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Comment & Response |

Preventable Acute Care Spending for Medicare Patients—Reply

Karen E. Joynt, MD, MPH1; Atul A. Gawande, MD, MPH1; Ashish K. Jha, MD, MPH1
[+] Author Affiliations
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
JAMA. 2013;310(18):1985. doi:10.1001/jama.2013.278607.
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In Reply Dr Young points out that we did not examine end-of-life care and suggests that we may have underestimated preventable spending. We agree that high-quality hospice or palliative care may reduce admissions at the end of life, including for conditions that are considered nonpreventable.

The frequency with which these costly inpatient services, such as hip replacement or major cardiac surgery, are occurring in people with advanced terminal illness is unknown. On the other hand, patients at the end of life may be sufficiently sick that their ED admission for typically preventable conditions, such as urinary tract infections, may actually be more difficult to avoid.

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November 13, 2013
Scott G. Weiner, MD, MPH; Peter B. Smulowitz, MD, MPH
1Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts
2Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA. 2013;310(18):1984-1985. doi:10.1001/jama.2013.278598.
November 13, 2013
Richard Young, MD
1Department of Family Medicine, JPS Hospital, Ft Worth, Texas
JAMA. 2013;310(18):1984. doi:10.1001/jama.2013.278604.
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