Like many in my hometown, I’m kind of passionate about Pittsburgh and the surrounding region. There’s much to offer here, on the surface visually and for those who dig a bit deeper to observe the Mister Rogers meets Annie Dillard fixer-upper Zen of the place.
One of our local treasures is Chris Briem over at Nullspace. On Wednesday he put up a post on “The Old Factor” here in Pittsburgh, referencing analysis done by Harold Miller at Center for Healthcare Quality and Payment Reform for a contribution to the Sunday Post-Gazette by Steve Twedt: “Pittsburgh hospitals’ care costs are highest in country.”
Chris embedded a Dartmouth Atlas map on the high costs of care for Medicare beneficiaries and pointed out its similarities to a map of aging in the US, particularly one that emphasized concentrations of the 85+ population. To illustrate Pittsburgh’s relative standing among proportions of the “Older Old,” he created a bar chart of the 40 largest metro areas showing the percentage of 65+ who are 85 and over.
At 16%, Pittsburgh trails only Providence. With Medicare costs concentrated at the end of life, it makes sense that our region would have higher Medicare costs. There’s an age effect in our high hospital costs to be sure.
But as the PG story notes, there’s also a practice effect in Pittsburgh:
with more than 90 per 1,000 Medicare enrollees being admitted for conditions that should not have required hospitalization, while places such as Denver, Portland and Seattle had just over 40 per 1,000 enrollees.
In Portland and Seattle, about 15% of their 65+ populations are the 85+ Older Old.
So there’s just no denying that Pittsburgh can and should be doing more to help elders from being unnecessarily readmitted to the hospital.
Again from the Dartmouth Atlas, here’s how we look on one measure of readmissions nationally:
What does all this mean for health care costs in the region going forward, particularly in the context of the demographic shifts underway here? And with our high costs of care and national efforts to bend the cost curve, how will our Eds & Meds jobs engine continue into the future?
As Chris has pointed out multiple times, Pittsburgh has now reached Peak Old with our overall 65+ population, and within a few years we will do so with our 85+ population. Pittsburgh will get younger as most all other regions of the US get older. Our early Peak Old experience is due in part to the felt absence of the Pittsburgh Diaspora and the last scenes of our Greatest-Generation’s long goodbye. Also some modest in-migration of the younger set (yay!)
So, what will we have learned from our Peak Old experience? Anything at all worth exporting? With our high readmission rates and high costs of care, one might be skeptical that Pittsburgh has much of anything to offer on the subject.
Oddly enough, our region can boast (in our not putting on airs way) some of the most informative and promising interventions aimed at preventing hospital readmissions, along with innovative models for how to make it all go smoothly in the context of payment reform. It’s work done in recent years by local providers and the Pittsburgh Regional Health Initiative (PRHI), and extended more recently via the CHQPR.
Now, if we could just get the entire health care community in the Pittsburgh region (hospitals, physicians, insurance companies, nursing homes, home care agencies, and the rest of us as informed consumers) to reflect on Harold Miller’s presentation at the National Medicare Readmissions Summit in June 2010 or his presentation to the Oregon Health Care Quality Corporation on October 4, 2011 (in 4 parts on YouTube), we might get finally somewhere in lowering our hospital readmission rates here in Pittsburgh.
In particular, watch Part 4 of Harold Miller’s presentation in Oregon where he talks about the idea of providers offering a warranty for readmissions. It’s a Win-Win-Win…
Or just read through this presentation (.pdf) on Successfully Using Payment Reform to Help Reduce Hospital Readmissions. It’s all about marrying the Medical Home initiatives with payment reform and collaborative efforts among hospitals and post-acute providers to reduce readmissions.
It’s going to take some wise leadership in the local health care community, but we have plenty of age-independent room for improvement in our practice patterns here.
It’s time we work together to transition to a future less dependent on the revolving door at the hospital.