Authors of a new study speculate that combined improvements in health, patient utilization patterns for health care, and healthcare delivery have dramatically reduced hospital utilization and per-beneficiary spending, while mortality declined among all Medicare fee-for-service enrollees, over the last 15 years. The research was published online in the Journal of the American Medical Association and reported by HFMA Weekly News.
The Medicare population grew from 33.5 million in 1999 to 42.4 million in 2013. However, the share of fee-for-service enrollees declined from 82 percent in 1999 to 71 percent in 2013.
Key findings for the years 1999 to 2013 for Medicare fee-for-service beneficiaries include:
- All-cause mortality declined from 5.30 percent to 4.45 percent.
- In-hospital mortality declined from 1.30 percent to 0.71 percent, 30-day mortality declined from 2.16 percent to 1.65 percent, and one-year mortality declined from 4.49 percent to 3.48 percent.
- Hospitalizations per 100,000 person-years decreased from 35,273 to 26,930.
- The number of beneficiaries admitted to the hospital at least once decreased from 21,782 per 100,000 person-years to 17,344.
- Patients were increasingly discharged to rehabilitation and nursing facilities or with home health care, and decreasingly discharged home without care.
- Pneumonia dropped from most frequent principle diagnosis for hospitalization in 1999 to fifth place by 2013, replaced by osteoarthritis, septicemia, heart failure and cardiac dysrhythmia.
- Mean inflation-adjusted inpatient expenditures per beneficiary declined from $3,290 to $2,801.
- Decrease in hospitalizations translates to more than 3 million hospitalizations averted in 2013 compared with what would have occurred if the rate in 1999 stayed the same.
The author of the study noted there was no evidence of this trend leveling out towards the end of 2013.
“Hospitals deserve some credit for this trend because of the team focus to rethink care delivery for inpatient admissions and delivery of outpatient care,” the author said. “The gains noted in the study are a result of widespread adoption of standardized processes, measuring and reporting of hospital quality improvement efforts, and prioritizing quality improvements throughout the hospital or health system.” (“Medicare Mortality, Hospitalizations, Spending Decline, Study Says,” HFMA Weekly News, July 31, 2015)
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