PACE Program Reduces Dual-Eligible Beneficiaries’ Risks of Hospitalizations, Re-hospitalizations, and Avoidable Hospitalizations
Over nine million Americans are eligible for both Medicare and Medicaid benefits. Known as “dual-eligibles,” many of these adults are frail and have complex and expensive health problems. Hospitalizations of these adults are very common, quite costly, and yet in many cases unnecessary.
A significant number of these hospitalizations can be prevented, confirms a new study in the Journal of the American Geriatrics Society (JAGS) published by Micah Segelman, MA, of the University of Rochester School of Medicine and Dentistry and co-authors. Their study focuses on the Program of All-Inclusive Care (PACE), a nationwide, community-based program for frail older adults. PACE provides “dual-eligibles,” and other complex patients, with individualized, comprehensive care provided by teams of interdisciplinary healthcare professionals. These teams include physicians, nurses, and other healthcare providers who work together to coordinate each patient’s care. Through the program, enrollees have access to a day center setting that includes medical services. Although it is anticipated that the PACE program will reduce hospitalization, recent research on hospitalizations in PACE is lacking.
New Research in the Journal of the American Geriatrics Society
The researchers in this study reviewed records from 61 PACE programs in the United States from June 2008 through May 2010. They then checked how often beneficiaries in the programs were hospitalized; and how often they were readmitted to a hospital within 30 days of being discharged. The researchers also checked how often these older adults had “potentially avoidable hospitalizations,” i.e. hospitalizations that may not have been necessary if the patient received appropriate outpatient care or which were for conditions that could possibly have been treated in the community.
The study found that beneficiaries enrolled in PACE programs had lower rates of hospitalizations, hospital readmissions, and avoidable hospitalizations than those in comparable programs, on average. The rate of hospitalization in PACE, for example, was between 24 percent and 43 percent lower compared to the rate in other programs nationally. Though hospitalizations were less frequent in the PACE programs than in the other programs, there were differences among the PACE programs as well. Some PACE sites had higher rates of admissions, readmissions, and potentially avoidable hospitalizations than other PACE sites. In light of this, more research is needed to determine why this is the case, and how to address it.
“The PACE model has evolved from a single local initiative to a healthcare program operating widely across the country and influenced by new practices”, note the authors. “Variations in hospitalization rates between PACE sites suggest an opportunity for narrowing the gap between PACE plans with regard to hospitalizations,” they conclude. “Further research is necessary to identify how best-performing PACE organizations prevent acute care conditions from rising and how such conditions are detected and managed on site.”
This summary is from the full report titled, “Hospitalizations in the Program of All –Inclusive Care for the Elderly.” It appears in the February 2014 issue of the Journal of the American Geriatrics Society. The report is authored by Micah Segelman, MA; Jill Szydlowski, BS, Bruce Kinosian, MD, Matthew McNabney, MD, Donna B. Raziano, MD, MBA, Catherine Eng, MD, Christine van Reenen, PhD, and Helena Temkin-Greener, PhD.