Study: Caution needed in handling care for dual eligibles

"Some of the most successful programs work well because they are targeted to subgroups of dual-eligible beneficiaries who face similar challenges," the authors noted.

They cited the "Program of All-Inclusive Care for the Elderly," which is designed for people at risk of entering nursing homes.

"It has been successful in reducing hospitalization rates and preventing nursing home admissions for this population. However, enrollment is relatively low. ... It remains to be seen whether or how this model can be adapted to other beneficiaries with different needs and circumstances," the authors wrote.

The average cost of care for a dual eligible is five times higher than that of a regular Medicare beneficiary, according to the Kaiser Family Foundation. There are an estimated 9 million such patients in the Medicare system.

The report, produced by officials at the Kaiser Family Foundation, recommended caution "before assuming that ... savings will materialize" from better coordinating dual-eligible care.

"The expectation of achieving Medicare and Medicaid savings through reforms for the dual-eligible population was also raised in the context of the debt reduction debate," the study said.

"[But] even when programs reduce hospitalization rates, they often incur costs, such as for care coordination teams, that offset savings or ultimately increase total costs, or both."

Medical specialists recently pushed back against the implementation of one such initiative that was created by the 2010 healthcare law.

In a letter, the Alliance of Speciality Medicine asked the Centers for Medicare and Medicaid Services (CMS) for a one-year delay on the grounds that the current "direction and speed" of the project's implementation would jeopardize payments to medical professionals.

"While the goal of the program is to eliminate duplication of services for these patients," the group wrote, "we are deeply concerned about unintended consequences."

The concerns were not the first voiced by the medical community over the projects — in April, the president and CEO of the Federation of American Hospitals cautioned "against expediency" in their implementation.