Geriatric focus cuts hospital costs

Apr 29 2013

By Peter Sergo, medwireNews Reporter

An Acute Care for Elders (ACE) unit with a focus on identifying and treating geriatric syndromes significantly reduces costs and 30-day readmissions for elderly patients, a study finds.

"In an era when improving care processes while reducing costs is a vital objective for the Medicare program and our nation as a whole, the ACE model meets these goals," write Kellie Flood (University of Alabama, Birmingham, USA) and colleagues in JAMA Internal Medicine.

Flood and team conducted a retrospective cohort examination of costs of care among hospitalists' patients (n=818) aged 70 years or older, who spent their entire hospital stay in either an ACE (n=428) or usual care (UC) (n=390) unit - which used the same attending physicians and unit staffing - during fiscal year 2010.

The analysis found that mean total variable cost per patient at the ACE was US$ 2109 (€ 1619), which was significantly lower than the average $ 2480 (€ 1904) that UC patients cost. ACE unit patients also had significantly lower mean daily direct costs ($ 484, € 372) than the UC group ($ 545, € 419).

The cost savings with the ACE unit were confined to patients who had low or moderate scores on the case mix index; for those with high scores the intervention was cost neutral.

A significantly smaller fraction of ACE patients required hospital readmission within 30 days for any cause compared with UC patients (7.9 vs 12.8%).

Among the 25 most common diagnosis-related groups (DRGs), the mean variable direct cost per ACE patient ($ 1693, € 1300) was also significantly lower than for UC unit patients ($ 2138, € 1642). The proportion of patients requiring readmission within 30 days was not significantly different though.

With $ 371 (€ 285) in variable direct cost savings per patient on account of care provided according to an ACE model with an IDT supporting hospitalists who did not participate in ACE team rounds, Flood et al calculated $ 148,000 (€ 11,3876) in savings for every 400 patients admitted to the ACE unit.

"An ACE team collaboratively supporting attending physicians who are not geriatricians can deliver geriatric care processes cost efficiently," conclude the authors. "Savings… are explained by improved care processes and coordination that stem from an IDT model, thereby enhancing geriatric assessment and appropriateness of care."

In an accompanying editorial, Lisa Walke (Yale University School of Medicine, New Haven, Connecticut, USA) recognizes the challenge in improving outcomes while lowering health costs but nonetheless predicts a "new paradigm of [geriatric] care" that would implement and coordinate core elements across sites and providers.

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