PHC4 Research Brief | PA’s “Super-Utilizers” of Inpatient Hospital Care

PHC4 Research Brief - PA’s “Super-Utilizers” of Inpatient Hospital Care - News Release

Contact: Joe Martin
717-232-6787 or

Harrisburg, PA - February 19, 2015 - Super-utilizers—patients with five or more admissions to a general acute care hospital per year, often for chronic illnesses—accounted for $761 million of Medicare and Medicaid expenditures for inpatient stays in Pennsylvania, according to a new research brief released today by the Pennsylvania Health Care Cost Containment Council.

The PHC4 analysis shows:

Fourteen percent—$545 million—of Medicare fee-for-service payments for inpatient stays were for super-utilizers.
Seventeen percent—$216 million—of Medicaid payments (including both fee for service and managed care) for inpatient stays were for super-utilizers.

“Having data on super-utilizers will help the Commonwealth’s policy makers and health care professionals as they determine the best way to care for those with chronic care needs while containing costs,” said Joe Martin, executive director of PHC4.

The PHC4 brief indicates that while super-utilizers represent a relatively small percent of patients, they tend to have longer hospital stays and account for a disproportionate amount of health care resources. Also included in the brief is the number of super-utilizers per 10,000 residents for each of Pennsylvania’s 67 counties. A list of the top reasons for super-utilizer admissions by county is available on PHC4’s website at www.phc4.org.

The brief is based on hospital data from fiscal year 2014. Payment figures were based on 2012 data, the most recent year available to PHC4.

PHC4 is an independent state agency charged with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in Pennsylvania.