Mr Alberts is the classic “frequent flyer.” At age 60 years, he has chronic obstructive pulmonary disorder, anxiety, and chronic pulmonary emboli. Formerly a computer network engineer, he has been unemployed since 2010. He was admitted to the hospital 4 times within the first 6 months of 2011. His cumulative charges to Medicaid were $82 952—substantially higher than the nation's median income and 8 times Mr Alberts's income.
Each year, 24.6 million Americans are hospitalized.1 Over 14% of all patients2 and nearly 20% of Medicare patients3 are readmitted within 30 days of a prior hospitalization. In 2004, unplanned readmissions cost $17.4 billion to Medicare alone. Low-income African American patients like Mr Alberts are up to 43% more likely than their higher-income white counterparts to find themselves back in the hospital within weeks of discharge.4,5 As a result, the cost of care for these disadvantaged patients is high, as illustrated by the population of low-income patients who are dually eligible for Medicare and Medicaid. Dually eligible individuals cost twice as much as other Medicare beneficiaries largely because they are 4 times as likely to be readmitted to hospitals for ambulatory care–sensitive conditions.6
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