Potentially Avoidable Hospitalizations Among Medicare and Dual Eligible Enrollees

Medicare spent $192 billion annually on inpatient hospitalizations from 2017 to 2020. Of those hospitalizations, almost 20 percent were potentially avoidable hospitalizations that could have been prevented or treated outside of an inpatient hospital setting. Reducing the occurrence of potentially avoidable hospitalizations (PAHs) would improve patient outcomes and reduce cost to the Medicare program.

BRG analysts explored PAH incidence and cost for the time period from 2017 to 2020, segmenting by Medicare program (Medicare Advantage or fee for service), dual status, various health conditions, locations in both the institutional and community setting, and other demographic factors.

• Introduction and Methodology
• Summary
• Full and Non-Dual Eligibles
• PAHs by Site of Care
• PAHs in FFS and MA
• PAHs by Enrollee Race
• PAHs by State

This research project was funded by Arnold Ventures.