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Outpatient Preventive Care Efforts Lower Costs Only Marginally

Cheryl Clark, for HealthLeaders Media, June 25, 2013

Outpatient care coordination does not significantly reduce hospitalizations among high-cost Medicare patients, researchers say. Instead 90% of inpatient spending for those patients was "for treatment of conditions that you wouldn't think would be preventable by outpatient management."

Aggressive preventive care efforts in outpatient settings have little effect on spiraling hospital costs in the most expensive patients, says a surprising Harvard study. Rather, hospital payments must be reduced for certain procedures if the campaign to lower healthcare costs has any chance of success.

"The big ticket items (in hospital care) are not for the diabetics who comes in for a couple of days to get their blood sugar controlled," says Karen Joynt, MD, of the Harvard School of Public Health and the report's principal author.

"It's someone coming in for bypass surgery or back surgery, or someone coming in with sepsis. It's the 65-year-old who comes in with a huge heart attack or a 70-year-old with a hemorrhagic stroke, who needs a 30-day hospitalization and rehabilitation," she says. "We found that the problem is just so much more complex than (can be managed) with outpatient care."

Joynt's co-authors in the paper, published in the Journal of the American Medical Association include Atul Gawande, MD, associate professor at Harvard Medical School, whose 2011 article in the New Yorker, The Hot Spotters, suggested that better care in outpatient settings such as clinics, and physician champions for high-cost patients, can reduce expensive hospitalizations among the system's most costly patients.

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