CMS's 21 Major Chronic Conditions-Perspectives on Cost & Utilization
Is the Per Capita Cost of Major Chronic Diseases Directly Related to the Frequency of ED and Inpatient Utilization?
Chronic conditions with a higher per capita cost do not typically have a higher ED and hospital (admission / readmission) use
Higher incidence of multiple comorbidities (5+) is associated with a higher per capita cost. This could explain the higher complexity of inpatient care and perhaps longer lengths of stay. On the other hand, higher ED visits & hospital inpatient use is closely associated with behavioral health conditions
There are four visible groups of chronic conditions- those with a High per capita cost, with a higher frequency of ED and hospital utilization, those with lower cost and utilization and those that are in the middle with cost and use
The bottom portion with conditions such as Hyperlipidemia, Hypertension, Diabetes are indicative (precursors) of the emerging array of other chronic conditions in the future. Autism Spectrum Disorders have a less likely chance of developing other chronic conditions per this data, however, ADHD, Anxiety, Seizures, and GI issues are commonly noted in these patients.
CMS's Definitions:
Chronic Condition Measures: The 21 chronic conditions are identified through Medicare administrative claims. A Medicare beneficiary is considered to have a chronic condition if the CMS administrative data have a claim indicating that the beneficiary received a service or treatment for the specific condition
Emergency department visits are presented as the number of visits per 1,000 beneficiaries. ED visits include visits where the beneficiary was released from the outpatient setting and where the beneficiary was admitted to an inpatient setting. Hospital readmissions are expressed as a percentage of all admissions. A 30-day readmission is defined as an admission to an acute care hospital for any cause within 30 days of discharge from an acute care hospital. Except when the patient died during the stay, each inpatient stay is classified as an index admission, a readmission, or both. Medicare spending includes total Medicare payments for all Medicare covered services in Parts A and B and is presented per beneficiary (i.e. per capita).
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