University of Colorado Hospital and Denver Health Medical Center Super Utilizers Contribute More to Readmissions, Revenue, and Length of Stay than National and State Averages
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By: Saparja Nag Nov. 17, 2017
Super utilizers are a significant subsection of the publicly insured population. Although they only account for about 5%-10% of the combined Medicare and Medicaid population, they are responsible for nearly half of the total cost of public healthcare. The high cost is due to excess emergency department visits and multiple hospital admissions.1 For an introduction to super utilizer analysis, read this article.
Super utilizers in the state of Colorado have lower contributions to readmission rates, revenue, and length of stay than the country as a whole, according to Dexur data analysis. The University of Colorado Hospital, however, has greater contributions to these quality outcomes than the state and the nation. The Denver Health Medical Center has an even greater super utilizer contribution to readmissions and revenue than the University of Colorado Hospital. The one difference between Denver Health and University of Colorado Hospital, however, is the contribution to length of stay. Denver Health super utilizers contribute less than the national average to overall length of stay. This data can be visualized in the graph below.
The Dexur data team was able to determine the percentage of unique patients and total discharges that were super utilizers, those with >3 discharges between October 2015 and September 2016. University of Colorado Hospital had 9,102 total Medicare inpatient discharges in this time frame. Nearly 14% of the unique patients served at this hospital were super utilizers, making up almost 26.5% of all Medicare discharges. Denver Health serves a smaller population, with only 1,706 total Medicare inpatient discharges. However, there was a greater proportion of super utilizers treated in this facility. More than 17% of unique patients at Denver Health were admitted more than 3 times within the year time period, which accounted for nearly 28.5% of all discharges. The analysis is shown below. These statistics can be used to understand the needs of certain populations and communities in order to implement effective super utilizer interventions.
| % of Medicare Unique Patients with >3 Discharges between Oct 2015 - Sep 2016 | % of Total Medicare Discharges with >3 Discharges between Oct 2015 - Sep 2016 | |
|---|---|---|
| University of Colorado Hospital | 13.91% | 26.44% |
| Denver Health Medical Center | 17.26% | 28.47% |
A study conducted in collaboration with University of Colorado School of Medicine and Denver Health Medical Center studied publicly insured or uninsured super utilizers. They focused on preventative policy initiatives at the community and primary care levels to decrease excessive healthcare costs. They found that although the percentage of super utilizers was relatively constant over time, the individual patients were constantly cycling in and out of super utilizer status month to month. Super utilizer patients often fell into a number of distinct categories: multiple chronic conditions, severe mental health diagnoses, and reported homelessness. These categories could allow for targeted specialized models and intervention programs to address different risk factors, decreasing super utilizer hospitalizations.1
Another study done by Denver Health implemented a team-based intervention program of risk-stratification to provide primary care resources to super utilizers. The program was based in an intensive outpatient clinic specifically targeted towards super utilizers and studied changes in utilization, discharges, and mortality. Unexpectedly total hospitalizations increased, but mortality rates and costs decreased significantly. They found that intensive care unit hospitalizations decreased as well. The results indicated that the quality and intensity of inpatient care, not just the volume of services provided, greatly affect super utilizer hospitalizations 2
References:
Johnson TL, Rinehart DJ, Durfee J, et al. “For many patients who use large amounts of health care services, the need is intense yet temporary.” Health Affairs. Aug 2015; 34(8): 1312-1319. DOI: 10.1377/hlthaff.2014.1186.
Durfee J, Johnson T, Batal H, et al. “The impact of tailored intervention services on charges and mortality for adult super-utilizers.” Healthcare. Aug 2017; S2213-0764(17)30057-X. DOI: 10.1016/j.hjdsi.2017.08.004.
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