Hospital EDs Seeing Sicker Medicare Patients

John Commins, May 8, 2013

The federal government's inpatient admissions guidelines and growing claims denials are heaping pressure on hospitals to treat Medicare patients in the ED rather than admit them. Meantime, the severity of illness is rising, says the American Hospital Association.

Hospital emergency departments are treating growing numbers of sicker Medicare patients who require more complex and expensive treatment regiments, the American Hospital Association reports [PDF].

"The drivers [are] both the aging demographic, but also just that people are getting sicker. Chronic diseases are skyrocketing," says Caroline Steinberg, AHA's vice president of trends analysis.

"A lot of it has to do with lifestyle factors like obesity. We did look to see if the aging of the Medicare population was driving this and we didn't find a big change in terms of age. We did find that people are simply getting sicker. That is what a lot of the researchers say, that most of the chronic disease burden is related to lifestyle factors, exercise, weight, that sort of thing."

The AHA says data shows that between 2006 and 2010, the severity of illness of Medicare patients in the emergency department increased, as did the rate of use, a trend that policymakers fear is leading to higher spending with inadequate reimbursements.

Steinberg says hospitals want the federal government to acknowledge what the data clearly shows.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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