New strategies needed to curb costs among expensive Medicare patients

Preventable emergency room visits and hospitalizations represent only a small part of the health costs among Medicare patients with the highest expenses, according to a new study by Harvard School of Public Health (HSPH) and Brigham and Women’s Hospital researchers. The study, appearing in the June 26, 2013 issue of theJournal of the American Medical Association (JAMA) and accompanied by an editorial, coincided with the paper’s presentation at the AcademyHealth annual research meeting.

“The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis and cancer, as well as expensive orthopedic procedures such as spine surgery and hip replacement,” wrote Karen Joynt, lead author, instructor in the Department of Health Policy and Management at HSPH, and colleagues. “These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare’s high-cost patients.”

Other authors included Atul Gawande, professor in the Department of Health Policy and Management; E. John Orav, associate professor of medicine (biostatistics), Harvard Medical School, and associate professor in the Department of Biostatistics, HSPH; and Ashish Jha, senior author, professor of health policy and management at HSPH.