Author Affiliations: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Drs Kangovi and Long); Robert Wood Johnson Clinical Scholars Program (Drs Kangovi and Long), Office of the Provost (Dr Emanuel), and The Wharton School (Dr Emanuel), University of Pennsylvania, Philadelphia; and Division of General Internal Medicine (Drs Kangovi and Long) and Department of Medical Ethics and Health Policy (Dr Emanuel), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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
Kangovi S, Long JA, Emanuel E. Community Health Workers Combat Readmission. Arch Intern Med. 2012;172(22):1756–1757. doi:10.1001/2013.jamainternmed.82