High-resource hospital users in an integrated delivery system

Area of Science:

• Healthcare Management
• Health Services Research
• Geriatric Medicine

Background:

• Limited research exists on frequent users of both emergency departments and inpatient services.
• Healthcare organizations face decreasing reimbursement, necessitating efficient resource management.

Purpose of the Study:

• Investigate frequent Medicare inpatient and emergency department users.
• Identify Medicare day outliers.
• Examine Medicare reimbursement/charge ratios.

Main Methods:

• Analysis of 4,920 elderly Medicare inpatient admissions and emergency department visits over one year.
• Creation of patient profiles for two categories of high-resource users.

Main Results:

• Frequent high users (n=75) had 6+ admissions/year, with cardiac, diabetic, and respiratory conditions, originating from home.
• Day outliers (n=148) were older patients with neoplasms and respiratory/circulatory diseases.
• Medicare reimbursement/charge ratios varied across high-volume diagnosis-related groups (DRGs).

Conclusions:

• Refine case management strategies for high-resource patients.
• Implement computer tracking for continuous patient monitoring.
• Integrate comprehensive healthcare delivery and support programs.
• Continuously monitor revenue to ensure organizational financial viability.