NYAPRS Note: Read the United Hospital Fund report referenced below here, and link to a recent UHF study on lessons learned in preventing readmissions.
Medicaid Data Shows High City Admission Rates for Preventable Illness
Capital New York; Laura Nahmias, 11/18/2014
Unusually high numbers of New York City’s poorest children are being admitted to hospitals for preventable conditions, particularly asthma and gastroenteritis, newly released state Medicaid data shows.
In New York City, the rate of children on Medicaid admitted for asthma in 2012 was 425 per every 100,000 Medicaid members, a rate more than twice the rate in the mid-Hudson Valley, and more than four times as high as the admission rate for asthma in central New York.
Asthma was the seventh-most frequent diagnosis for patients admitted to health facilities in New York City, and was even more frequently diagnosed in the Bronx, where it’s the second-most frequent diagnosis after hospitalizations for women giving birth.
The data also shows upstate health care providers are battling different patient problems than providers in New York City. Upstate regions had larger-than-expected numbers of preventable hospital admissions for emergency conditions such as stomach pain, and lower numbers of admissions for patients seeking treatment for chronic conditions like diabetes and asthma. In New York City, those patterns were reversed—a greater than expected number of patients were admitted to hospitals for preventable chronic conditions than for acute ones.
The data, compiled by the United Hospital Fund, uses information collected by the state health department. Health care providers are supposed to use that information to figure out where exactly they need to focus their efforts, as they plan ways to improve healthcare delivery statewide under a new Medicaid reform plan.
The state $8 billion federal Medicaid waiver will give providers money over five years to change the way they deliver health care services, with the ultimate goal of improving health statewide, and lowering the number of avoidable, costly hospital visits in the state.
New York ranks 36th among states in the country in potentially preventable readmissions—with 36,080 potentially preventable emergency room visits per 100,000 visits.
New York also has one of the costliest Medicaid programs in the country, with nearly six million enrollees out of a total state population of 19.3 million. The program spends more than $50 billion a year.
The charts show that in 2013, New York’s Medicaid enrollees filed 277,094,128 claims. That’s an average of 53 claims per patient.
New York City has the largest per capita Medicaid enrollment of any area in the state.
Out of a population of 8.4 million people, 3.14 million were Medicaid beneficiaries who filed a claim in 2013, or 37.4 percent of the total population.
In most regions of the state, about 20 percent of the total population filed a Medicaid claim in 2013. Those percentages are much larger in New York City. The Bronx has the highest percentage of Medicaid enrollees as a portion of its population—51 percent of residents filed a Medicaid claim in 2013.