Journal of Diabetes & Metabolism

ISSN - 2155-6156

+441518081309

Research Article - (2014) Volume 5, Issue 3

Medicare Fee-for-Service Spending for Diabetes: Examining Aging and Comorbidities

Erkan Erdem1 and Holly Korda2*
1KPMG, LLP, Economic and Valuation Services, USA
2Health Systems Research Associates, USA
*Corresponding Author: Holly Korda, Health Systems Research Associates, 15 Birch Lane, Portland, ME 04064, USA, Tel: 207-934-0646/240-606-3885 Email:

Abstract

This research report examines prevalence and spending on diabetes for fee-for-service (FFS) beneficiaries of the Medicare program, the health insurance program that covers the majority of adults age 65 and above in the U.S. To date, most studies of spending on diabetes care in the U.S. have relied on self-reported survey data and estimates of utilization and spending, but do not represent actual spending identified through administrative claims. This report is based on newly available administrative claims data from the Centers for Medicare & Medicaid Services 2010 Chronic Conditions Public Use File. Diabetes was prevalent among approximately 1/4 of Medicare FFS beneficiaries in 2010. Prevalence increased with age initially for the aged population, but dropped for beneficiaries > 85. Only about 1/4 of diabetic beneficiaries had diabetes without a comorbidity. Beneficiaries with diabetes had 2.8 chronic conditions (including diabetes) with average Medicare Part A and Part B spending of $5,741 and $5,991, and drug costs of $3,119, respectively. Spending increased with age for beneficiaries >65. Findings of these analyses consider diabetes in the context of chronic comorbidities and contribute to understand claims-based prevalence and spending for older adults with diabetes in the Medicare FFS population.

Keywords: Diabetes, Comorbidities, Medicare, Fee-for-service, Healthcare spending

Introduction

Diabetes Mellitus is a chronic condition affecting an estimated 25.8 million people, or 8.3% of the population of the United States in 2010, including 10.9 million adults age 65 and above [1]. Type 2 diabetes is responsible for 90-95% of diabetes cases and the majority of health spending, with prevalence increasing with age; Type 1 diabetes, formerly known as juvenile diabetes and gestational diabetesaccount for most of the remaining cases [2-5]. Diabetes is a leading cause of death and is often associated with comorbidities including kidney failure, lower limb amputations, adult onset blindness, obesity, hypertension, nerve damage, heart disease and stroke. Health care reform legislation in the U.S. under the Affordable Care Act (ACA) of 2010 identifies diabetes as a major population health concern, with provisions that address diabetes prevention, screening, access to wellness and prevention programs, healthcare and prescription drug coverage, enhanced surveillance and quality standards, and demonstration programs for non-institutionalized individuals with diabetes [6,7].

The total economic cost of diagnosed diabetes in the U.S. is estimated at $245 billion in 2012, including $176 billion in medical costs and $69 billion attributed to reduced productivity [3]. This represents a 41% increase over the $174 billion in total economic costs estimated for 2007 [2]. Diabetes is associated with higher use of health care services, medications, and other supplies, with medical costs per case increasing with age [8].

Individuals 65 years of age and above account for approximately 59% of national spending on diabetes care in the U.S., most of which is paid by Medicare [9], the publicly-funded health insurance program administered by the Centers for Medicare & Medicaid Services (CMS) that covers the majority of adults age 65 and above in the U.S. [3]. Medicare Fee-for-Service (FFS) coverage has multiple parts. Medicare Part A (also known as hospital insurance) covers care in hospitals, skilled nursing facilities and other institutions for the more costly and complex treatment needs. Medicare Part B (also known as medical insurance) covers doctors’ services, outpatient services, diagnosis, examinations, care, equipment and supplies relating to diabetes, as well as some preventive services for individuals at risk for diabetes and self-management training for those newly diagnosed or at risk for complications relating to their diabetes. Medicare Part D (also known as prescription drug insurance) provides prescription drug coverage and covers supplies for injecting or inhaling insulin, and is provided through private insurance companies that contract with CMS.

This report examines Medicare spending on diabetes care for fee-for-service (FFS) beneficiaries, with a focus on individuals age 65 and above (older adult population) to better understand prevalence and spending patterns. Previous studies of spending and resource use on diabetes care in the U.S. have relied on large self-reported survey data such as the Behavioral Risk Factor Surveillance System, National Medical Expenditure Survey or the Medical Expenditure Panel Survey, or from Medicare Part D health plans. These data sources enable estimates of utilization and spending, but do not represent actual hospital, medical and pharmaceutical spending that can be identified through administrative claims. For the Medicare program, funded by public dollars, this information is critical for program policy and management, especially as diabetes accounts for a growing proportion of program expenditures.

Methods

We address prevalence and spending associated with diabetes (all types combined) among Medicare beneficiaries age 65 and above in calendar year 2010 using the 2010 Chronic Conditions PUF newly available through the CMSi. These PUFs contain claims information from 100% of Medicare FFS beneficiaries (complete universe rather than a sample) for Medicare Part A (hospital insurance), Part B (physician and outpatient services) spending, and Part D (prescription drug) spendingii. Information (e.g., utilization, Medicare spending) is summarized in profiles (or groups) of beneficiaries defined by gender, age categories, dual-eligibility status, eleven chronic condition indicators (whether or not the condition exists), and length of enrollment (i.e., full year or less than full year). So, the observations in the data are not beneficiaries or claims, but groups of enrollees that have the same combinations of demographics as well as health status. For each profile, the data provide information on utilization and Medicare payments, such as average Medicare reimbursement per enrollee for inpatient services together with number of beneficiaries enrolled in Medicare Part A which the average is based on. Chronic conditions included in the PUF are: Alzheimer’s Disease and Related Disorders or Senile Dementia (ALZ); Cancer including one or more of the following types: breast, colorectal, prostate, or lung (CAN); Congestive Heart Failure (CHF); Chronic Kidney Disease (CKD); Chronic Obstructive Pulmonary Disease (COPD); Depression (DEPR); Diabetes (DIAB); Ischemic Heart Disease (IHD); Osteoporosis (OSTEO); Rheumatoid Arthritis/Osteoarthritis (RA\OA); and Stroke\Transient Ischemic Attack (S\TIA)iii.

The 2010 CMS Chronic Conditions PUF contains eight (8) “segments” distinguished by the type of care (Part A, Part B, Part C: Medicare Advantage, and Part D) and length of enrollment (i.e., full year vs. less than full year)iv,v Our analyses focus only on Part A, Part B, and Part D and beneficiaries enrolled for the full year in 2010 who are not dual-eligible (eligible for both Medicare and Medicaid benefits). Dualeligible beneficiaries are a diverse group of individuals with different health care use patterns compared to those eligible by only Medicarevi. Beneficiaries may be enrolled in one or more of these segments, and thus may be represented in one or more segment analyses in the rest of the study. Also, cost estimates for this study only include Medicare spending and exclude all other costs such as out-of-pocket expenses (e.g., co-insurance, deductible payments) and payments by third parties.

Results

The 2010 Chronic Conditions PUF provides summary information for more than 50 million Medicare FFS beneficiaries in 2010. Average Medicare reimbursements for full-year (i.e., 12 months of continuous enrollment) beneficiaries that are not dual-eligible were $3,146 and $4,056 per beneficiary in Part A and Part B, respectively. Average drug spending per beneficiary was an additional $2,048 per beneficiary.

Table 1 summarizes the most common 15 combinations of chronic conditions among Part A, Part B, and Part D beneficiaries sorted by number of Part A beneficiariesvii. About 38.3% of Medicare Part A beneficiaries 10,245,731 out of 26,751,682) and 31.5% of Medicare Part B beneficiaries (7,468,750) did not have any of the eleven chronic conditions available in the data. Also, these most common combinations of chronic conditions were identical among Part A and Part B beneficiaries. Beneficiaries enrolled in Part D were relatively healthier compared to Part A and Part B: about 57% of Medicare Part D enrollees (10,200,308 out of 17,832,558) did not have any of the eleven chronic conditions. The only striking difference between Part A-B and Part D was that Alzheimer’s ranked markedly higher among Part D enrollees than it did among Part A-B enrollees. Beneficiaries with only diabetes were about 5.4 (6.0)% of the Part A (Part B) beneficiaries, but another 2.4 (2.6)% had both diabetes and ischemic heart disease, and 1.1 (1.2)% had both diabetes and arthritis within the most common combinations provided in the table. Also, ischemic heart disease is the most common comorbidity of diabetes among Medicare beneficiaries.

Conditions
(Part A & Part B)
Conditions
(Part D)
Number of Beneficiaries (Part A) Mean Medicare Payment
(Part A)
Number of Beneficiaries (Part B) Mean Medicare Payment (Part B) Number of Beneficiaries (Part D) Mean Total Drug Cost
(Part D)
None None 10,245,731 $245 7,468,750 $1,266 10,200,308 $1,569
DIAB DIAB 1,457,641 $537 1,412,250 $2,146 721,715 $2,214
IHD IHD 1,381,884 $1,228 1,337,306 $2,870 663,984 $2,008
RA\OA RA\OA 1,087,123 $1,901 1,075,092 $3,183 506,029 $1,687
OSTEO OSTEO 780,153 $689 771,700 $2,410 362,094 $1,520
DIAB & IHD DIAB & IHD 642,840 $1,502 626,484 $3,501 297,262 $2,847
DEPR DEPR 506,759 $1,528 485,388 $2,885 243,769 $2,798
CAN ALZ 364,414 $1,270 356,644 $6,138 155,801 $2,904
IHD & RA\OA CAN 324,979 $3,256 323,380 $4,679 151,442 $1,707
DIAB & RA\OA IHD & RA\OA 296,557 $2,139 294,210 $3,737 149,652 $2,187
OSTEO & RA\OA DIAB & RA\OA 292,620 $2,639 292,042 $4,249 139,793 $2,419
CHF & IHD OSTEO & RA\OA 282,873 $3,890 277,055 $4,610 137,675 $2,001
CKD CHF & IHD 278,485 $2,558 263,884 $4,795 134,076 $2,280
ALZ CKD 263,117 $2,741 257,461 $2,160 124,410 $2,322
COPD COPD 252,725 $1,912 245,031 $3,237 110,731 $2,587
All other All other 8,293,781 $8,305 8,191,094 $7,435 3,733,817 $3,246
Total Total 26,751,682 $3,146 23,677,771 $4,056 17,832,558 $2,048
ALZ: Alzheimer’s Disease; CAN: Cancer; CHF: Congestive Heart Failure; CKD: Chronic Kidney Disease; COPD: Chronic Obstructive Pulmonary Disease; DEPR: Depression; DIAB: Diabetes; IHD: Ischemic Heart Disease; OSTEO: Osteoporosis; RA/OA: Rheumatoid Arthritis/Osteoarthritis; S/TIA: Stroke\Transient Ischemic Attack.

Table 1: Most Common Combinations of Chronic Conditions among Medicare FFS Beneficiaries.

More than 6 million (22.6%) Part A beneficiaries were diagnosed with diabetes making it the most commonly observed chronic condition among non-dual Medicare FFS beneficiaries (Table 2). The share of diabetic beneficiaries was higher (25.0%) among Part B beneficiaries, but lower (15.6%) among Part D beneficiaries. These differences were also consistent for every gender and age category. Male beneficiaries 65 and older suffered more from diabetes compared to female beneficiaries in Part A, Part B, and Part D. For example, in all age categories (except for under 65), the percentage of beneficiaries with diabetes was at least 3-4 percentage points higher for males than females in Part A. The prevalence of diabetes increased with age initially for the aged Medicare population, but dropped for beneficiaries 85 years of age and older compared to age group 80-84 (e.g., from 28.7% to 24.2% for males and from 24.0% to 19.8% for females in Part A). This may reflect shorter life expectancies identified among individuals with diabetes, and warrants more in-depth investigation.

Sex Age Number of Diabetic Beneficiaries (Part A) Number of Beneficiaries (Part A) Percent of Diabetic Beneficiaries (Part A) Number of Diabetic Beneficiaries (Part B) Number of Beneficiaries (Part B) Percent of Diabetic Beneficiaries (Part B) Number of Diabetic Beneficiaries (Part D) Number of Beneficiaries (Part D) Percent of Diabetic Beneficiaries (Part D)
Male Under 65 344,314 1,725,793 20.0% 325,820 1,337,152 24.4% 160,748 857,082 18.8%
65 - 69 669,752 3,283,386 20.4% 639,698 2,583,428 24.8% 294,165 1,806,708 16.3%
70 - 74 724,400 2,768,046 26.2% 710,794 2,442,030 29.1% 327,174 1,860,326 17.6%
75 - 79 572,521 2,007,903 28.5% 565,949 1,861,032 30.4% 224,863 1,328,837 16.9%
80 - 84 420,795 1,467,095 28.7% 417,790 1,393,865 30.0% 158,825 931,401 17.1%
85 & over 300,642 1,241,694 24.2% 299,223 1,146,914 26.1% 107,782 686,930 15.7%
Female Under 65 263,361 1,309,322 20.1% 250,044 1,031,500 24.2% 129,696 782,221 16.6%
65 - 69 587,972 3,320,661 17.7% 570,296 2,784,123 20.5% 289,823 2,293,537 12.6%
70 - 74 657,549 2,990,307 22.0% 650,827 2,761,257 23.6% 332,197 2,326,153 14.3%
75 - 79 568,653 2,363,845 24.1% 565,596 2,259,042 25.0% 281,116 1,864,736 15.1%
80 - 84 480,022 2,000,004 24.0% 478,716 1,936,706 24.7% 241,969 1,527,556 15.8%
85 & over 451,254 2,273,626 19.8% 451,327 2,140,722 21.1% 233,621 1,567,071 14.9%
Total   6,041,235 26,751,682 22.6% 5,926,080 23,677,771 25.0% 2,781,979 17,832,558 15.6%

Table 2: Prevalence of Diabetes among Medicare FFS Beneficiaries by Sex and Age.

Table 3 provides an overview of comorbidities by summarizing the top 15 combinations of chronic conditions for beneficiaries with diabetes in Part A, Part B, and Part D. Ischemic heart disease, arthritis, chronic kidney disease, and congestive heart failure appear as the major comorbidities of diabetes. Stroke\transient ischemic attack (not in the most common comorbidities), Alzheimer’s, chronic obstructive pulmonary disease, cancer, and depression are not as significant comorbid chronic conditions for diabetes as the others. Only about 24% of Part A and Part B beneficiaries with diabetes did not have a comorbidity. Hence, 3 out of every 4 beneficiaries dealing with diabetes also deal with at least one more other chronic condition.

Conditions (Part A) [2] Percent of Beneficiaries (Part A) Average Medicare Part A Spending Conditions (Part B)[2] Percent of Beneficiaries (Part B) Average Medicare Part B Spending Conditions (Part D) [2] Percent of Beneficiaries (Part D) Average Medicare Part D Spending
DIAB only (1) 24.13% $537 DIAB only (1) 23.83% $2,146 DIAB only (1) 25.94% $2,214
DIAB & IHD (2) 10.64% $1,502 DIAB & IHD (2) 10.57% $3,501 DIAB & IHD (2) 10.69% $2,847
DIAB & RA\OA (2) 4.91% $2,139 DIAB & RA\OA (2) 4.96% $3,737 DIAB & RA\OA (2) 5.02% $2,419
DIAB & CKD (2) 3.46% $2,642 DIAB & CKD (2) 3.38% $5,534 DIAB & CKD (2) 3.44% $3,252
DIAB & CHF & IHD (3) 3.20% $4,294 DIAB & CHF & IHD (3) 3.20% $5,365 DIAB & CHF & IHD (3) 3.27% $3,174
DIAB & CKD & IHD (3) 2.61% $4,674 DIAB & RA\OA & IHD (3) 2.65% $5,388 DIAB & RA\OA & IHD (3) 2.60% $2,958
DIAB & RA\OA & IHD (3) 2.61% $3,526 DIAB & CKD & IHD (3) 2.59% $7,402 DIAB & CKD & IHD (3) 2.47% $3,785
DIAB & CHF & CKD & IHD (4) 2.48% $12,792 DIAB & CHF & CKD & IHD (4) 2.48% $12,437 DIAB & CHF & CKD & IHD (4) 2.42% $4,177
DIAB & OSTEO (2) 2.11% $927 DIAB & OSTEO (2) 2.13% $3,052 DIAB & DEPR (2) 2.12% $3,530
DIAB & DEPR (2) 2.05% $2,009 DIAB & DEPR (2) 2.02% $3,642 DIAB & OSTEO (2) 2.10% $2,307
DIAB & CAN (2) 1.54% $1,435 DIAB & CAN (2) 1.55% $6,515 DIAB & CAN (2) 1.40% $2,459
DIAB & CHF (2) 1.20% $1,896 DIAB & CHF (2) 1.18% $3,570 DIAB & CHF (2) 1.35% $2,795
DIAB & COPD (2) 1.08% $2,328 DIAB & COPD (2) 1.07% $3,877 DIAB & ALZ (2) 1.14% $3,474
DIAB & ALZ (2) 1.05% $2,720 DIAB & ALZ (2) 1.05% $3,018 DIAB & COPD (2) 1.03% $3,200
DIAB & COPD & IHD (3) 0.94% $4,296 DIAB & CHF & IHD & RA\OA (4) 0.96% $7,248 DIAB & CHF & IHD & RA\OA (4) 0.97% $3,306
All other combinations (4.4) 36.0% $12,183 All other combinations (4.4) 36.4% $9,618 All other combinations (4.3) 34.0% $3,913
All combinations (2.8) 100.0% $5,741 All combinations (2.8) 100.0% $5,991 All combinations (2.7) 100.0% $3,119
[1] Total number of diabetic beneficiaries in Part A, Part B, and Part D are provided in Table 2.
[2] Values in parenthesis denote the number of chronic conditions. For last two rows of the table, they denote the average number of chronic conditions.

Table 3: Combinations of Chronic Conditions among Medicare FFS Beneficiaries with Diabetes [1].

Average Medicare spending for a Part A enrollee with diabetes and no chronic conditions was $537. Average Part B expenditures for a diabetic enrollee without other chronic conditions was $2,146. Average total drug costs were about $2,214. However, Medicare Part A spending increased drastically with comorbidities – 2.8 fold with ischemic heart disease, 4 fold with arthritis, 5 fold with chronic kidney disease, and 8 fold with ischemic heart disease and congestive heart failure. The increases in Medicare Part B spending were also significant but not as drastic relative to Part A – 1.6 fold with ischemic heart disease, 1.7 fold with arthritis, 2.6 fold with chronic kidney disease, and 2.5 fold with ischemic heart disease and congestive heart failure. Finally, among the comorbidities presented in the table, the increases in total drug costs due to comorbidities were not more than 1.9 fold (90%) which was for beneficiaries with three comorbidities: congestive heart failure, chronic kidney disease, and ischemic heart disease. On average, diabetic beneficiaries in Part A and Part B had 2.8 chronic conditions (including diabetes) with average Medicare spending of $5,741 and $5,991. Total drug costs for Part D beneficiaries were $3,119.

Figure 1 shows average Medicare Part A and Part B spending, and Part D cost for diabetic and non-diabetic beneficiaries by age (for number of beneficiaries provided in Table 2. Average Medicare Part A and Part B spending increases with age (except for beneficiaries under age 65). However, the increase in Part A spending is relatively steeper than the increase in Part B spending. Part D costs increase slightly with age for non-diabetic beneficiaries, but are flat for diabetic beneficiaries. Average Medicare spending and drug costs for diabetic beneficiaries are higher than for non-diabetic beneficiaries. For example, average Medicare spending for 65-69 year old beneficiaries with diabetes is about 3.5 and 2 times higher than for beneficiaries without diabetes for Part A and Part B, respectively. Some of this increase is explained by the differences in the average number of chronic conditions between diabetic and non-diabetic beneficiaries as shown on the right hand side of Figure 1. Interestingly, the differences in average number of chronic conditions are the largest among Part D beneficiaries, but average Medicare drug spending does not increase by age for diabetic beneficiaries even though they increase slightly for non-diabetic beneficiaries.

diabetes-metabolism-Medicare-Spending

Figure 1: Average Part A & B Medicare Spending and Part D Cost.

Discussion

These analyses show actual treated prevalence and hospital and medical spending (and prescription drug spending) for individuals in the Medicare FFS population using claims information available from newly available CMS public use files. Findings are generally consistent with trends identified in surveys and research that show diabetes as a common chronic condition, especially among older adults, with increases in prevalence and associated spending as the population ages, and shorter life expectancy [1-5]. The findings also show overall increases in the prevalence of chronic conditions with advancing age.

People with diabetes account for approximately a quarter of Medicare FFS beneficiaries in 2010 with a larger share among Part A beneficiaries and a significantly lower share among Part D beneficiaries (Table 2). Most beneficiaries with diabetes had other chronic conditions, which averaged 2.8 conditions (with diabetes). Spending was modest for the 5-6% of Part A and Part B beneficiaries with only diabetes and no other chronic conditions, but increased substantially for the majority of beneficiaries with diabetes who also had other chronic conditions. For example, annual spending associated with hospital care (Part A) increased by about 3 fold ($1,502 vs. $537), on average, if a diabetic beneficiary also had ischemic heart disease (Table 3) which is the most common comorbidity for beneficiaries with diabetes.

Not surprisingly, hospitalization accounts for the largest portion of overall resource use and spending for diabetes in this and other studies [2,3,10]. According to the ADA, diabetes contributes to higher rates of hospital admissions and longer average length of stay regardless of the reason for admissions (and controlling for other factors that affect hospital length of stay) [2].

As this study and others have found, health care spending was substantially greater for individuals with diabetes than for individuals without diabetes, and health resource utilization and associated spending increases with age [2,3,11]. This trend is clear for the population 65 years of age and over. However, beneficiaries under age 65 had higher, off-trend spending than the population age 65 and over, likely reflecting their eligibility and enrollment as a result of their disability status.

These analyses also confirm reports showing that diabetes often occurs along with other chronic conditions, and that comorbidities increase with advancing age [10,12]. Some of these conditions, such as ischemic heart disease, are related to diabetes, others are comorbidities independent of diabetes, such as osteoarthritis or Alzheimer’s disease. The most common comorbidities identified in this study include: ischemic heart disease, arthritis, chronic kidney disease, osteoporosis and depression. Medicare spending increased across age groups as the number of chronic conditions increased. This finding is consistent with research by Struijs and colleagues who reported that the number of comorbidities is a strong predictor for the volume of medical care utilization for patients with diabetes [10].

The presence of comorbidities such as those in this study can complicate diabetes management, including patients’ abilities to manage their self-care, and increase overall costs of care [13,14]. As Piette and Kerr [13] and others [15,16] point out, conditions such as depression and arthritis may impair patient functioning and present barriers to lifestyle change and regimen adherence, while conditions unrelated to diabetes such as emphysema and chronic low back pain can have a more debilitating impact on patients’ health status than diabetes, and disabling conditions such as advanced heart failure and dementia may make diabetes self-care goals impossible to reach. These conditions also compete for patients’ time and financial resources.

Complications of diabetes, particularly cardiovascular diseases, neurological diseases, and renal conditions, also lead to increased use of health resources and spending [2,10]. A 2012 ADA study found medical spending increases from 25 percent in emergency departments to 45 percent in hospital inpatient facilities were due to treating complications of diabetes [3]. Other studies have found that people with uncontrolled diabetes or with diabetes complications incur diabetes costs two to eight times more than people with controlled or non-advanced diabetes. [17,18] Diabetes also increases the cost of treating general conditions that are not directly related to diabetes [3,10].

Effective population health tools and interventions—including diabetes education, self-management and self-care programs—are available and are expected to increase availability under the ACA that can improve diabetes management and prevent complications and, potentially, prevent or delay the development of Type 2 diabetes and its frequently occurring comorbid sequellae in persons at high risk. But despite medical and public health advances, it is not clear which interventions work best with which populations.

Limitations

These analyses have several limitations. They profile prevalence and spending for FFS Medicare beneficiaries, but do not examine whether and to what extent these patterns resemble prevalence, spending and chronic conditions in beneficiaries enrolled in non-FFS settings such as Medicare Advantage managed care plans. Data to enable such a comparison are not available, as CMS does not collect or release comparable data from these plans.

The CMS data used for these analyses do not collect information on out-of-pocket spending, although out-of-pocket spending is considerable for individuals with diabetes. These costs can be a barrier to condition management and regiment adherence, especially for those beneficiaries who do not have Medicare Supplemental insurance. Outof- pocket spending for medication incurred by people with diabetes are higher than for individuals with most other chronic conditions [19]. Other out-of-pocket spending may include co-pays and transportation related to medical care, and purchases of healthy food to maintain diabetic dietary requirements.

The data contain information on only eleven chronic conditions. Hence, we cannot observe and control for other diseases (e.g., obesity, hypertension) that might affect the health of Medicare beneficiaries. Estimates for total and average number of chronic conditions may underestimate actual values and establish lower bounds. However, if these unknown chronic conditions have a random distribution over Medicare enrollees in the data, then our estimates for Medicare spending and drug costs may not be biased in any direction.

Study data do not include information on Medicare beneficiaries’ race and ethnicity, so this study does not address prevalence and spending or profile chronic conditions across racial and ethnic groups. Blacks, Hispanics, and Native Americans have higher reported prevalence of diabetes than White populations [4]. These populations are also more likely to report having chronic conditions and lower incomes and Blacks, in particular, are less likely to report having Medicare supplemental policies to help cover associated care costs [9].

Conclusion

Medicare FFS spending for diabetes-related care for older adults is substantial, with management and treatment often complicated by comorbid conditions and complications that further fuel spending for patients and the Medicare program. This research report provides prevalence and spending trends from 2010 that represent actual hospital, medical and pharmaceutical spending that can be identified through Medicare administrative claims. This information is critical for program policy and management as Medicare implements new ACA initiatives and continues to focus on prevention and treatment to curb increases in diabetes and related program expenditures for older adults in the FFS population.

Conflict of Interest

The authors have no financial disclosures or conflicts of interest relating to submission of this manuscript. The authors received support for the research in this paper from the Centers for Medicare & Medicaid Services under Contract Number 500-2006-00007I/#T0004 with IMPAQ International. The views expressed in this article are those of the authors and do not necessarily reflect the views of the U.S., Department of Health and Human Services, the Centers for Medicare & Medicaid Services, IMPAQ International, or KPMG.

Acknowledgements

The authors thank Kenneth McLeroy, Ph.D., Social and Behavioral Health, Texas A&M School of Rural Public Health, and Samuel “Chris” Haffer, Ph.D., Office of Information Products & Data Analytics, Centers for Medicare & Medicaid Services, for their careful review and comments.

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Citation: Erdem E, Korda H (2014) Medicare Fee-for-Service Spending for Diabetes: Examining Aging and Comorbidities. J Diabetes Metab 5:345.

Copyright: © 2014 Erdem E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.