ACHE Trendwatch: Hot Spotting

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Cat VaskoAs a patient who desperately wants health care costs to come down, I can’t deny the appeal of the hot-spotting approach: targeting the most expensive patients, usually those with chronic disease, and intensively managing their conditions to lower their health care utilization. I share a risk pool with these people, and I’m tired of them driving up my costs to the point that I pay more money for two months of health insurance than is spent on my health care in a year. They need help – I say let’s give it to ‘em. So part of me is delighted to see hot spotting as a topic on people’s minds at this year’s ACHE Congress. Nate Kaufman brought it up Monday as one innovative approach hospitals should consider in the face of bundled payments/capitation, and I heard about it again Tuesday in a session featuring Dan Wolterman, the CEO of Memorial Hermann. MH has implemented a type of hot spotting program to bring down the costs of its substantial Medicaid patient base, and the results have been dramatic – MH now spends an average of $6,000 per high-utilization patient, about a third of what they were spending before. But I can’t help but wonder how much of those savings come from decreasing the utilization of imaging. If models like this take hold around the country, will there be a significant enough impact on utilization to impact revenue? Or would hot spotting do radiology a favor by weeding out unnecessary procedures on patients who, for the most part, couldn’t really pay for them anyway? What do you think?