Self-reported functional impairment and frailty improve the prediction of healthcare expenditures

1. In this retrospective cohort study, the inclusion of functional impairment and phenotypic frailty more accurately predicted healthcare costs in Medicare patients than claims-based indicators alone.

2. A greater number of self-reported functional impairments were associated with more significant incremental costs compared to those without functional impairments.

Evidence Rating Level: 3 (Average)

Study Rundown: Older adults account for a disproportionate amount of healthcare expenditure. Existing predictive models of healthcare costs are composed of claims-based indicators of the number of complex chronic medical conditions, which may fail to account for differences in patient characteristics. In this retrospective study of Medicare fee-for-service patients, 49.1% of women and 31.9% of men reported at least one functional impairment, and 34.3% of women and 19.1% of men met the phenotypic definition of frailty. Individuals with more significant functional impairment or greater frailty had higher Centers for Medicare & Medicaid Services Hierarchical Condition Category (CMS-HCC) scores, a greater burden of chronic medical conditions, higher claims-based frailty index, and higher subsequent health care costs during the 36-month follow-up period. Adding functional impairments or the frailty phenotype to the claims-based models predicted additional costs not captured by claims-derived measures alone. This study is limited in generalizability as the patients examined were all community-dwelling patients that may represent a potentially higher functioning group at baseline and may not capture all of the associated costs of older patients living precariously or in institutions with high levels of support.

Click to read the study in AIM

Relevant Reading: Concentration of potentially preventable spending among high-cost medicare subpopulations

In-Depth [retrospective cohort]: This retrospective cohort study examined whether self-reported functional impairments and phenotypic frailty were associated with increased healthcare costs after accounting for claims-based multimorbidity measures. Community-dwelling older adults underwent an index examination assessment of self-reported functional status and frailty phenotype. All participants were enrolled in Medicare fee-for-service programs from 12 months before the index examination until 36 months after. A total cohort of 4,318 women and 3,847 men were included in the analyses. Mean unadjusted costs were higher among individuals with versus without functional impairment. For women and men with three or four functional impairments, the costs were $26,142 and $32,964, respectively. For women and men without functional impairments, the costs were $8,408 and $10,427, respectively. The average marginal cost increase in women was $5,825 (95% Confidence Interval [CI], $4,585 to $7,066) per one standard deviation (SD) increment in the log-transformed CMS-HCC score. The average incremental costs for women with versus without functional impairments ranged from $2,632 to $6,065. Similarly, the average incremental costs for men with versus without functional impairment ranged from $2,093 to $9,627. The estimated total costs after adjustment for claims-based indicators varied by the number of functional impairments and frailty categories. The total cost for robust women without impairment was $8,124, and for robust men without impairment was $11,831. In summary, models that included functional impairments and the frailty phenotype resulted in more accurate cost prediction with an improvement and variability in cost.

Image: PD

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