Hospitals, others work to decrease ‘super utilizers’

These are people who are hospitalized often

Only 3 percent of hospitalized patients in Pennsylvania qualify as “super utilizers” — patients who are hospitalized five or more times in one year.

But that group generates 10 percent of all hospital payments, about $1.25 billion in all, according to newly released research by the Pennsylvania Health Care Cost Containment Council (PHC4), an independent state agency based in Harrisburg.

The encouraging news is that the number of super utilizers has decreased — from 24,045 in 2012 to 21,968 last year, as hospitals and others have taken steps to help people stay out of the hospital.

“Hospitals are pretty aware of this issue and are trying many different things to help decrease utilization because it’s not good for them and it’s not good for the patients,” said Jane Montgomery, vice president clinical services and quality, Healthcare Council of Western Pennsylvania in Warrendale.

Those initiatives include sending health professionals into the home to help with minor problems such as needing fluids before those develop into something that requires a hospital visit. “The physician practices are trying to reach out to patients as well with health coaches and treatment coaches,” she said.

There can be challenges, though, if patients cannot afford their medications, she added, “and sometimes there is an issue of non-compliance because they don’t like the way [the medication] makes them feel.”

Hospitals do have a bottom line stake in limiting readmissions within 30 days, as the Centers for Medicare and Medicaid Services can penalize them up to 3 percent on their reimbursement payments if they

have too many readmissions.

Typically “super utilizers” are patients with chronic conditions such as heart failure or mental health disorders, conditions that often require ongoing monitoring and treatment that may run up medical costs.

The largest demographic represented are Pennsylvanians 60 years and older who constitute 58 percent of all super utilizers, according to the report.

Just over 80 percent of super utilizers are Medicare beneficiaries. About 18 percent have coverage through Medicaid, and another 18 percent have both Medicare and Medicaid coverage.

Lower income and black Pennsylvania residents also had higher rates of super utilization, the PHC4 data found.

The report can be viewed online at www.phc4.org.