The Pennsylvania Health Care Cost Containment Council has released a new research brief on so-called super-utilizers: a small portion of the population that consumes an inordinate amount of health care. Super-utilizers are defined as individuals with five or more hospital admissions a year.
According to the PHC4 report,
- Three percent of hospitalized patients accounted for 10 percent of hospital payments, or $1.25 billion, in 2016.
- Super-utilizers accounted for three percent of hospitalized patients, 10 percent of hospital payments, 12 percent of hospital admissions, and 15 percent of hospital days.
- 46 percent of that care was paid for by Medicare, 19 percent by Medicaid, and 19 percent was for dually eligible patients.
- The top three reasons for admissions among super-utilizers were sepsis, heart failure, and mental health disorders.
- Diabetes and alcohol and substance abuse disorders were among the leading causes of admission for Medicaid patients.
- The highest rates of super-utilizers were among blacks, low-income individuals, and older people.
The PHC4 report breaks down super-utilizers by county and shows the reasons for super-utilizers’ hospital admissions. Its side-by-side comparison of 2012 and 2016 shows a decline in super-utilizer admissions to hospitals, perhaps because of efforts by hospitals to reduce admissions and avoid Medicare penalties for avoidable hospital readmissions.
Go here to find the PHC4 report Pennsylvania’s “Super-Utilizers” of Hospital Care.