An analysis showed that 10% of high-cost Medicare patients accounted for 33% and 79% of emergency department and hospitalization costs between 2009 and 2010, respectively. The study found the main causes of inpatient spending for these patients were catastrophic events such as sepsis, stroke and heart attack, as well as cancer and orthopedic procedures such as spine surgery and hip replacement. Although improving outpatient chronic disease management is very important, it "may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients," researchers wrote in the Journal of the American Medical Association.

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