Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Ouslander, Joseph G.; Lamb, Gerri; Perloe, Mary; Givens, JoVonn H.; Kluge, Linda; Rutland, Tracy; Atherly, Adam; Saliba, Debra

doi:10.1111/j.1532-5415.2010.02768.x

Cited by 425 publications

(433 citation statements)

References 40 publications

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“…This offers a tempting target for efforts to reduce that utilization. Some enthusiasm has been generated about the potential for introducing better primary care for nursing home residents and thereby saving money for Medicare (Grabowski, O'Malley, & Barhydt, 2007;Ouslander et al, 2010;Saliba et al, 2000;Sylvia et al, 2008), but so far few such efforts have been effective (Peikes, Chen, Schore, & Brown, 2009). One successful model was developed by Evercare, a Medicare Advantage institutional Special Needs Program; it used aggressive care from nurse practitioners to treat nursing home residents in the nursing home and paid the nursing homes for agreeing to retain such patients (Kane, Keckhafer, Flood, Bershadsky, & Siadaty, 2003).…”

Section: Resultsmentioning

confidence: 99%

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Kane¹,

Wysocki²,

Parashuram³

et al. 2013

MMRR

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Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions:Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. Access, Demand Uninsured, 2011Uninsured, , 2012 Kane, Homyak, Parashuram, Lee, & Woodhouse, 2008; Kasper, Watts, & Lyons, 2010; Young, Garfield, Musumeci, Clemens-Cope, Lawton, 2012). However, the data are mainly descriptive and do not account for the role of casemix or other characteristics. One explanation for disproportionate costs is that double program coverage results in overlaps and inefficiencies, leading to proposed solutions such as integrated care (Gold, Jacobson, & Garfield, 2012;Meyer, 2012;Neuman, Lyons, Rentas, & Rowland, 2012). There is a clear need to identify the specific characteristics of Medicare-Medicaid enrollees that account for their disproportionately high expenditures for medical and long-term care. Keywords:The only study to examine the effect of casemix on Medicare-Medicaid enrollees' higher LTC costs found that they were largely attributable to greater levels of dysfunction and disease burden (Liu, Long, & Aragon, 1998). Our study builds upon this work with more recent data and a separate examination of the role of LTC care setting and case mix for elderly MedicaidMedicare beneficiaries. We analyzed Medicare and Medicaid data to examine how type of long-term care and case mix affect expenditures towards medical care and LTC for older MedicareMedicaid enrollees and non-duals, and how these expenditures vary between programs and settings. In response to the findings of Bubolz, Emerson, and Skinner (2012), we also looked for evidence of de facto cross-subsidization among those covered by both Medicare and Medicaid; namely, was nursing home use (covered only by Medicaid) associated with lower medical care use (covered by Medicare)? Methods Study PopulationOur study population consists of individuals aged 65 years and older in 2005, enrolled in (1) Medicaid only, (2) Medicare only, and (3) Medicare and Medicaid simultaneously. We selected residents from seven states (Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington) who illustrate diverse management techniques across the target populations, and diverse state characteristics; e.g., demographics, size, geography, structure of county government, and policies. The LTC waiver, state plan programs, and plan variations are summarized in Appendix Exhibit A1. All of the states had an aging and disability waiver.In order to analyze the characteristics and expenditures of duals and non-dual beneficiaries based on LTC utilization, we classified our study sample into four groups based on program enrollment and LTC use: MMRR 2013: Volume 3 ...

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Section: Resultsmentioning

confidence: 99%

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Kane¹,

Wysocki²,

Parashuram³

et al. 2013

MMRR

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“…This finding is in keeping with results from other healthcare systems. 23,24 Responses suggest a lack of awareness of the services available, and addressing these knowledge gaps must be a priority if we are to improve care delivered to this vulnerable patient group. Comments about availability of specialist opinion or immediate access to investigations to prevent admission are a concern, and suggest that the interface between care homes and secondary care could be improved.…”

Section: Themes Common To Various Scenariosmentioning

confidence: 99%

Appropriateness of unscheduled hospital admissions from care homes

Harrison

McKay²,

Grant

et al. 2016

Clinical Medicine

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“…1 There has been a widespread concern that some hospital admissions from nursing homes are 'inappropriate' or 'avoidable' [2][3][4][5][6][7][8] although there is little consensus about which admissions are avoidable. 9 It is unclear how admission decisions are made and what the key influencing factors are.…”

Section: Introductionmentioning

confidence: 99%

Hospital admissions from nursing homes: a qualitative study of GP decision making

McDermott¹,

Coppin²,

Little³

et al. 2012

Br J Gen Pract

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BackgroundDecisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As 'gatekeepers' to NHS, GPs are expected to make best use of resources and may be criticised for 'inappropriate' admissions. Little is understood about the influences on GPs as they make such decisions AimTo explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital. Design and settingA purposive sample of 21 GPs from two counties in the South of England. MethodData from semi-structured, one-to-one interviews with GPs were analysed using thematic analysis following principles of the constant comparative method. ResultsThis study suggests that while clinical assessment, perceived benefits and risks of admission, and patients' and relatives' preferences are key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication (particularly informational continuity), training and support for nursing staff, and peer support for GPs. Local initiatives to address these issues were very variable. ConclusionDeveloping a systematic palliative care approach to address poor documentation and communication, the capability of nursing homes, and medico-legal concerns has the potential to improve decision-making regarding hospital admissions.

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Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Cited by 425 publications

References 40 publications

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Appropriateness of unscheduled hospital admissions from care homes

Hospital admissions from nursing homes: a qualitative study of GP decision making

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