AHRQ Stats: Medicaid "Super-Utilizer" Patients

Among Medicaid patients younger than 65 in 2012, mood disorder was the most common diagnosis for “super-utilizers” — those with four or more hospital stays. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #190:Characteristics of Hospital Stays for Super-Utilizers by Payer, 2012.)

May 2015

Characteristics of Hospital Stays for Super-Utilizers by Payer, 2012

H. Joanna Jiang, Ph.D., Audrey J. Weiss, Ph.D., Marguerite L. Barrett, M.S., and Minya Sheng, M.S.

Highlights

For this Statistical Brief, super-utilizers were defined as privately insured patients with three or more hospital stays in 2012 or patients covered by Medicare or Medicaid with four or more stays in 2012.

The average all-cause 30-day readmission rate was four to eight times higher for super-utilizers than for other patients. Among patients aged 1-64 years, super-utilizers accounted for more than half of all 30-day readmissions.

For all payers, patients with multiple chronic conditions accounted for a greater share of stays among super-utilizers than among other hospitalized patients. For example, among the privately insured, patients with two or more chronic conditions constituted 60.2 percent of all stays for super-utilizers compared with 36.4 percent for other patients.

Super-utilizers were more likely to be admitted for medical conditions rather than surgical or other types of conditions. For example, among the privately insured, 65.1 percent of all stays for super-utilizers were admitted for medical conditions compared with 33.3 percent for other patients.

Common chronic and acute conditions, such as congestive heart failure and septicemia, were among the 10 most common principal diagnoses for hospitalized super-utilizers across all payers.