With the increasing costs of a growing Medicare population and of an American population that is living longer but with more chronic disease, the U.S. healthcare system needs to utilize better care coordination and payment reform to keep costs down, according to a report from the American Hospital Association (AHA).
"Our perspective is that it needs to be recognized that sicker patients require more resources and hospitals are getting their Medicare benefits cut," said Caroline Steinberg, vice president of trends and analysis at the AHA.
Baby boomers are reaching the Medicare eligibility age of 65 at the rate of 10,000 per day and about four out of five seniors are affected by a chronic condition, such as heart disease and cancer, hypertension, stroke and diabetes, the report noted. The number of older Americans living with multiple chronic conditions has also grown. In 2008, two-thirds of all Medicare beneficiaries had at least two or more chronic conditions.
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"The most prominent point coming out of the report is that Medicare patients are getting sicker. This is driven in large part by sedentary lifestyle issues and the growing obesity numbers," said Steinberg. "It's important to understand, too, that people are living longer in large part due to medical technology. People are living longer with chronic conditions that have to be managed, and older people are developing more diseases we hadn't seen in such large numbers before, like Alzheimer's and other forms of dementia – the diseases we often affiliate with very old age."
According to the report, it's the rising prevalence of obesity in the U.S. that puts many Americans at a higher risk for conditions like heart disease, hypertension and diabetes. The report noted that the prevalence of obesity among Medicare beneficiaries has doubled since 1987 with 38 percent of people age 65 and over obese in 2009 and 2010. Meanwhile, the rate of diabetes among those age 65 and older has grown as well – from 18 percent in 2002 to nearly 27 percent in 2010.
The older and sicker Medicare population is using increased amounts of healthcare services, said the report, which includes both inpatient and outpatient care. In general, overall healthcare spending for a person with one chronic condition is almost three times greater than spending for someone without any chronic conditions and spending is about 17 times greater for someone with five or more chronic conditions. In addition, the older Americans get, the higher spending becomes. In 2008, healthcare per capita expenditures were $7,626 for beneficiaries age 65 to 74 compared to $13,219 for those age 85 and older.
"On a national scale, we really do have to do more in terms of prevention so that we are reducing obesity levels at younger ages and we are being more proactive in terms of managing diseases like diabetes and hypertension so that these conditions are better managed in an outpatient setting," said Steinberg. "For those that do end up in the hospital, we need to make sure that the care they receive is coordinated with follow-up care across the continuum."
[See also: AHA leaders say healthcare reform needs fixes]