Hospitalization, death, cost drop among older Medicare beneficiaries

Between 1999 and 2013, Medicare fee-for-service beneficiaries aged 65 years and older had lower rates of mortality and hospitalization, as well as lower expenditures associated with their care, according to recently published data in JAMA.

Researchers analyzed data from Medicare denominator and inpatient files to assess patterns in national mortality, hospitalizations and costs among Medicare beneficiaries, aged 64 years and older, between 1999 and 2013. In total, 68,374,904 participants — either Medicare fee-for-service or Medicare Advantage beneficiaries — were included in the study.

Results demonstrated that among Medicare beneficiaries, all-cause mortality dropped 0.85 percentage points, from 5.3% in 1990 to 4.45% in 2013.

A decline in the total number of hospitalizations — from 35,274 to 26,930 — was seen among fee-for-service beneficiaries between 1999 and 2013 (difference, 8,344; 95% CI, 8,315-8,374).

After adjusting for inflation, a mean decline of $489 per fee-for service patient for inpatient expenditures was seen from 1999 to 2013.

Overall, there was a decline from 1999 to 2013 in the use of inpatient care during fee-for-service beneficiaries’ last 6 months of life, including less hospitalizations and fewer days in inpatient care.

The researchers noted that between 1999 and 2009, an increase of $2,111 per patient for inpatient expenditure ($15,312 in 1999 to $17,423 in 2009) was seen. However, by 2013, a decrease of $4,035 per patient for inpatient expenditures ($17,423 in 2009 to $13,388 in 2013) was seen.

“Even though it is difficult to disentangle the specific reasons for improvement, it is clear that over the past 15 years there have been marked reductions in mortality, hospitalization, and adverse hospital outcomes among the Medicare population aged 65 years or older,” the researchers wrote. – by Casey Hower

Disclosure: Krumholz reports having research agreements with Medtronic and Johnson & Johnson and acting as chair of a cardiac scientific advisory board for UnitedHealth. Please see the full study for a list of all other researchers’ relevant financial disclosures.