Survey and Chart Review to Estimate Medicare Cost Savings for Home Health as an Alternative to Hospital Admission Following Emergency Department Treatment.
BACKGROUND
Almost 70% of hospital admissions for Medicare beneficiaries originate in the emergency department (ED). Research suggests that some of these patients' needs may be better met through home-based care options after evaluation and treatment in the ED.


OBJECTIVE
We sought to estimate Medicare cost savings resulting from using the Home Health benefit to provide treatment, when appropriate, as an alternative to inpatient admission from the ED.


METHODS
This is a prospective study of patients admitted from the ED. A survey tool was used to query both emergency physicians (EPs) and patient medical record data to identify potential candidates and treatments for home-based care alternatives. Patient preferences were also surveyed. Cost savings were estimated by developing a model of Medicare Home Health to serve as a counterpart to the actual hospital-based care.


RESULTS
EPs identified 40% of the admitted patients included in the study as candidates for home-based care. The top three major diagnostic categories included diseases and disorders of the respiratory system, digestive system, and skin. Services included intravenous hydration, intravenous antibiotics, and laboratory testing. The average estimated cost savings between the Medicare inpatient reimbursement and the Home Health counterpart was approximately $4000. Of the candidate patients surveyed, 79% indicated a preference for home-based care after treatment in the ED.


CONCLUSIONS
Some Medicare beneficiaries could be referred to Home Health from the ED with a concomitant reduction in Medicare expenditures. Additional studies are needed to compare outcomes, develop the logistical pathways, and analyze infrastructure costs and incentives to enable Medicare Home Health options from the ED.
Gary and Mary West Health Institute, La Jolla, California.
Christopher
C
Crowley
Gary and Mary West Health Institute, La Jolla, California.
Amy R
AR
Stuck
Gary and Mary West Health Institute, La Jolla, California.
Tracy
T
Martinez
Gary and Mary West Health Institute, La Jolla, California.
Alan C
AC
Wittgrove
Gary and Mary West Health Institute, La Jolla, California.
Feng
F
Zeng
Department of Emergency Medicine, University of California, San Diego, San Diego, California.
Jesse J
JJ
Brennan
Department of Emergency Medicine, University of California, San Diego, San Diego, California.
Theodore C
TC
Chan
Department of Emergency Medicine, University of California, San Diego, San Diego, California.
James P
JP
Killeen
Department of Emergency Medicine, University of California, San Diego, San Diego, California.
Edward M
EM
Castillo
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017046:Cost Savings; D004066:Digestive System Diseases / Q000191:economics / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D057240:Patient Preference; D018579:Patient Selection; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000191:economics / Q000628:therapy; D012871:Skin Diseases / Q000191:economics / Q000628:therapy; D011795:Surveys and Questionnaires; D014481:United States
D000900:Anti-Bacterial Agents
cost; emergency department; home health; hospital admission