Authors Cite Better Health, Lower Costs

Researchers are documenting substantial reductions in Medicare hospitalizations, mortality and costs over a fifteen year period, based on a review of 68 million admissions of fee-for-service Medicare patients across the U.S. For 2013 compared to 1999, hospitalizations were found to have fallen by 24% and costs were judged to have fallen by 15%. And risk of inpatient death during the same period fell by 45%, according to researchers. Lead researcher Harlan M. Krumholz, MD, SM, a cardiologist and professor at the Yale University School of Medicine, told USA Today that the reported 16% decline in Medicare mortality is “a jaw dropping finding. We didn’t expect to see such a remarkable improvement over time.” Authors cite five possible factors influencing cost reductions and improved outcomes. These include: (1) the 1992 Health Care Quality Improvement Initiative, in which QIOs were asked to work with hospitals to focus on collaborative quality improvement rather than inspections of care; (2) adoption of healthier behaviors by Americans over the fifteen year period; (3) public health advances that tend to benefit patients born in later years; (4) better procedures, technologies, devices and drugs; and (5) the possibility that patients in Medicare Advantage plans are sicker than fee-for-service patients, thus leading to an over-estimation of the gains for all Medicare beneficiaries. The authors say their findings were consistent across ages, sexes and races. They also found sharp declines in hospitalizations in the last six months of life (28%), and the percentage of beneficiaries with one or more hospitalizations (14%). The article “Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013,” appears in the Journal of the American Medical Association, July 28, 2015. To obtain a copy of the article, visit the JAMA website at www.jama.com.