The authors drew their conclusions after looking at costs of inpatient and outpatient services for Medicare beneficiaries from 2009 and 2010. They identified the most expensive 10% and then detailed what types of emergency and inpatient services made up their high-priced Medicare bills. They then dissected which conditions and services might have been prevented through better outpatient management.
The 10% of patients who had the highest costs accounted for 79% of inpatient costs but only 9.6% were attributable to preventable hospitalizations, while 16.8% of costs within the non-high-cost group were due to preventable hospitalizations. Among the cohort of the most expensive Medicare beneficiaries, 10% were older. They were more likely to be male and more likely to be black.
Joynt is quick to point out that she doesn't think the study should prompt clinicians to abandon hospital, clinic, or physician-based prevention programs.
"We don't in any way want to imply that outpatient care coordination isn't the right thing to do, or isn't extremely valuable," she says. "But it is to say that if we're really going to bend the cost curve, we have to make the per episode cost lower. We can't just rely on reducing the number of episodes."