Nearly 60% of Medicare beneficiary visits to emergency rooms and 25% of their hospital admissions are “potentially preventable” if patients receive better care at home or in outpatient settings.

The Medicare Payment Advisory Commission staff offered commission members that assessment at the advisory panel’s Oct. 5 meeting. Based on preliminary results of a staff study, the most common diagnosis for which ER visits could be prevented is upper respiratory infections and the most common diagnosis for preventable hospital admissions is congestive heart failure.

The central factor in lowering ER and hospital admission rates for both diagnoses is how well a community’s outpatient care system, including physicians’ offices and community health centers, perform, MedPAC principal policy analyst Nancy Ray told commissioners. Hospital admissions, for example, could be prevented if conditions such as asthma, diabetes or heart failure were better monitored by patients and their doctors, Ray said.

The study analyzed health services provided to 5 percent of all traditional Medicare program beneficiaries from 2006 to 2008.  It also looked at care provided to all Medicare beneficiaries in six markets: Boston, Phoenix, Miami, Minneapolis, Greenville, S.C., and Orange County, Calif.

Editor's note: For the preliminary results of the MedPAC study, see here.