Potentially avoidable medical complications in people covered by job-related health insurance add at least 30 cents to every dollar spent by their employers on their care for six chronic conditions, according to a new study. The researchers said that even reducing the current average rate of potentially avoidable complications in workers and their dependents treated for high-blood pressure, heart disease, heart failure, diabetes, asthma, or chronic obstructive pulmonary disease from 29 percent to 26 percent could save employers nationwide as much as $6.5 billion a year. Complications boost employers' costs because they cause additional care, such as emergency room visits, hospitalizations, tests, and more medicines. But studies show that high-quality care ambulatory care reduces potentially avoidable complications.
Francois de Brantes, M.S., M.B.A., of the Health Care Incentives Improvement Institute, and his fellow researchers also found that the rate of complications among the nearly 690,000 persons they studied varied widely. Heart failure had the highest rate (58 percent), followed by chronic obstructive pulmonary disease (40 percent), diabetes (30 percent), asthma (30 percent), high blood pressure (17 percent), and heart disease (15 percent).
In another study in the same journal, researchers led by Jeffrey H. Silber, M.D., Ph.D., of the University of Pennsylvania School of Medicine, found that elderly surgical patients who were operated on in hospitals with an aggressive treatment style were 8 percent less likely to die within 30 days of admission compared with similar patients who had their surgery in hospitals with a less aggressive style. Hospitals that used more intensive care unit days and more overall patient days for these patients were considered to have a more aggressive treatment style than those that spent fewer of these resources on their elderly surgical patients.
The researchers, who analyzed data on more than 4.5 million elderly Medicare patients admitted to 3,065 hospitals between 2000 and 2005 for general, orthopedic, or vascular surgery, found that the patients who underwent surgery in the more aggressive hospitals were no more likely to suffer complications than those operated on in the less aggressive ones. However, when they did have a complication, the patients in the more aggressive hospitals were much more likely to survive than the patients who suffered a complication in a less aggressive hospital.
The studies are part of a December 2010 special theme issue of Health Services Research on payment reform, published in collaboration with the Agency for Healthcare Research and Quality (AHRQ). AHRQ Director Carolyn M. Clancy, M.D., said, "The research in this special issue shows collectively that it's not simply deciding which payment system works best to improve quality and value, but when and under what circumstances does it work to achieve certain objectives."