The effect of geriatric evaluation and management on Medicare reimbursement in a large public hospital: a randomized clinical trial.

Objective: To study the effect of a geriatric evaluation and management program on health care charges and Medicare reimbursement.

Design: Prospective randomized controlled trial during a 1-year study period.

Setting: Large medical school-affiliated public hospital in an urban community.

Subjects: Patients at least 70 years old admitted to the medicine service were screened and randomized into two groups of 100 patients each.

Intervention: Patients randomized to the experimental group underwent initial comprehensive geriatric evaluation and once discharged from the hospital were enrolled in a geriatric care management and treatment program. The control group received usual care only. The major intervention of this study was in outpatient long-term care.

Main Outcome Measure: Total charges for services billed to Medicare Part A and Part B and total Medicare reimbursement. The Medicare charge and reimbursement data were obtained by use of the Medicare Automated Data Retrieval System, a linked Medicare Part A and Part B utilization file.

Results: Total charges and reimbursement were greater for the control group but not significantly so. Subset analysis revealed significantly greater inpatient charges (P < 0.03) and Medicare reimbursement (P < 0.005) for the control patients and a greater likelihood of utilization of home health care services in the experimental group (P < 0.01).

Conclusion: A geriatric evaluation and management program appeared to shift utilization and Medicare expenditures from inpatient services to home health care services. There was no evidence that the experimental program resulted in increased expenditures for Medicare. In selected populations, geriatric evaluation and management programs may contribute to cost containment.