With aging baby boomers expecting active retirements and Congress grappling with spiraling Medicare costs, the last thing either group wants to see is an increase in the frequency and cost of unplanned or avoidable hospitalizations among Americas seniors. But thats exactly the recent trend.
Over an eight-year period ending in 2004, the percentage of elder hospitalizations originating in the emergency room rose from 49% to 57%, while the average cost per hospital stay for this group jumped almost 26% to $9,800, according to statistics released last year by the U. S. Agency for Healthcare Research and Quality.
As a result, theres plenty of motivation to help this older population avoid mad dashes to the hospital by changing the way we manage their common medical conditions and where we care for them. An added benefit is the potential to save Medicare billions of dollars each year.
For solutions, a lot of eyes are turning to the home health providers, whose medical advances and more consistent clinical and business practices have made them emerging players in delivering higher quality and more efficient healthcare outside of costly facilities. Yet, despite their current efforts, over a million elderly Medicare recipients go to the hospital each year for unplanned visits during or immediately following an episode of home care. Thats about 28% of all Medicare patients served by home health agencies.
This percentage hasnt changed in the three-plus years that the CMS has been measuring hospitalization rates as a part of home health clinical performance. But a campaign is now under way to move the needle, thanks to a CMS-led national quality initiative and its Home Health Quality Improvement Organization Support Center, with the backing of more than 5,200 of the nations 8,100 Medicare-certified home health agencies. The participating home-care organizations are now concentrating on evidence-based best practices in such critical areas as disease management, fall prevention and oral medication management to help reduce those avoidable and costly hospital stays within the next year.
With the over-65 population expected to double during the first three decades of this century, the stakes are high for patients, their families, physicians, hospitals, Medicare and the home health agencies themselves. A reduction in the avoidable hospitalization rate from 28% to 25%a key goal of the quality initiativecould help an additional 110,000 older Americans remain at home each year, and save Medicare about $2.7 billion annually, according to a January 2006 study by Briggs Corp., a long-term-care and home-care consulting firm. (Story continues below.)