With a little help from the Affordable Care Act, there's been a dramatic reduction in avoidable hospitalizations over the last several years, particularly among residents of long-term care facilities, according to the Centers for Medicare and Medicaid Services.
In recent years, the overall rate of hospitalizations dipped by 13 percent for dually eligible Medicare and Medicaid beneficiaries. But for those living in long-term care facilities, the dip has been greater. Between 2010 and 2015, the hospitalization rate for six potentially avoidable conditions -- bacterial pneumonia, urinary tract infections, congestive heart failure, dehydration, asthma and skin ulcers -- decreased by 31 percent among such patients.
Those six conditions accounted for almost a third of the 270,000 hospitalizations in 2015 among Medicare patients with full Medicaid benefits living in long-term care. Overall in that year, Medicare fee-for-service beneficiaries living in those facilities totaled 352,000.
In 2010, the rate of potentially avoidable hospitalizations for dually-eligible beneficiaries in long-term care was 227 per 1,000 beneficiaries; by 2015, the rate had decreased to 157 per 1,000. This decrease occurred nationwide, according to CMS' figures, with improvement in all 50 states. That rate of reduction among dually eligible long-term care patients translated into 133,000 avoided hospitalizations over the past five years.
CMS said that treating conditions before hospitalization, and preventing them whenever possible, can save Medicare and Medicaid money, as well as improve the health of long-term care patients.
The agency noted a number of contributing factors in this trend, among them an initiative launched in 2011 by the Medicare-Medicaid Coordination Office and the CMS Innovation Center, and the AHRQ Safety Program for Long-Term Care, which reduced catheter-associated urinary tract infections in hundreds of long-term care facilities across the country. Accountable Care Organizations, bundled payments and the Hospital Readmission Reduction Program were also credited by CMS as having an impact.
The results are consistent with ongoing efforts to prevent hospital-acquired conditions, where about 125,000 fewer patients died due to such conditions from 2010 to 2015 -- saving more than $28 billion in healthcare costs over that time.