Report: Allegheny County ranks high in preventable hospitalizations
IN THE PITTSBURGH AREA, “THE RIGHT CARE AT THE RIGHT TIME AND AT THE RIGHT PLACE” IS A MANTRA FOR MANY HOSPITAL EXECUTIVES.
Allegheny County has the distinction of hospitalizing more people for preventable medical problems than Pennsylvania or the U.S. overall, according to a new report by the University of Wisconsin Population Health Institute.
The number of preventable hospitalizations in the county in 2019 — the latest data available — was 4,223 per 100,000 Medicare members, which exceeded the Pennsylvania rate of 3,966 per 100,000 population. It was also higher than the U.S. rate of 3,767.
The data, part of a long running survey updated in April, was based onMedicare claims data and age-adjusted to account for the incidence of more serious disease that can come with older age. Comparisons to prior years were not possible becauseof changes in ranking data.
While Allegheny County’s numbers were above the state average, other counties in the state fared evenworse.
Rural Greene County — which has only one 23-bed hospital — had the highest rate of hospitalization for preventable conditions among Pennsylvania’s 67 counties at 6,504, followed by Cambria County at 5,518 and Bradford at 5,446, each per 100,000 Medicare enrollees, accordingto the report.
The problem of hospital over-utilization is huge: Medicare paid hospitals $33.7 billion for 3.5 million preventable patient hospitalizations in 2017, with congestive heart disease as the most common and highest cost reason for potentially avoidable admissions, according to theAgency for Healthcare Research and Quality, a Rockville, Md.-based arm of the U.S. Department of Healthand Human Services.
The issue has been a focus in part because treating patients in hospitals is much more expensive than otheroptions.
High rates of preventable hospitalizations for such things as diabetes, asthma and congestive heart disease persist in Allegheny County despite years of efforts by insurers, including both Highmark and UPMC Health Plan, to curb hospitalizations for conditions that can be effectively treated at a lower cost at a doctor’s office.
“Itreally represents a breakdown inchronic disease management, not just in the preceding weeks or months, but in some cases years earlier,” said Commonwealth Fund Senior Scientist David Radley, who was not involved in the University of Wisconsin study. “With a good, strong network of primary care, you should be able to avoid a lot of thesekinds of admissions.”
The issue in Pittsburgh may be systemic, Mr. Radley said — not enough primary care doctors to
help patients outside hospitals or barriers accessing care such as poor public transportation. The New York City-based Commonwealth Fund is a private foundation that promotesquality medical care.
Working to reduce unneeded hospitalizations has been a focus in Allegheny County and elsewhere for a while. In the Pittsburgh area, “the right care at the right time and at the right place” is a mantra for manyhospital executives.
The county’s high ranking in the University of Wisconsin report shows the difficulty in getting patientsto the most appropriate places for care, despite years of economic incentives and “pay for performance” initiatives by Medicare and health insurers Highmark and
UPMC Health Plan meant to empower health care practictioners to take steps to curb preventable admissions.
Health systems have also expanded office hours for primary care doctors to make it easier for patients to see their physician before turningto the emergency room.
Most recently, UPMC created a paramedicresponse team to answer health plan member calls for urgent care that could be provided in the home instead of a hospital, while Highmark’s Allegheny Health Network has begun providing acute care services in the patient’s home thatpreviously were in a hospital.
But at the time patients are admitted, many hospitalizations later judged preventable were entirely
appropriate,Mr. Radley said.
Instead, he said, Allegheny County’s high ranking suggests a breakdown in the management of medical problems that can turn acute suddenly without regular attention.
The preventable hospitalization metric, based on Centers for Medicare and Medicaid Services data, is “verywell established” and in use at least15 years, Mr. Radley said.
Study results, which were based on Medicare claims data, were ageadjusted to account for the incidence of more serious disease that can come with older age. Comparisonsto prior years were not possible becauseof changes in ranking data.
Whilesome data indicates that the Pittsburgh area has too many hospital beds — and competition between healthsystems has seen more investments in expanding those kinds of services into different areas of the region in recent years — Mr. Radley said a connection between an oversupply of hospital beds and hospitalizationsis not clear.
“There’s a theory of supply induced demand that when you have a lot of supply in hospital settings, that supply tends to get used,” he said. “Hospitals aren’t making money if there’s not a lot of patients inbeds.”
But, he added, the connection was“really hard to prove.”