Hospital superusers in Pennsylvania ring up $1.25B tab

Hospital lobby
Superusers—defined as patients with five or more hospital admissions per year—generated 10% of all hospital payments in 2016, according to a new report. (Getty/monkeybusinessimages)

They only represent 3% of hospitalized patients in Pennsylvania, but superusers consume a large proportion of healthcare resources at a high cost: $1.25 billion to be exact.

These superusers—defined as patients with five or more hospital admissions per year—generated 10% of all hospital payments in 2016, according to a new report (PDF) by the Pennsylvania Health Care Cost Containment Council (PHC4). They also represent 12% of hospital admissions and 15% of hospital days.

The analysis found that 80% of those payments were for Medicare and/or Medicaid patients:

  • $581 million for Medicare patients
  • $170 million for Medicaid patients
  • $239 million for patients covered by both Medicare and Medicaid

Overall, the top three reasons superusers were admitted to the hospital were sepsis, heart failure and mental health disorders.

The good news, according to the report, is the number of superusers dropped between 2012 and 2016 from 24,045 to 21,968.

But in addition to the high number of hospitalizations, superusers in 2016 also had frequent visits to the emergency department. Seventy percent of Medicare superusers made at least one visit and 49% had five or more ER visits that did not lead to an admission but added to an extra $28 million in costs. The data also finds higher rates of superusers among black, lower income and older residents.

“Many of Pennsylvania’s superutilizers have chronic health needs,” said Joe Martin, executive director of PHC4, in an announcement about the findings. “Results from this brief can help policy makers and healthcare professionals determine the best approach to care for these patients while containing costs.”

Hospitals in Pennsylvania have taken steps to address the problem. For example, hospital staff advise frequent hospital users to visit their primary care provider for follow-up care, and many organizations have nurses and pharmacists check on patients by phone and visit them at home, Robert Shipp III, vice president of population health strategies for the Hospital and Healthsystem Association of Pennsylvania, told Philly.com.

RELATED: Illinois hospital offers housing to curb ER superusers

Organizations across the country have tried to tackle the problem of high-cost superusers. When the University of Illinois Hospital noticed that its most frequent superusers were chronically homeless patients, it launched an initiative to provide them with furnished apartments and support services. The organization’s $250,000 investment in the program has resulted in a 35% drop in monthly hospital visits and a 40% decrease in the annual cost of their care.

RELATED: Kaiser Permanente Northwest takes new approach to redirect ER superusers

And Kaiser Permanente Northwest in Oregon has had success using ER navigators to connect superuser patients with community resources. The program has led to a 55% drop in ER readmissions among those superusers, a 38% decrease in hospital admissions and a 30% decline in the number of days the patients stay in the hospital.