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One-Third Of Medicare Hospital Stays Involve Dual-Enrollment Patients

A new report authored by the Agency for Healthcare Research and Quality (AHRQ) says that one-third of Medicare hospital stays in 2008 involved patients who were dually eligible for Medicare and Medicaid. According to the report, Medicaid pays the Medicare insurance premiums for about 8 million beneficiaries each year, about 18% of all Medicare beneficiaries. Dual-eligible patients account for about half of all Medicaid spending and about one-quarter of all Medicare spending in any given year.

Healthcare expenditures for dual enrollees are likely to be higher because dual enrollees typically have a number of chronic health conditions (some of which make them eligible for Medicare), and are more likely to need catastrophic medical coverage and long-term continuing care services.

The AHRQ report says that the three top causes of “potentially preventable” hospitalizations in 2008 among dual enrollees were bacterial pneumonia, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Other potential preventable hospitalizations included pressure ulcers, asthma, diabetes and urinary tract infections.

Among “potentially preventable” hospitalizations, Medicare and Medicaid spent more to treat pressure ulcers than any other diagnosis. The report also noted that dual enrollees were more than twice as likely to be admitted for pressure ulcers, asthma, diabetes and urinary tract infections than traditional Medicare beneficiaries were, and nearly one-third more likely to be admitted for bacterial pneumonia and COPD than Medicare beneficiaries.

More than half of all hospitalizations among dual-enrollees between 18 and 64 were for asthma- and diabetes-related illnesses, while more than one-third of hospitalizations for dually enrolled beneficiaries over the age of 85 were for falls. One quarter of hospitalizations among elderly dual beneficiaries 85 and above were for bacterial infections, UTIs and bacterial infections, UTIs.

The most likely group of dual beneficiaries to require hospitalization for potentially preventable conditions, however, were those between the ages of 65 and 74. The report, which was presented as a statistical brief, did not include recommendations on reducing the number of potentially preventable admissions among dual beneficiaries, however it does provide a basis for continued research into improved treatments and preventive care that could reduce the number of potentially preventable admissions among dually enrolled Medicare/Medicaid beneficiaries.

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