A Kaiser Family Foundation study released Tuesday ties the disproportionately high cost of caring for Medicare seniors in long-term care facilities to frequent trips to the hospital. And if such hospitalizations were reduced by 25 percent, Medicare savings could top $2.1 billion.
Donald Berwick, who heads the Centers for Medicare and Medicaid Services, said the report's findings were a key example of how the nation could achieve better integrated care -- a hallmark of his "triple aim" for CMS to improve the coordination of health care, enhance preventive care for the wider population, and reduce costs without harming patients.
"I see no stronger testimony to that integration than these reports, as we document the kind of flaws, interruptions, the defects, that enter long-term care," Berwick told a crowd of largely policy analysts at the report's rollout.
The authors of the study acknowledged that the health care overhaul law included several attempts to control the cost of Medicare, including financial penalties for hospitals with frequent readmission rates. But they also said they found that "much of the focus thus far has been on post-acute care and beneficiaries with certain chronic conditions, rather than on care provided to people living in long-term care facilities."
Researchers said the "relatively little attention" given to hospitalizations of long-term care facilities could be due to Medicaid being the major government fund for nursing-home care. But the study's authors point out that Medicare still covers seniors' medical care in nursing homes, and they are often "among Medicare's high spenders."
The study finds that long-term care residents require more than twice as much spending as other Medicare enrollees, with those in nursing homes claiming an average of $14,538 per person, versus just $6,726 for Medicare enrollees in the community.
Viewed another way, researchers found that 6 percent of all Medicare enrollees were living in long-term care, but they claimed 17 percent of Medicare spending that year, or $45 billion of a total $270 billion.
Nearly 40 percent of the average cost for a Medicare beneficiary in a long-term facility was spent on hospitalizations. The study referenced other research that found between 30 percent and 67 percent of those hospitalizations could be preventable, and estimated $2.1 billion in Medicare savings if hospitalizations were reduced by 25 percent.
In a complement to the data on long-term care facilities, another report funded by the Kaiser Family Foundation and conducted by Lake Research Partners found several recurring reasons for frequent hospital trips for seniors in long-term care, including concerns about liability and family members' reluctance to prevent hospital trips.
By conducting 43 interviews across the country at nursing homes and assisted-living facilities, researchers also found that limited on-site capacity of the organizations played a role in hospitalizations, notably in the ability to get quicker testing done at the hospital, too few nurses to staff long-term care, and licensing problems. Physician preferences for admitting patients was also highlighted, with one medical director in Philadelphia telling the authors that treating patients in a hospital is "logistically easier, more effective, better coordinated, and financially profitable."