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To the Editor The study on preventable acute care spending by Dr Joynt and colleagues1 had a number of limitations. The authors did not look specifically at end-of-life costs and the savings generated by a physician who keeps a patient out of the hospital through the appropriate provision of palliative or hospice services would not be counted.
For example, if a nonambulatory patient with dementia and living in a nursing home rolled out of bed and broke her hip but did not have surgery, this event would not count as a preventable ED admission according to the methods used in the study, even though nonoperative management may be the best approach.2
Young R. Preventable Acute Care Spending for Medicare Patients. JAMA. 2013;310(18):1984. doi:10.1001/jama.2013.278604