Comorbidity and the Concentration of Healthcare Expenditures in Older Patients with Heart Failure

OBJECTIVES: To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. DESIGN: Retrospective analysis of older fee‐for‐service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. SETTING: Variety of clinical settings. PARTICIPANTS: One thousand two hundred sixty‐six older HF patients from a nationally representative survey. MEASUREMENTS: Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. RESULTS: Medicare spent an average of $16,514 on medical reimbursement for each HF patient in 1996. Eighty‐one percent of patients had one or more comorbid diseases according to a 17‐disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more‐expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure $26,954), myocardial infarction (16% of patients, mean total expenditure $29,867), renal disease (8% of patients, mean total expenditure $33,014), and hemiplegia or paraplegia (5% of patients, mean total expenditure $33,234). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. CONCLUSION: Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.