Chronic disease rising among seniors

CHRONIC CONDITIONS are becoming more common among the Medicare population. They are also contributing to a rise in the use of healthcare services.

According to a report by the American Hospital Assn. (AHA), four out of five seniors are affected by a chronic condition. In 2008, the Centers for Medicare and  Medicaid Services (CMS) also reported that two-thirds of all Medicare beneficiaries had at least two or more chronic conditions.

Life expectancy has risen steadily and is now at 78.2 years, according to the United Nations Dept. of Economic and Social Affairs. Caroline Steinberg, AHA vice president of trends analysis, says living longer translates to people having more chronic conditions.

“In past generations, patients who may have died of heart disease are now living with heart disease, or living into an older age and getting Parkinson’s or Alzheimer’s diseases,” she says. “People are living longer because we are able to better manage life with disease.”

MANAGING MULTIPLE CONDITIONS
According to CMS, 50% of Medicare recipients with stroke or heart failure have five or more chronic health conditions that need to be managed when they receive care on an inpatient or outpatient basis.

“Many more people are managing more than one chronic condition,” Steinberg says. “And that’s very costly for the healthcare system, adding complexity in terms of the number of physicians seen.”

For example, beneficiaries with comorbidities often have multiple physicians and medication regimens.

“That’s a real opportunity to better coordinate care across multiple specialty areas,” she says.

Preventive therapies can assist with disease reversal, such as exercise programs and weight management. Hospitals are also working to manage care better and prevent hospital readmissions, she says.

“Keeping people out of the hospital in the first place is where things need to improve,” Steinberg says. “By getting to patients early on, their illness can be managed so they never end up with an emergency or hospital visit. Right now, the system isn’t really set up to do that.”

According to Steinberg, the Medicare Severity-adjusted Diagnostic Related Groups (MS-DRG) system, introduced in fiscal year 2008, has greatly improved the measurement of acuity for inpatient care. Unfortunately, CMS is not using it for purposes of payment.

“They’ve made it budget neutral,” she says. “It helps to assess the acuity of patients, but it hasn’t resulted in fair payment for the fact that patients are getting sicker.”

Steinberg recommends management in the outpatient setting so patients don’t develop acute manifestations of their diseases that lead them to an inpatient setting.

“The idea is to focus on management of chronic disease and management of care across the continuum,” Steinberg says.