One of the most significant reasons for the high cost of health care in the Pittsburgh area is the high rate of expensive hospitalizations for what are called "ambulatory care sensitive" conditions. That's according to Harold D. Miller, professor of public policy and management at Carnegie Mellon University, and president of Future Strategies LLC, a management and policy consulting firm based in Pittsburgh."Ambulatory care sensitive" (ACS) conditions are chronic diseases like congestive heart failure, pneumonia, and COPD which typically do not require expensive and resource-draining hospitalization if the right kind of low cost health care is being provided in the community.According to Mr. Miller, in 2005, among Medicare enrollees, Pittsburgh had the third highest rate of hospitalizations for ACS conditions among the top 40 regions in the country. In other words, community medical providers in the Pittsburgh area are doing a bad job -- relative to almost every other region in the country -- of preventing the preventable hospitalizations of patients with ACS conditions. For example, in 2005 Pittsburghers with congestive heart failure were hospitalized more than twice as often as in Denver, Minneapolis, San Diego, Seattle, and Portland, OR.Mr. Miller suggests that hospital ACS condition admission rates can be reduced significantly through simple and inexpensive improvements in primary care, including better education for patients on how to manage their ACS condition; and more frequent health care provider contact with patients suffering from an ACS condition to identify and treat health problems before they get worse and require hospitalization.