Inpatient rehabilitation utilization for Medicare beneficiaries with multiple sclerosis.

OBJECTIVE: To explore the use of inpatient rehabilitation facility services and levels of impairment for Medicare beneficiaries with multiple sclerosis (MS) by comparing differences in service utilization and clinical characteristics between Medicare beneficiaries with MS to the overall Medicare population. DESIGN: Medicare beneficiaries with MS were identified using Medicare claims data. Claims and assessment data were analyzed to compare outcomes for beneficiaries with MS who used inpatient rehabilitation compared with a random sample of Medicare beneficiaries without MS. SETTING: Inpatient rehabilitation facilities. PARTICIPANTS: Medicare beneficiaries with a diagnosis of MS who received inpatient rehabilitation during the 2007 calendar year (n=4669) and a random sample of Medicare beneficiaries without MS (n=14,397). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in functional impairment levels between admission and discharge to inpatient rehabilitation and length of stay. RESULTS: There were several differences in beneficiary characteristics between the 2 groups. Beneficiaries with MS had lower change in functional levels (-3.3 points on the FIM) and longer length of stay (0.4d). CONCLUSIONS: While beneficiaries with MS account for a small proportion of the Medicare population, the benefit is important to those who qualify for Medicare coverage. This study illustrates the differences between the subpopulation of beneficiaries with MS and other Medicare beneficiaries. The findings show that populations with MS had less functional improvement than other Medicare populations using the inpatient rehabilitation setting. Higher rates of depression within the MS Medicare population was a secondary finding that presents another important consideration for rehabilitation service needs for this group.

Depression and fibromyalgia: treatment and cost when diagnosed separately or concurrently.

OBJECTIVE: Depression and fibromyalgia (FM) are often coincident. Both syndromes share common symptoms and impose significant economic burdens. This study compared claims for treatment and costs of FM plus depression with those for FM or depression alone. METHODS: Administrative claims data from a national Fortune 100 manufacturer were used to identify 3 mutually exclusive patient cohorts based on claims with a diagnosis for: FM only, depression only, and FM plus depression. A fourth cohort comprised a random sample of 10% of the employer's overall beneficiary population. Cohorts were compared for demographics, comorbid conditions, and healthcare resources utilization. Mean direct (treatment) costs were calculated and indirect (work loss) costs imputed, and these were assessed using Student's t test and Bonferroni adjustments. RESULTS: Mean annual employer payments (direct plus indirect costs) per patient were 5,163 dollars for FM only, 8,073 dollars for depression only, 11,899 dollars for FM plus depression, and 2,486 dollars for the overall sample. Mean incremental employer payments (i.e., above those for the random sample) per patient with FM plus depression were 9,413 dollars, an amount more than the sum of incremental costs for those with FM or depression alone (8,264 dollars). These costs are consistent with costs of other chronic diseases. CONCLUSION: Patients with FM plus depression are high users of healthcare services. As in studies that established relationships between depression and other medical conditions, incremental costs for patients with FM plus depression were more than additive of costs for each condition alone.

Treatment costs of community-acquired pneumonia in an employed population.

BACKGROUND: Community-acquired pneumonia (CAP) is a serious clinical problem, causing hospitalization in about 20% of cases and death in up to 16% of hospitalized patients. Work-loss cost estimates indicate that the treatment of CAP also has a large economic impact. The purpose of this study was to assess the medical and prescription drug (treatment) costs of managing CAP in an employed population. METHOD: The costs of CAP were determined from an administrative claims database covering the years 1996 to 1998 for an employed population and their dependents [65 years of age (100,000 population)]. Treatment costs for managing both inpatient and outpatient cases of CAP were calculated from payments by the health plan. RESULTS: A total of 7,249 episodes of CAP among 6,415 individuals were identified. The hospitalization rate was 19.6%, and the mortality rate for those hospitalized was 9.1%. Patients requiring hospitalization were older and had more comorbid conditions. The mean (+/- SD) treatment cost for an inpatient episode of CAP (including all inpatient and outpatient medical care) was $10,227 +/- 15,342. The costs for inpatients who died during hospitalization (mean cost, $15,822 +/- 26,541) were higher than for episodes in which patients were discharged from the hospital alive (mean cost, $9,595 +/- 13,641). The mean treatment cost for an outpatient episode of CAP was $466 +/- 1,038. CONCLUSIONS: The treatment cost of managing CAP in this employed population was higher than previously estimated. It is estimated that the annual cost of treating CAP in the United States is $12.2 billion.

Economic cost and epidemiological characteristics of patients with fibromyalgia claims.

OBJECTIVE: Fibromyalgia (FM) is characterized by widespread pain that can lead to significant patient disability, complex management decisions for physicians, and economic burden on society. We investigated the total costs of FM in an employer population. METHODS: Administrative claims data of a Fortune 100 manufacturer were used to quantify direct (i.e., medical and pharmaceutical claims) and indirect (i.e., disability claims and imputed absenteeism) costs associated with FM. A total of 4699 patients with at least one FM claim between 1996 and 1998 were contrasted with a 10% random sample of the overall beneficiary population. Employee-only subsets of both samples also were drawn. RESULTS: Medical utilization, receipt of prescription drugs, and annual total costs were proportionately similar yet significantly greater among FM claimants than the overall sample (all p < 0.0001). Total annual costs for FM claimants were $5945 versus $2486 for the typical beneficiary (p < 0.0001). Six percent of these costs were attributable to FM-specific claims. The prevalence of disability was twice as high among FM employees than overall employees (p < 0.0001). For every dollar spent on FM-specific claims, the employer spent another $57 to $143 on additional direct and indirect costs. CONCLUSION: Hidden costs of disability and comorbidities greatly increase the true burden of FM. Regardless of the clinical understanding of FM, when a claim for FM is present, considerable costs are involved. Findings suggest that within the management of FM there may be large cost-offset opportunities for reductions in patient, physician, and employer burdens.