Me. Grasso et al., CAPITATION, MANAGED CARE, AND CHRONIC OBSTRUCTIVE PULMONARY-DISEASE, American journal of respiratory and critical care medicine, 158(1), 1998, pp. 133-138
Citations number
24
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
Expenditure and utilization patterns of aged Medicare beneficiaries wi
th chronic obstructive respiratory disease (COPD) (n = 42,472) were co
mpared with all Medicare beneficiaries (n = 1,221,615) using a 5% nati
onally representative sample of aged Medicare beneficiaries participat
ing in the fee-for-service program in 1992. Per capita expenditures fo
r an aged Medicare beneficiary with COPD were 2.4 times the per capita
expenditures for all Medicare beneficiaries. The most expensive 10% o
f Medicare beneficiaries with COPD accounted for nearly half of total
expenditures for this population. Higher comorbidity, as measured by t
he Deyo-adapted Charlson index, was associated with higher expenditure
s. For Medicare Part B claims, internal medicine accounted for the lar
gest portion of physician expenditures (14%). Per capita expenditures
for pulmonologists were 7.5 times higher for beneficiaries with COPD c
ompared with all Medicare beneficiaries. Results from this study sugge
st that there is a subgroup of individuals with COPD who are likely to
be very expensive during the year. Additional analytic studies are ne
eded to more specifically identify characteristics associated with the
se individuals. As more Medicare beneficiaries enroll in managed care
and as physicians are increasingly being paid on a capitated basis thi
s information will be useful to physicians as they monitor the care pr
ovided to patients and assess the financial risks they accept under ca
pitation.