Rutgers Report Reveals Different Patterns of Hospital Use Among Poorer Communities

Andrew Kitchenman | March 27, 2013 | Health Care
Data from study could help save money, reduce number of avoidable ER visits

New Jerseyans who live in different communities use hospitals at widely different rates, and those differences could pave the way to improving healthcare and reducing costs, according to a new report by Rutgers University researchers.

The report, Hospital Utilization Patterns in 13 Low-Income Communities in New Jersey: Opportunities for Better Care and Lower Costs, found wide variations in how many avoidable ER visits residents make.

The reason that this information is so valuable, according to coauthor Joel Cantor, director of the Rutgers Center for State Health Policy, is that it opens up the possibility that communities that rely heavily on hospitals for primary care can learn from those who make fewer trips to the ER.

For example, the report found that Camden residents had more than three times as many avoidable visits to emergency departments than did residents of the Union City-West New York-North Bergen region.

“Our intention was to start a dialogue and I think we’ve succeeded,” Cantor said. The report has been shared with state health and Medicaid officials, as well as community leaders, he noted.

The report didn’t examine the reasons for varying hospital utilization rates. Instead, it compiled data on emergency-room visits and inpatient hospital stays and compared communities with the highest and lowest rates.

The communities were chosen for the study because they are potential candidates for the state’s pilot Medicaid accountable care organization (ACO).

The way this project will work is that an ACO will be set up in each participating community, and it will be paid to coordinate patient care. Organizations will earn more if they improve the quality of care as measured by objective benchmarks; expand access to primary and behavioral healthcare; and reduce costs.

New Brunswick was the only one of the 13 communities that had consistently low rates of emergency department use, inpatient visits, and hospital readmissions.

Cantor said that New Brunswick’s admirable achievement could result from it having a strong primary care infrastructure, which other communities could try to replicate.

But not all success factors can be replicated, such as having a large immigrant population that uses hospitals less.

“Some things are outside of (community) control,” Cantor said.

Cantor did say that the ACO model is well-positioned to address many factors that lead to excessive hospital use, such as substance abuse. In addition, ACO staff are trained to help patients receive services that alleviate many of the root causes of ER and healthcare overuse.

Many of the report’s findings will give community healthcare leaders a lot to think about.

For example, only 1 percent of the patients in the study were among the highest users of both inpatient care and emergency departments.

“They are really quite different populations,” Cantor said. And that could help communities realize that they need to come up with different strategies to solve each problem.

He also noted that patients with private insurance made up the largest percentage of frequent users of ERs (33.3 percent of that category statewide).

“The hospitals don’t mind when insured patients show up frequently,” Cantor said. “The incentives aren’t necessarily aligned for the hospitals, at least to tackle this problem.”

While hospitals are working to reduce use by uninsured residents, the increase in the number of insured patients as a result of the federal Affordable Care Act may reverse this trend.

Emergency department “overcrowding is a problem that is not going to go away and may get worse,” Cantor said.

The largest potential savings are among those who reduce inpatient treatment. If high-use communities could match their lowest-use counterparts (Elizabeth and Linden), hospitals could save $284.3 million annually, according to the report. Cantor said that could be achieved by reducing the number of patients overall or by providing care at a lower cost.

“It’s a lot of money on the table,” Cantor said, characterizing the potential savings for communities.

One potential path for savings is suggested by the fact that 38.6 percent of the most frequent inpatient hospital visitors had mental-health disorders, including substance-abuse problems. If mental-health needs could be met before they lead to hospitalizations, the savings could be quite large, Cantor said.

The report was funded by the Nicholson Foundation, which has ongoing healthcare projects in three communities that were the subject of more detailed reports: Camden, Newark, and Trenton.