚组的干预措施可能有助于减少可预防的医疗利用。
