Almost a third of all hospitalizations now treat diabetic patients, and cost more than average. Diabetic admissions may be a problem that regulators, ACOs and prevention-minded providers need to start solving for the long-term.
In California, one in three hospital stays in 2011 were for diabetic patients, according to a study by Ying-Ying Meng and colleagues at the UCLA Center for Health Policy Research. Those hospitalizations cost on average $2,220 more than patients without diabetes, regardless of the conditions for admission, Ying-Ying found.
There were 2.4 million hospitalizations in California in 2011, and based on discharge data from the Office of Statewide Health Planning and Development, Meng and colleagues found that 31 percent — about 729,000 — of those adults admitted that year over 35-years-old were diagnosed diabetics.
Although diabetes is not usually the primary driver of a patient’s hospitalization — representing just under 2 percent in California — it “may exacerbate other conditions” and lead to hospitalizations that could be prevented, Meng and colleagues write.
Not including one of California’s largest health systems, Kaiser Permanente, hospitalizations for diabetics accounted for $11.6 of statewide hospital charges in 2011, more than 20 percent of the total, Meng and colleagues found. The average cost of a hospital visit for a patient with diabetes was around $18,700 — compared to an average of $16,500 for non-diabetic inpatients.
The majority of those hospitalizations for diabetic patients were covered by public payers — 60 percent by Medicare and 16 percent by Medicaid — and 57 percent were ages 65 and older.
Profound impact on costs
The findings are a sign of the diabetes epidemic taking its toll, the authors argue, and portend the possibility of more serious illness to come across populations, with diabetes raising the risk of heart attack, stroke and kidney failure, as well as blindness, neuropathy and amputation.
“The profound burden of diabetes among the hospitalized population in California suggests that more effort is needed to address the incidence and prevalence,” Meng and colleagues write.
Some 19 million Americans, or 8.3 percent of the population, are now diagnosed with diabetes, a rate that’s tripled over the last three decades. Perhaps 7 million Americans may be living with undiagnosed diabetes and as many as 79 million are estimated to have prediabetes, according to the American Diabetes Association.
“At-risk individuals need to have adequate and sufficient access to quality primary and specialty care services,” and they also need better ways to get physical activity — along with diet one of the best ways to treat and prevent diabetes — Meng and colleagues argue.
Providers need to focus on early detection and set up comprehensive treatment programs that address diet and exercise, and should “remove sugary drinks from healthcare facilities,” they argue, while payers should be sure to reimburse for pre-diabetes and diabetes prevention and treatment, especially for self-management education.
And all large health organization should consider dedicating “a substantial proportion of community benefits funds to building healthy communities,” they write. One place to start might be setting an example with the healthcare workforce, making that staff can use “active transportation,” as Kaiser Permanente thought leaders say, to get to and from work by bike, sidewalks or mass transit.
“Lack of physical activity is a significant risk factor for diabetes and obesity, and further policies should be developed to facilitate active living—for example, creating safe environments for walking and biking, providing access to safe parks and other places for recreation and physical activity, and offering worksite programs to facilitate regular physical activity for adults of all ages,” Meng and colleagues write.
With diabetes epidemic and related obesity epidemic now coming to the fore and also plaguing younger generations, preventive strategies implemented now, both in clinical and community programs, will have a long-term ROI that should outlive fee-for-service reimbursement. Hospitalizations associated with diabetic complications are already being targeted as preventable and thus wasteful spending by accountable care initiatives.