NEW ORLEANS — Medicare beneficiaries with heart failure see an average of 16–23 different physicians annually, depending upon the severity of their heart failure.
This finding, based on extrapolation from fiscal year 2005 data on a representative sample of more than 1.7 million Medicare beneficiaries, underscores the need to develop systems and processes of coordinated care for the nation's more than 5 million heart failure patients, Robert L. Page II, Pharm.D., said at the annual scientific sessions of the American Heart Association.
Better-coordinated care is the key to avoiding duplication of services, improving care, and reining in health care costs in the heart failure population. In 2005, patients with heart failure accounted for 37% of all Medicare spending and nearly 50% of all inpatient costs, added Dr. Page of the University of Colorado, Denver.
The overall Medicare population, more than 34 million strong, saw an average of 7.9 different physicians in 2005. In contrast, Medicare beneficiaries with mild heart failure saw an average of 15.9 physicians that year. Those with moderate heart failure saw an average of 18.6 different physicians, while the more than 537,000 patients with severe heart failure saw an average of 23. The average number of physicians who ordered care for these patients ranged from 8.3 to 11.2, depending on heart failure severity.
Heart failure patients saw an average of 5.8–11 different physicians in the inpatient setting over the course of the year. Only 10% of all outpatient physician visits by patients with mild heart failure were specifically for their heart failure. Among patients with moderate or severe heart failure, this figure was 20%. The other 80%-90% of outpatient visits were driven largely by the numerous comorbidities present in the heart failure population. (See box.)
Close to half of all outpatient care for Medicare beneficiaries with heart failure was provided by internists and family physicians. Cardiologists handled 16%-20% of all outpatient visits, with the proportion climbing as severity of heart failure increased.
As severity of heart failure increased, so did total costs of care and the proportion of those costs devoted to inpatient or emergency department care. There were significant racial and sex differences in this spending. For example, total 2005 costs of care in black men with mild, moderate, and severe heart failure averaged $35,106, $43,536, and $55,457, respectively, compared with $26,433, $30,536, and $44,433 in white men. Costs in black women with heart failure were lower than in black men but higher than in white men. Costs in white women were lowest of all.
ELESEVIER GLOBAL MEDICAL NEWS