Are Medicare Patients Getting
Sicker?
December 2012
Research and analysis by
Avalere Health
More seniors are obese, leading to a host of other
chronic health problems.
Chart 1: Percentage of Seniors Who Are Obese, 1988 – 1994 and 2009 – 2010
45%
43%
27%
30%
27%
24%
1988 - 1994
19%
13%
65 - 74
75 and older
Men
65 - 74
75 and older
Women
Source: National Institutes of Health. (2012). Older Americans 2012: Key Indicators of Well-being.
Research and analysis by Avalere Health
2009 - 2010
Chronic disease rates are rising in the Medicare
population.
Chart 2: Rates of Chronic Conditions Among Medicare Beneficiaries,* 2000 – 2009
30%
Diabetes
25%
Rheumatoid Arthritis /
Osteoarthritis
20%
Depression
Chronic Kidney Disease
15%
10%
5%
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
* Includes
random 5% sample of Medicare beneficiaries.
Source: CMS Chronic Condition Data Warehouse Medicare 5% Sample. Medicare Beneficiary Prevalence for
Chronic Conditions for 2000 Through 2009.
http://www.ccwdata.org/cs/groups/public/documents/document/wls_ucm1-000774.pdf.
Research and analysis by Avalere Health
The occurrence rate of ESRD, one of the highest
cost conditions for Medicare, is ballooning.
Chart 3: Medicare Beneficiaries with End-stage Renal Disease, 1980 – 2010
600,000
Medicare Beneficiaries
500,000
400,000
300,000
200,000
100,000
0
1980
1985
1990
1995
2000
2005
2010
Source: United States Renal Data System. 2012 Reference Tables.
Research and analysis by Avalere Health
More seniors are living with two or more chronic
conditions.
Chart 4: Percentage of Seniors* with Two or More Chronic Conditions, 1999 – 2000
and 2009 – 2010
49%
45%
43%
39%
37%
36%
1999-2000
2009-2010
Total
Men
Women
* Seniors are defined as individuals age 65 and older.
Source: Freid, V., et al. (July 2012). Multiple Chronic Conditions Among Adults Aged 45 and Over: Trends Over
the Past 10 Years.
Research and analysis by Avalere Health
People with multiple chronic conditions use more
health care resources.
Chart 5: Average Yearly Per Capita Health Spending for Individuals with Chronic
Conditions, 2006
Average Per Capita Health Spending
$16,000
$14,000
$12,000
$10,000
$8,000
$6,000
$4,000
$2,000
$0
0
1
2
3
Number of Chronic Conditions
4
5+
Source: Anderson, G. (2010). Chronic Care: Making the Case for Ongoing Care. Johns Hopkins
University and the Robert Wood Johnson Foundation.
Research and analysis by Avalere Health
Costs of each episode of care rise with the number
of a beneficiary's chronic conditions.
Chart 6: Average Medicare Episode Payment by Number of Chronic Conditions
for Major Joint Procedure Without Major Complication* for 30-day, Fixed-length
Episodes, 2007 – 2009
$28,000
$26,000
$24,000
$22,000
$20,000
$18,000
$16,000
$14,000
$12,000
$10,000
0
1
2
3
4
5
6
7
Number of Chronic Conditions
8
* MS-DRG 470.
Source: Dobson | DaVanzo (October 2012). Medicare Payment Bundling: Insights from Claims Data and
Policy Implications.
9
Research and analysis by Avalere Health
10+
Overall health care spending rises with age.
Chart 7: Distribution of Average Health Care Spending* Per Person by Age, 2009
$9,744
$5,511
$2,739
$1,695
$1,834
5-17
18-24
25-44
45-64
65+
Age
*Health care spending includes total payments from all sources (including direct payments from individuals
and families, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals,
physicians, other providers (including dental care), and pharmacies; health insurance premiums are not
included.
Research and analysis by Avalere Health
Source: Kaiser Family Foundation. (May 2012). Health Care Costs: A Primer.
Medicare patients with complex care needs are
making up a greater proportion of inpatient visits.
Chart 8: Proportion of Inpatient Visits for Disabled and Dual-eligible* Medicare
Beneficiaries,** 2006 – 2010
32%
31%
30%
Disabled
29%
Dual-eligible
28%
27%
26%
2006
2007
2008
2009
2010
*Individuals eligible for both Medicare and Medicaid.
** Based on random 5% sample of Medicare beneficiaries.
Source: Avalere Health analysis of Medicare National Claims History Standard Analytical Files.
Research and analysis by Avalere Health
All of these trends are contributing to rising acuity
levels in the inpatient setting…
Chart 9: Health Risk Scores* for Admitted Patients, 2006 – 2010
3.30
3.25
3.20
3.15
3.10
3.05
3.00
2.95
2.90
2.85
2.80
2006
2007
2008
2009
2010
*Hierarchical Condition Category Scores is a measure used by CMS for risk-adjustment in the Medicare
Advantage program.
Source: The Moran Company Analysis of Medicare 5% Standard Analytic Files for 2006-2010.
Research and analysis by Avalere Health
…as evidenced by greater use of costly resources
such as intensive care units.
Chart 10: Percent of Medicare Discharges Involving Intensive Care, FY 2000 – 2011
Percent of Discharges
30%
25%
20%
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: The Moran Company. (2010). Issues in Measuring Documentation and Codling Change.
Paper presented to the American Hospital Association, Federation of American Hospitals, and
Association of American Medical Colleges. Updated data for 2010 and 2011 provided by the Moran
Company.
2009
2010
Research and analysis by Avalere Health
2011