Despite a rise in obesity and complex conditions such as end-stage renal disease in recent years, patients are living longer due to advances in medicine and improved use of health care services, which is creating an older and sicker population requiring hospitalization, a report concluded.
The American Hospital Association is making the case in a white paper that noted the potential for what could become a more complex population requiring more care for more chronic diseases.
The paper examined disease and population trends found in the medical literature and put them in the context of how reimbursement changed under the Medicare Severity-adjusted Diagnostic Related Groups (MS-DRGs) that were implemented in 2008 to account for these changes.
The AHA makes the case that in 2008, two-thirds of all Medicare beneficiaries had at least two or more chronic conditions, a factor that rises along with the increasingly aging population.
For example, obesity among Medicare beneficiaries has doubled since 1987, right along with accompanying diseases such as diabetes. Another examples is end-stage renal disease, which grew by more than half
Meanwhile, longer life expectancy and better medical treatments for chronic disease will result in a doubling of the number of Medicare beneficiaries in the next 40 years.
Already there are more Medicare inpatient admissions that included an ICU stay, with more ICU care for longer stays during the last six months of life. There are more observation stays involving sicker patients. And more seniors are presenting at the emergency department.
The AHA white paper points out, "Seeking to ensure that these changes alone did not lead Medicare to pay more for the same services and patients than it would have paid before, CMS made a downward adjustment to hospitals' payment rates. The AHA is asking policymakers to consider the results of these changes and as to whether that adjustment appropriately separates the effect of changes in how hospitals report severity from actual changes in the complexity and severity of illness of Medicare patients."