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Rural elderly present need for nursing continuity
Nursing Economic$
|May 1, 1997
Summary
Rural elderly patients, often with chronic conditions, incur high hospital costs exceeding Medicare reimbursement. This study identifies factors contributing to extended Length of Stay (LOS) for this vulnerable population.
Area of Science:
- Geriatric Medicine
- Health Services Research
- Rural Health
Background:
- Over 25% of the elderly population resides in rural areas.
- Rural elders experience lower incomes compared to their urban counterparts.
- Medicare reimbursement challenges exist for rural hospitals.
Purpose of the Study:
- To identify common characteristics of Medicare patients with extended hospital Length of Stay (LOS).
- To analyze factors contributing to 17+ day LOS outliers in a rural hospital setting.
- To inform strategies for managing costs and improving care for rural elderly patients.
Main Methods:
- Retrospective analysis of one year of data from 1,972 Medicare admissions.
- Categorization of patients based on Length of Stay (LOS).
- Identification of patient demographics, diagnoses, and service utilization for extended LOS outliers.
Main Results:
- Sixteen percent of Medicare admissions had a LOS of 17+ days.
- Patients with extended LOS were older, had chronic illnesses, and required multiple services.
- Cardiac diagnostic codes were prevalent (21.5%) among the high-cost, extended LOS group.
- Reimbursement for extended LOS patients covered only one-third of actual care costs.
Conclusions:
- Extended hospital stays for rural Medicare patients, particularly those with chronic conditions, represent a significant financial burden.
- Cardiac-related diagnoses are a major driver of resource-intensive, long LOS cases.
- Developing systems to reduce Emergency Department (ED) visits and hospitalizations is crucial for preparing for capitated reimbursement and enhancing patient quality of life.