Association Between Reported Homelessness and Inpatient Resource Use for Medicare Beneficiaries.

OBJECTIVE

Evaluate the association between reported homelessness and inpatient resource use among Medicare beneficiaries, and investigate variation therein.

DATA SOURCES AND STUDY

DESIGN

Cross-sectional study of 6.3 million 2022 Medicare inpatient claims from 3,200 U.S. hospitals, examining the association between homelessness and three outcomes: cost, length of stay (LOS), and non-intensive care days using multilevel models. Robustness checks were conducted on five cross-sectional clinical subgroups.

PRINCIPAL FINDINGS: Among Medicare inpatient discharges, 0.63% reported homelessness, with teaching hospitals reporting 0.67%, in contrast to 0.55% in non-teaching hospitals. Overall, homelessness is associated with $829 (p<.001) higher costs and 2.45 (p<.001) longer LOS, primarily days outside of intensive care. For some patient subpopulations, the homelessness-cost association was greater than the national $829 magnitude.

CONCLUSIONS

Reported homeless rates vary by hospital type and involve different hospital resources depending on hospital and patient type, including higher costs and longer inpatient hospital stays.