Super Utilizers Cost Pennsylvania Medicare, Medicaid $761 Million

Hospital super utilizers in Pennsylvania account for $761 million of the state’s Medicare and Medicaid expenditures for inpatient stays, according to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4).

Super utilizers were defined as patients with 5 or more admissions to a general acute care hospital per year. Often they are being treated for chronic illnesses. The report from PHC4 found that 14% of Medicare fee-for-service payments and 17% of Medicaid payments (both fee-for-service and managed care) for inpatients stays were for super utilizers.

“Having data on super-utilizers will help the Commonwealth’s policy makers and health care professionals as they determine the best way to care for those with chronic care needs while containing costs,” Joe Martin, executive director of PHC4, said in a statement.

Super utilizers only represented 3% of hospitalized patients, but 31% of them had 7 or more admissions in fiscal year 2014 and 12% had 9 or more admissions.

The top reasons for super utilizers to be admitted to the hospital were heart failure, septicemia and mental health disorders, and on average patients admitted 5 or more times throughout the year stayed 5.9 days. In comparison, the 88% of patients admitted to a Pennsylvania hospital just once or twice during the year had an average length of stay of just 4.4 days.

One state over in New Jersey, Jeffrey Brenner, MD, president and chief executive officer of the Camden Coalition of Healthcare Providers has delved into the data of super utilizers in Camden, NJ, and he found astonishing numbers. Half of the city’s population actually visited the emergency room during the course of a year and the most common reason to do so was for heard colds.

Just 1% of the city’s 79,000 residents accounted for 30% of spending at hospitals. One individual had visited the hospital more than 100 times during a year, and over the course of 5 years someone had been to the hospital 324 times.

The large amounts of money being spent for patients to continuously visit the hospital were not being put to good use.

“It’s not like there’s outbreaks of health and wellness for the money we’re spending,” Dr Brenner said. “We’re just wasting money.”

Dr Jeffrey Brenner Talks Hospital Super Utilizers in Camden, NJ