Confirmation of that article, Joynt says, was what she and her co- investigators in this study expected to find.
"But instead, what we found was that 90% of inpatient spending for patients in the high-cost group [of Medicare patients] was for treatment of conditions that you wouldn't think would be preventable by outpatient management, at least in the near term."
For example, she explains, at the top of the list of the most expensive types of care among high-cost patients are orthopedic procedures like joint replacement and spine surgery, which account for about $300 million a year to the Medicare program, followed by ischemic heart disease, then cancer and chemotherapy, rehabilitation, sepsis, gastrointestinal tract infections and GI disorders, arrhythmia, device and procedural complications, and stroke or intracranial hemorrhage, none of which is really preventable through outpatient interventions, the authors said.
The most expensive preventable reason for hospitalization among high-cost patients, congestive heart failure, accounted for about $75 million, followed by bacterial pneumonia and chronic obstructive pulmonary disease, at less than $50 million each.
"Just having a nurse take better care of the outpatient medicines for patients (at risk of stroke or heart attack, for example) in the short term is not going to make any population-based differences in people having strokes or heart attacks," she says.