Nearly half of potentially preventable Medicare spending focused on frail elderly patients

1. High-cost frail elderly persons account for almost half of the potentially preventable Medicare spending.

2. The greatest amount of spending related to admissions for urinary tract infections, dehydration, heart failure, and bacterial pneumonia was directed towards frail elderly patients.

Evidence Rating Level: 2 (Good)

Study Rundown: There are few studies regarding the potentially preventable Medicare spending among Medicare beneficiaries. The authors of this study aimed to determine the proportion of total spending that is potentially preventable when assessing different subpopulations of high-cost Medicare beneficiaries. In general, it was found that nearly half of potentially preventable Medicare spending was focused on frail elderly patients. This study has several limitations. First, the study was limited to a 30-day time frame; however, it is possible for preventable spending to extend beyond this window of time. Additionally, the estimation of chronic disease may be underestimated in this study as claims data was used to make this assessment. Overall, the results of the study suggest that frail elderly persons are likely to incur costs that could be modifiable.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: Contribution of Preventable Acute Care Spending to Total Spending for High-Cost Medicare Patients

In-Depth [retrospective cohort]: The authors assessed 6 112 450 Medicare beneficiaries in this study. Specifically, they obtained claims from 2011 and 2012. Costs were calculated using the Centers for Medicare and Medicaid Services methodology, with an emphasis on standardized costs. “High-cost” patients were characterized as those in the highest 10% of spending in 2012. It was found that in 2012, 4.8% of Medicare spending was potentially preventable. Of this number, 73.8% was due to high-cost patients. High-cost frail elderly persons incurred a total of $6593 per person, or 43.9% of total potentially preventable spending money. Finally, the major complex chronic subgroup of Medicare beneficiaries incurred $3327 per person, or a total of 11.2% of potentially preventable spending.

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