Can high healthcare costs be reduced? - Empirical evidence from community hospitals

Haichang Xin1, PhD, Mark L. Diana2, PhD, Anjum Khurshid3, PhD, Lisanne Brown3, PhD, Snigdha Mukherjee3, PhD

1. University of Alabama at Birmingham; 2. Tulane University; 3. Louisiana Public Health Institute

Presenter Disclosures

Haichang Xin, PhD

No relationships to disclose

• Hospital inpatient costs comprise the largest proportion of health care expenditures.

• This study examines cost drivers and cost savings attributed to preventable hospital admissions.

• The results will inform policies on cost containment.

Introduction and Objectives

• Retrospective study design • Hospital discharge data • Jefferson and Orleans parishes • Patients ages 18 and older

Methods---Overall

• High cost defined as top ten percentile charges, over $14,682.5

• Patient characteristics, including age group, gender, race, insurance status, treatment categories, and length of stay

• Logit model

Methods---Cost Drivers

• Ambulatory care sensitive conditions

• Prevention quality indicators (PQIs) from AHRQ

• Preventable hospital admissions in 2010

• Diabetes and heart disease

• Cost charge ratio converts charges to costs

Methods--- Cost Savings

• 1612 diabetes discharges and 3228 heart disease discharges

• A total related cost of $49.2 million • Insignificant difference among age group, gender,

and race • Significant results (P<0.05): Medicare and other type insurance, compared to Medicaid; Urology medicine and general surgery; Longer patient length of stay

Results---Cost Driver

Results---Cost Savings

  Number of Preventable Hospital Admission (N)

Preventable Hospitalization Costs ($)

Diabetes 284.5 4.5 million

Heart disease

666.3 7.5 million

Total   12 million

• More research needed for cost reduction from patient side

• Substantial room for cost savings from provider side on ambulatory care quality

• Future endeavors should identify specific areas on cost containment

Conclusions