Hospital super-users have complex needs, limited care access

Nurse with patient

The problem of super-users--patients admitted to a general acute-care hospital more than five times in a year--may be avoidable in many cases, according to a new study from Pennsylvania's Health Care Cost Containment Council (PHC4).

More than 21,000 of these patients made up 14 percent of hospital stays and 11 percent of total admissions in fiscal 2014, according to the study. They accounted for $545 million in Medicare payments for inpatient stays and $216 million in Medicaid payments in 2012. The report did not measure whether any of these stays or admissions could have been prevented by improved outpatient care, but researchers widely assume they could, PHC4 Executive Director Joe Martin told Philly.com.

On average, the state has 21.2 super-users per 10,000 residents, with the largest concentration--33.2 per 10,000--concentrated in Philadelphia, according to the study, with the number considerably lower in suburban counties. The main reasons for hospitalization among super-users were heart failure, blood infections and mental health disorders, according to PHC4. African-Americans, people 75 and older and residents of low-income neighborhoods were the demographics most likely to produce super-users. Other research indicates a personality test could help identify those patients most likely to overuse healthcare services, FierceHealthcare previously reported.

These findings indicate super-users tend to have a combination of complicated healthcare needs and limited primary and specialty care access, Michael Consuelos, senior vice president of clinical integration for the Hospital and Healthsystem Association of Pennsylvania, told Philly.com. That's why healthcare leaders must do more to address the "social determinants of health," he said, such as poverty or employment status.

The healthcare system has long sought ways to improve outcomes for these patients, with the Robert Wood Johnson Foundation funding programs that addressed the issue in six communities across the country in 2013. And in 2014, a clinic-based multidisciplinary team cut frequent emergency department user visits 22 percent, FierceHealthcare previously reported.

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