Harvard School of Public Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (J.F.F., A.K.J.).
Harvard School of Public Health, Boston, Massachusetts (Z.L.).
Ann Intern Med. 2018 Oct 16;169(8):528-534. doi: 10.7326/M18-0085. Epub 2018 Oct 2.
Little is known about the persistence of high-cost status among dual-eligible Medicare and Medicaid beneficiaries, who account for a substantial proportion of expenditures in both programs.
To determine what proportion of this population has persistently high costs.
Observational study.
Medicare-Medicaid Linked Enrollee Analytic Data Source data for 2008 to 2010.
1 928 340 dual-eligible Medicare and Medicaid beneficiaries who were alive all 3 years.
Medicare and Medicaid payments for these beneficiaries were calculated for each year. Beneficiaries were categorized as high-cost for a given year if their spending was in the top 10% for that year. Differences in spending were then examined for those who were persistently high-cost (all 3 years) versus those who were transiently high-cost (2008 but not 2009 or 2010) and those who were non-high-cost in all 3 years.
In the first year, 192 835 patients were high-cost. More than half (54.8%) remained high-cost across all 3 years. These patients were younger than transiently high-cost patients, with fewer medical comorbidities and greater intellectual impairment. Persistently high-cost patients spent $161 224 per year compared with $86 333 per year for transiently high-cost patients and $22 352 per year for non-high-cost patients. Most of the spending among persistently high-cost patients (68.8%) was related to long-term care, and very little (<1%) was related to potentially preventable hospitalizations for ambulatory care-sensitive conditions.
Potential misclassification of preventable spending and lack of detailed clinical data in administrative claims.
A substantial majority of high-cost dual-eligible beneficiaries had persistently high costs over 3 years, with most of the cost related to long-term care and very little related to potentially preventable hospitalizations.
Peterson Center on Healthcare.
在医疗保险和医疗补助双重资格的受益人中，高成本状态的持续时间知之甚少，他们在这两个项目中都占了相当大的支出比例。
确定该人群中有多少人持续存在高成本。
观察性研究。
2008 年至 2010 年医疗保险-医疗补助联合参保人分析数据来源。
1928340 名医疗保险和医疗补助双重资格的受益人，他们在这 3 年中都存活。
计算了这些受益人的医疗保险和医疗补助支付情况，每年都要计算。如果当年的支出处于前 10%，则当年该受益人被归类为高成本。然后，比较了那些持续高成本（所有 3 年）与那些暂时高成本（2008 年但 2009 年或 2010 年没有）和所有 3 年都非高成本的受益人之间的支出差异。
在第一年，有 192835 名患者是高成本。超过一半（54.8%）的人在所有 3 年中一直保持高成本。这些患者比暂时高成本患者年轻，合并症较少，智力障碍程度较大。持续高成本患者每年花费 161224 美元，而暂时高成本患者每年花费 86333 美元，非高成本患者每年花费 22352 美元。持续高成本患者的大部分支出（68.8%）与长期护理有关，很少（<1%）与可能可预防的门诊护理敏感条件相关的住院治疗有关。
行政索赔中潜在的可预防支出分类不当和缺乏详细的临床数据。
在 3 年中，大多数高成本的医疗保险和医疗补助双重资格受益人持续存在高成本，其中大部分与长期护理有关，与潜在可预防的住院治疗相关的成本很少。
彼得森医疗保健中心。
