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From Health Law Daily, March 29, 2013

CMS provides data on care for chronic conditions to help find better care models

By Jay Nawrocki, MA

CMS has released a new tool that will help researchers, physicians, public health professionals, and policy makers compare data on how beneficiaries with multiple chronic conditions (MCCs) are treated across the country, by demographics, by services provided and by money spent. The Chronic Conditions Dashboard will allow users to customize the data and generate reports to a high level of specificity. CMS states that analyzing this data as an important step in transforming Medicare from a fee-for-service based payer to a value-based purchaser of care that links payments to quality and efficiency rather than to sheer volume of services.

Chronic conditions. CMS defines a chronic condition as one that lasts a year or more and requires ongoing medical attention or limits activities of daily living. CMS' Chronic Conditions Dashboard tracks 15 conditions (the number in parenthesis following the condition is the percentage of Medicare beneficiaries who had the condition in 2010): high blood pressure (58 percent); high cholesterol (45 percent); ischemic heart disease (31 percent); arthritis (29 percent); diabetes (28 percent); heart failure (16 percent); chronic kidney disease (15 percent); depression (14 percent); COPD (12 percent); Alzheimer's disease (11 percent); atrial fibrillation (8 percent); cancer (8 percent); osteoporosis (7 percent); asthma (5 percent); and stroke (4 percent).

Cost impacts. Tracking chronic conditions and individuals with more than one chronic condition is important as 66 percent of total health care spending in the United States is associated with care for the individuals with multiple chronic conditions, according to CMS. In 2011, 93 percent of all Medicare spending, or $276 billion, was on beneficiaries with two or more chronic conditions. Using the dashboard to identify trends and issues in treating individuals with MCC will help lower the cost of providing care, and help these individuals receive better care.

In 2010, for example Medicare spent $100 billion on hospitalizations and 55 percent of this amount was spent on beneficiaries with 6 or more chronic conditions. In 2010, 10 percent of people admitted to a hospital needed post-acute care (PAC) services from a skilled nursing facility, a home health agency or other types of providers. Medicare spent $54.7 billion on these services. Beneficiaries with 6 or more chronic conditions accounted for 63 percent of these costs.

Readmissions. Beneficiaries with MCCs are the main cause of hospital readmissions. CMS' Chronic Conditions among Medicare Beneficiaries Chartbook for 2012 showed that beneficiaries with 2 or more chronic conditions accounted for 98 percent of the 1.9 million Medicare beneficiaries readmitted to a hospital within 30 of days of an inpatient discharge in 2010. The 14 percent of beneficiaries with 6 or more chronic conditions accounted for 70 percent of the readmissions.

Service utilization. Beneficiaries with MCCs used emergency room and home health services far more than beneficiaries without MCCs. CMS' 2010 Chartbook showed that 27 percent of beneficiaries with six or more chronic conditions had three or more emergency room visits in 2010 and 70 percent of these beneficiaries had at least one emergency room visit. The number of home health visits increased with the number of chronic conditions as well. In 2010, 3.1 million beneficiaries or 10 percent received at least one home health visit, but 27 percent of beneficiaries with 6 or more chronic conditions received 13 or more home health visits during that year.

Demographic variance. The percentage of an ethnic group or race that had MCCs did not vary. Roughly 30 percent of each race or ethnic group had no more than one chronic condition and roughly 15 percent of each race or ethnic group had six or more chronic conditions. Women, elderly and beneficiaries who were eligible for both Medicaid and Medicare were more likely to have MMCs then men, young beneficiaries and beneficiaries who were not enrolled in Medicaid.

Cost disparity. The cost of treating beneficiaries with MCCs is high. Medicare spent $140 billion of the $300 billion it spent in 2010 on beneficiaries with 6 or more chronic conditions. Medicare spent only 7 percent of the $300 billion in 2010 on beneficiaries with no more than one chronic condition. The average amount spent by Medicare on a beneficiary with 1 or no chronic conditions is $2,025 in 2010. The average amount spent on a beneficiary with 6 or more chronic conditions in 2010 was $32,658. This average spending amount jumped dramatically when a beneficiary had 6 or more chronic conditions. The average cost to Medicare for a beneficiary with 4 or 5 chronic conditions was $12,174.

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