Potentially Avoidable Hospitalizations of Medicare Patients for Pneumonia and Chronic Obstructive Pulmonary Disease

Physician Experience Counts But Lack of Resources Contributes to High Hospitalization Rates

News Release
May 24, 2007

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Elderly Medicare patients at high risk for hospitalization for two common conditions—bacterial pneumonia and chronic obstructive pulmonary disease (COPD)—were more likely to stay out of the hospital if treated by experienced physicians, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center (MSKCC) in the June edition of the journal Medical Care.

But patients of physicians reporting more difficulty accessing ancillary services for patients—for example, home oxygen or respiratory therapy—and physicians treating more poor patients were at higher risk of hospitalization for both conditions, the study found.

Bacterial pneumonia and COPD are the third and fifth most common reasons for hospitalization among Medicare patients aged 65 and older, but some of the hospitalizations are avoidable with high-quality outpatient management.

"The study confirms what many physicians practicing in low-income areas intuitively know—that a lack of resources hinders their ability to provide high-quality care and may increase the need for hospitalization," said Ann S. O'Malley, M.D., M.P.H., the study's lead author and a senior health researcher at HSC, a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

The article concludes "making additional clinical resources available to subgroups of physicians who have less access to ancillary services and a high proportion of Medicaid patients may help reduce their patients' risk of hospitalization from COPD and bacterial pneumonia."

The study, "Potentially Avoidable Hospitalizations for COPD and Pneumonia: The Role of Physician and Practice Characteristics" is based on HSC's 2000-01 nationally representative Community Tracking Study Physician Survey, which collected information from 12,000 practicing physicians, and Medicare claims information on beneficiaries these physicians treated in 2000-02. Data on physicians and patients were linked with the use of the physicians' unique provider identification number, and a total of 5,764 physicians and 509,613 elderly Medicare patients were included in the study.

Key study findings include:

• Elderly Medicare beneficiaries whose usual physician had more years of experience-more than 10 years vs. less than 10 years in practice-had a lower risk of hospitalization for pneumonia and COPD.
• Patients of physicians reporting more difficulty accessing ancillary services were at higher risk of hospitalization for both conditions.
• Patients of physicians with a higher proportion of practice revenue from Medicaid—greater than 5 percent—were more likely to be hospitalized for bacterial pneumonia or COPD.
• Patients of physicians with a higher proportion of practice revenue from managed care were less likely to have been hospitalized for bacterial pneumonia or COPD.
• Patients of physicians reporting clinical practice guidelines had an important effect on their practice were less likely to be hospitalized for COPD.

The study was coauthored by Hoangmai H. Pham, M.D., M.P.H., of HSC; Deborah Schrag, M.D., M.P.H., of MSKCC; Beny Wu, M.S., of Social Scientific Systems; and Peter B. Bach, M.D., M.A.P.P., of MSKCC; and was supported by grants from the National Cancer Institute, the National Institute on Aging and the Robert Wood Johnson Foundation.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.

Memorial Sloan-Kettering Cancer Center is the world's oldest and largest private institution devoted to prevention, patient care, research and education in cancer. MSKCC scientists and clinicians generate innovative approaches to better understand, diagnose and treat cancer. MSKCC specialists are leaders in biomedical research and in translating the latest research to advance the standard of cancer care worldwide. For more information, go to www.mskcc.org