High-Cost Frail Adults Comprise 44% of Preventable Medicare Spending

A recent study published in the Annals of Internal Medicine found that although medically frail elderly persons comprise only four percent of the Medicare population, they account for 44% of Medicare spending. Researchers from the Harvard T.H. Chan School of Public Health further concluded that this degree of spending on this demographic may be preventable in many situations.

The Harvard study analyzed fee-for-service claims of over six million “high-cost” Medicare beneficiaries. Researchers used algorithms, as well as in-patient and related 30-day associated post-acute costs of ambulatory care-sensitive conditions to sum costs of avoidable emergency department visits by these individuals. Using this method of analysis, the team found that 4.8% of Medicare spending is potentially preventable, the vast majority (73.8%) of which is incurred by the high-cost frail elderly. Accordingly, only four percent of the Medicare population is elderly and frail, but yet they account for 43.9% of the potentially preventable spending, which is almost $6,600 per person. Potentially preventable spending included treatment for urinary tract infections, heart failure, dehydration, and bacterial pneumonia.

Up until this study, there had been little time and effort spent studying potentially preventable Medicare costs for this small but expensive group of Medicare beneficiaries. With this information in hand, they can work toward shifting away from high-cost care toward value-based care, primarily through prevention techniques and other avenues designed to eliminate unnecessary spending.

Developing a medical condition that leads to frailty in an older adult is only one of the many situations that skilled nursing care may be necessary. Unfortunately, residing in a nursing home all too often can lead to abuse or neglect by caregivers. If you or a loved one is seriously injured as a result of elder abuse, or your family has suffered the loss of a loved one due to negligence by nursing home or assisted living facility staff, you may be entitled to compensation. This inquiry involves determining which party or entity was at fault for the accident, acted negligently, or otherwise caused the incident that led to your injuries or your loved one’s death. At Boller & Vaughan, our Madison assisted living facility and nursing home elder abuse lawyers can help you with these determinations, and support you through any personal injury or wrongful death claims that you may have.