Hospitals and Superutilization

Abstract

A small percentage of patients consume most of the health services in the US. These cases of superutilization affect hospitals, but little is known about what it is, the impact on hospitals, or how hospitals can identify potential cases of superutilization. We conducted exploratory research using the Medical Expenditure Panel Survey (MEPS) datasets for 2019 to examine superutilization as it relates to hospitals. Using total charges for health services to identify superutilization, we found a surprising amount of superutilization was not related to hospital care. When superutilization did occur in hospitals, there was reduced reimbursement for care in superutilization as measured by the reimbursement relative to charges. Demographic variables had limited utility in predicting superutilization. Our demographic analysis suggested that there are potential cases of superutilization that are not accessing hospital care. Our analyses suggest that given the amount of care that cases of superutilization require, the decreased reimbursement for the high levels of care and the untapped potential of superutilization, hospitals should consider developing capabilities to manage these challenging cases.

Keywords: Superutilization; health care costs; health care spending; high utilization; hotspotting.