Jose F. Figueroa, MD, MPH; Karen E. Joynt Maddox, MD, MPH; Nancy Beaulieu, PhD; Robert C. Wild, MS, MPH; Ashish K. Jha, MD, MPH
Grant Support: By grant 20140227 (“Care Utilization and Spending Patterns for High-Cost Medicare Beneficiaries”) from The Commonwealth Fund.
Disclosures: Dr. Figueroa reports grants from The Commonwealth Fund during the conduct of the study. Mr. Wild reports that this work was funded and supported by The Commonwealth Fund. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0767.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available in the Appendix. Statistical code: Portions available on request. Please contact firstname.lastname@example.org with specific queries. Data set: Not available. Research-identifiable Medicare claims data are obtained and analyzed under a data-use agreement with the Centers for Medicare & Medicaid Services and can be shared only with its prior authorization.
Requests for Single Reprints: Ashish K. Jha, MD, MPH, 42 Church Street, Cambridge, MA 02138; e-mail, email@example.com.
Current Author Addresses: Drs. Figueroa and Jha: Harvard T.H. Chan School of Public Health, 42 Church Street, Cambridge, MA 02138.
Dr. Joynt Maddox: Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110.
Dr. Beaulieu and Mr. Wild: Harvard Medical School, 180 Longwood Avenue, Door A, Boston, MA 02115.
Author Contributions: Conception and design: J.F. Figueroa, K.E. Joynt Maddox, N. Beaulieu, A.K. Jha.
Analysis and interpretation of the data: J.F. Figueroa, K.E. Joynt Maddox, N. Beaulieu, R.C. Wild, A.K. Jha.
Drafting of the article: J.F. Figueroa, A.K. Jha.
Critical revision of the article for important intellectual content: J.F. Figueroa, K.E. Joynt Maddox, R.C. Wild, A.K. Jha.
Final approval of the article: J.F. Figueroa, K.E. Joynt Maddox, N. Beaulieu, R.C. Wild, A.K. Jha.
Obtaining of funding: K.E. Joynt Maddox, A.K. Jha.
Administrative, technical, or logistic support: J.F. Figueroa, A.K. Jha.
Collection and assembly of data: J.F. Figueroa, N. Beaulieu, R.C. Wild.
Little is known about whether potentially preventable spending is concentrated among a subset of high-cost Medicare beneficiaries.
To determine the proportion of total spending that is potentially preventable across distinct subpopulations of high-cost Medicare beneficiaries.
Beneficiaries in the highest 10% of total standardized individual spending were defined as “high-cost” patients, using a 20% sample of Medicare fee-for-service claims from 2012. The following 6 subpopulations were defined using a claims-based algorithm: nonelderly disabled, frail elderly, major complex chronic, minor complex chronic, simple chronic, and relatively healthy. Potentially preventable spending was calculated by summing costs for avoidable emergency department visits using the Billings algorithm plus inpatient and associated 30-day postacute costs for ambulatory care–sensitive conditions (ACSCs). The amount and proportion of potentially preventable spending were then compared across the high-cost subpopulations and by individual ACSCs.
6 112 450 Medicare beneficiaries.
Proportion of spending deemed potentially preventable.
In 2012, 4.8% of Medicare spending was potentially preventable, of which 73.8% was incurred by high-cost patients. Despite making up only 4% of the Medicare population, high-cost frail elderly persons accounted for 43.9% of total potentially preventable spending ($6593 per person). High-cost nonelderly disabled persons accounted for 14.8% of potentially preventable spending ($3421 per person) and the major complex chronic group for 11.2% ($3327 per person). Frail elderly persons accounted for most spending related to admissions for urinary tract infections, dehydration, heart failure, and bacterial pneumonia.
Potential misclassification in the identification of preventable spending and lack of detailed clinical data in administrative claims.
Potentially preventable spending varied across Medicare subpopulations, with the majority concentrated among frail elderly persons.
The Commonwealth Fund.
Jose F. Figueroa, Karen E. Joynt Maddox, Nancy Beaulieu, Robert C. Wild, Ashish K. Jha. Concentration of Potentially Preventable Spending Among High-Cost Medicare Subpopulations: An Observational Study. Ann Intern Med. 2017;167:706–713. doi: 10.7326/M17-0767
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Published: Ann Intern Med. 2017;167(10):706-713.
Published at www.annals.org on 17 October 2017
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