Fall-related injuries cost Medicare billions

Study suggests that substantial savings could be gained by focusing on prevention.

By Markian Hawryluk, amednews staff. Dec. 16, 2002.

Washington -- Medicare is spending billions to treat preventable injuries incurred by aging beneficiaries, according to a study published in the November-December Health Affairs.

Researchers, led by Christine Bishop, PhD, a professor at Brandeis University's Schneider Institute for Health Policy, Waltham, Mass., found that Medicare spent more than $8 billion in 1999 to treat injuries to seniors, accounting for 6% of Medicare fee-for-service claims for these beneficiaries. One in five seniors in fee-for-service Medicare was treated for an injury in 1999 at a cost of $1,272 per incident, the study said.

Injuries in the elderly
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"Medicare savings would be substantial if even half of spending attributable to injury could be avoided or mitigated through prevention," the researchers said.

They suggested that many of the injury-related costs could be saved through better use of preventive measures. "Although gerontologists and other practitioners have designed and demonstrated effective interventions to reduce the risk of injury in the elderly, these interventions are not widely disseminated," researchers said.

Part of the problem is that, although Medicare will pay for treatment and some preventive services, most approaches to reducing injuries lie outside the purview of most plan coverage. Home assessments and modifications, assistive devices for activities of daily living, gait and strength training, and protective devices can mitigate the risk of falls and fractures.

The researchers recommended focusing on fractures in particular because of their high cost and prevalence. Fractures accounted for two-thirds of the injury-related spending, with total claims of $5.5 billion.

In 1997, Congress approved Medicare coverage for bone mass measurements that would screen for osteoporosis. But Medicare does not cover prescription drugs, nutrition counseling and strength training that could increase bone mass and reduce the risk of fractures. Many of the breaks result from falls, prompting policy-makers and health experts to turn to fall-prevention efforts.

Sens. Tim Hutchinson (R, Ark.) and Barbara Mikulski (D, Md.) introduced the Elder Fall Prevention Act of 2002 earlier this year. The bill would fund a three-year educational campaign by the National Safety Council focusing on ways to reduce the risk of elder falls and would provide grants to states for local educational efforts.

The measure also would require the Dept. of Health and Human Services to evaluate the effect of falls on Medicare and Medicaid, and the potential to reduce costs by expanding covered services. Medicare and Medicaid are expected to spend more than $32 billion for fall-related injuries by 2020.

Although Senate hearings on fall-prevention strategies were held in June, senators did not vote on the legislation. A companion House bill introduced by Rep. Frank Pallone (D, N.J.) also languished in committee. The measure would have to be reintroduced next session to be considered by lawmakers again. The legislation was backed by the American Geriatrics Society and the NSC.

"Many Americans do not know how simple changes -- in lighting, floor coverings, handrail installation, vision corrections, exercise and various aspects of home design can reduce falls," NSC Vice President Bobby Jackson said. "Additionally, pre- and post-fall counseling of seniors and their families are proven, effective measures that have demonstrated a reduction in elder falls."

Physicians' role

Last year, the geriatric society released new clinical practice guidelines for fall prevention in older persons. The guidelines recommend that physicians make a habit of asking their older patients whether they have experienced falls.

"People often underestimate the seriousness of falls and fail to report them to their physicians until injury and disability has already occurred," said Laurence Rubenstein, MD, who chaired the expert panel that developed the guidelines. "Once the history is established, then the doctor can determine if the cause is environmental or if there are more serious underlying health concerns, such as a heart condition or impaired neurological function."

Fractures make up two-thirds of Medicare injury-related spending.

Some private health plans serving Medicare beneficiaries have instituted their own preventive measures.

Group Health Cooperative, a nonprofit health plan in Seattle, has developed a fitness program for seniors aimed at improving overall health, including preventing falls. The cooperative serves more than 60,000 beneficiaries through its Medicare+Choice plan.

According to Christine Himes, MD, GHC director of geriatrics, the cooperative can invest in preventive programs because it receives the Medicare+Choice premium for each senior up front.

"Simply stated, when you are not paid on an encounter-by-encounter or procedure-by-procedure basis, you can shift your focus to include longer-term improvement in health outcomes," Dr. Himes said.

Using a geriatric assessment with accompanying interventions and follow-up by a nurse practitioner, GHC assessed its members 70 or older who were participating in the exercise program. The program has led to a 72% reduction in utilization, Dr. Himes said.

Building on the evidence from the fitness program, GHC now offers its Medicare+Choice enrollees health club memberships so they can take special senior-focused fitness classes. The company is also asking its physicians to write "exercise prescriptions" for all of their senior patients and to conduct regular follow-up on their progress.

ADDITIONAL INFORMATION:

Injuries in the elderly

Fractures accounted for two-thirds of Medicare fee-for-service spending for injuries in 1999.

Fractures: 67%
Open wounds: 11%
Internal injuries: 6%
Sprains/strains: 4%
Contusions/superficial injuries: 3%
Dislocations: 2%
All other injuries: 7%

Source: Health Affairs

Weblink

Abstract, "Medicare Spending For Injured Elders: Are There Opportunities For Savings?" Health Affairs, November-December, in pdf

Report, "Guideline for the Prevention of Falls in Older Persons," American Geriatrics Society, in pdf (http://www.americangeriatrics.org/products/positionpapers/Falls.pdf)