Fee-for-service Medicare beneficiaries with self-reported functional impairments and phenotypic frailty had higher subsequent healthcare costs, a prospective cohort study shows. The differences remained even after adjustments for several claims-based indicators of costs. “Our results suggest that assessing self-reported functional impairments and the frailty phenotype by health care systems may improve identification and characterization of older community-dwelling adults at increased risk for costly care to facilitate efforts to better tailor and target integrative patient-centered care interventions aimed at reducing future health care expenditures,” the authors conclude.
Tha analysis used index examinations of 4 prospective cohort studies from 2002 to 2011 of linked Medicare claims for 8,165 community-dwelling fee-for-service beneficiaries (4,318 women, 3,847 men). Self-reported functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) were derived from cohort data. Based on weighted (CMS Hierarchical Condition Category index) and unweighted (count of conditions) multimorbidity and frailty indicators for 36 months after index examinations, the investigators found: “Average annualized costs (2020 U.S. dollars) were $13,906 among women and $14,598 among men. After accounting for claims-based indicators, average incremental costs of functional impairments versus no impairment in women (men) were $3,328 ($2,354) for 1 impairment increasing to $7,330 ($11,760) for 4 impairments; average incremental costs of phenotypic frailty versus robust in women (men) were $8,532 ($6,172). Mean predicted costs adjusted for claims-based indicators in women (men) varied by both functional impairments and the frailty phenotype ranging from $8,124 ($11,831) among robust persons without impairments to $18,792 ($24,713) among frail persons with 4 impairments. Compared with the model with claims-derived indicators alone, this model resulted in more accurate cost prediction for persons with multiple impairments or phenotypic frailty.”
Editorial: “Perhaps the most impactful use of enriched measures of functional status and frailty is not for the purpose of population segmentation or payment at all,” writes an editorialist. “There is a strong argument that these measures have direct clinical implications. If they are included as part of standard [electronic health records], we as clinicians could better address the needs of our older patients. Inclusion of functional status into our clinical assessments and decision making would draw our attention to unmet needs related to disability associated with functional impairments. This would in turn remind us to align disease-management approaches with capabilities and prognosis, to engage caregivers when warranted, and give us the opportunity to alter the trajectory of functional decline in situations where that remains possible.”