Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries

There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers. To evaluate th...

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Bibliographic Details
Published in:JAMA network open 2021-03, Vol.4 (3), p.e2037334-e2037334
Main Authors: Hwang, Ula, Dresden, Scott M, Vargas-Torres, Carmen, Kang, Raymond, Garrido, Melissa M, Loo, George, Sze, Jeremy, Cruz, Daniel, Richardson, Lynne D, Adams, James, Aldeen, Amer, Baumlin, Kevin M, Courtney, D Mark, Gravenor, Stephanie, Grudzen, Corita R, Nimo, Gloria, Zhu, Carolyn W
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Beneficiaries
Cost control
Cost Savings
Cross-Sectional Studies
Emergency Medical Services
Emergency Medicine
Emergency Service, Hospital - economics
Expenditures
Fee-for-Service Plans
Geriatric Assessment
Geriatrics
Health Services for the Aged - economics
Hospital Costs
Hospitals
Humans
Medicare
Online Only
Original Investigation
Patient Care - economics
Referral and Consultation - economics
Social Work - economics
Transitional Care - economics
United States
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Summary:There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers. To evaluate the association of GED programs with Medicare costs per beneficiary. This cross-sectional study included data on Medicare fee-for-service beneficiaries at 2 hospitals implementing Geriatric Emergency Department Innovations in Care Through Workforce, Informatics, and Structural Enhancement (GEDI WISE) (Mount Sinai Medical Center [MSMC] and Northwestern Memorial Hospital [NMH]) from January 1, 2013, to November 30, 2016. Analyses were conducted and refined from August 28, 2018, to November 20, 2020, using entropy balance to account for observed differences between the treatment and comparison groups. Treatment included consultation with a transitional care nurse (TCN) or a social worker (SW) trained for the GEDI WISE program at a beneficiary's first ED visit (index ED visit). The comparison group included beneficiaries who were never seen by either a TCN or an SW during the study period. The main outcome evaluated was prorated total Medicare payer expenditures per beneficiary over 30 and 60 days after the index ED visit encounter. Of the total 24 839 unique Medicare beneficiaries, 4041 were seen across the 2 EDs; 1947 (17.4%) at MSMC and 2094 (15.4%) at the NMH received treatment from either a GED TCN and/or a GED SW. The mean (SD) age of beneficiaries at MSMC was 78.8 (8.5) years and at NMH was 76.4 (7.7) years. Most patients at both hospitals were female (6821 [60.8%] at MSMC and 8023 [58.9%] at NMH) and White (7729 [68.9%] at MSMC and 9984 [73.3%] at NMH). Treatment was associated with statistically significant mean savings per beneficiary of $2436 (95% CI, $1760-$3111; P 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2020.37334