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Volume 9 - July 2017

Medicare Fee-For-Service Beneficiaries with Disabilities, by End Stage Renal Disease Status, 2014

Key Findings:
  • 54.2% of the Medicare beneficiaries with disabilities and ESRD had six or more chronic conditions as compared to 20.5% of the beneficiaries with disabilities and without ESRD.

  • Among the list of other chronic and disabling conditions, Peripheral Vascular Disease (PVD) and Pressure and Chronic Ulcers were significantly higher among Medicare beneficiaries with disabilities and ESRD (26.2% and 17.9%, respectively) compared to beneficiaries with disabilities and without ESRD (9.7% and 5.2%, respectively).

  • Among hospitalized beneficiaries, the Medicare beneficiaries with disabilities and ESRD had higher rates of 30-day hospital readmissions (33.8%) and were high utilizers (32.8%) compared to beneficiaries with disabilities and without ESRD (17.3% and 19.9%, respectively).

Data Source: 2014 Medicare Chronic Conditions Data Warehouse (CCW), Centers for Medicare & Medicaid Services

Introduction

According to 2014 data from the U.S. Census Bureau, American Community Survey (ACS), 12.6% of U.S. adults have disabilities.[1] Several studies have shown that adults with disabilities have poor health and poor outcomes.[2,3] Adults with disabilities are four times more likely to report their health to be fair or poor than people with no disabilities (40.3% vs 9.9%).[3] A subset of adults with disabilities also have End Stage Renal Disease (ESRD). ESRD is the last stage of chronic kidney disease (CKD), when the kidneys fail to function permanently. Similar to adults with disabilities, those with ESRD are at risk for poor outcomes. For example, compared with patients without renal disease, ESRD patients are at high risk for mortality, hospitalization and subsequent readmission to the hospital.[4] Readmission rates for ESRD patients are extremely high and are twice that of the general Medicare population.[3] Not only are the outcomes worse for Medicare beneficiaries with ESRD, but Medicare spending for ESRD is disproportionately high. Even though the ESRD population constitutes less than 1% of the Medicare population, between 2013 and 2014 Medicare Fee-for-Service (FFS) spending for beneficiaries with ESRD rose by 3.3%, from $31.8 billion to $32.8 billion, accounting for 7.2% of the overall Medicare paid claims costs.[5]

Currently, there is lack of information that describes people with disabilities who also have ESRD. Due to this gap in literature regarding this unique and vulnerable population, it is important to describe and study their characteristics and outcomes. A better understanding is crucial to increase their quality of life, have better outcomes, and decrease cost. Using data from the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse (CCW), this report describes Medicare beneficiaries by disability and ESRD status. Disability was defined by using the Original Reason for Entitlement Code (OREC) which is determined after an individual has received Social Security Disability benefits for 24 months and is then reported to CMS. Data from the U.S. Census Bureau was used to report on the Federal Poverty Level.

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References

  1. Kraus, Lewis (2015). 2015 Disability Statistics Annual Report. Durham, NH: University of New Hampshire https://disabilitycompendium.org/annualreport

  2. Havercamp SM, Scandlin D, Roth M. Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Rep. 2004; 119(4):418e426. http://dx.doi.org/10.1016/j.phr.2004.05.006

  3. Altman BM, Bernstein A. Disability and Health in the United States, 2001-2005. Hyattsville, MD: National Center for Health Statistics; 2008. https://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf

  4. Mathew AT, Strippoli GFM, Ruospo M, and Fishbane S. Reducing hospital readmissions in patients with end-stage kidney disease. Kidney International 2015; 88: 1250-1260.

  5. United States Renal Data System. 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2016.



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07/21/2017 09:49 AM