High-resource hospital users in an integrated delivery system.
OBJECTIVE
With decreasing healthcare reimbursement, nurse administrators need to aggressively manage care for high-resource users of hospital services to ensure the viability of their healthcare organization. The objective of this study was to (1) investigate frequent Medicare inpatient admission and emergency department users, (2) investigate Medicare day outliers, and (3) examine Medicare reimbursement/charge ratios.


BACKGROUND
Although much research has focused on patients who have been readmitted frequently to the hospital, little research has examined patients who are frequent users of both emergency departments and inpatient services.


METHODS
In this study, all 4,920 elderly Medicare inpatient admissions and emergency department visits for 1 year in a 222-bed general hospital were included. Patient profiles of two categories of high resource users were created.


RESULTS
Results showed the frequent high user group (n = 75), who had six or more combined emergency department and inpatient admissions per year, had cardiac, diabetic, and chronic respiratory conditions, and came to the hospital from their homes. The day outlier profile (n = 148) consisted of older patients who have neoplasms, and respiratory and circulatory diseases. The mean Medicare reimbursement/charge ratio varied for high volume diagnosis-related groups (DRGS.)


CONCLUSIONS
From the study, implications include refining case management, monitoring high-resource patients by computer tracking, analyzing high-user trends by several different methods, incorporating many facets of an integrated healthcare delivery into their care, expanding patient, outpatient, and community support programs, and continually monitoring revenue for organizational viability.
Belcher
J V
JV
College of Nursing and Health, Wright State University, Dayton, Ohio, USA.
Alexy
B
B
D000368:Aged; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups / Q000145:classification* / Q000191:economics; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008484:Medicaid; D016347:Medical Records Systems, Computerized; D009718:Nurse Administrators; D010359:Patient Readmission / Q000706:statistics & numerical data; D012424:Rural Population; D018511:Systems Integration; D014481:United States