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Additionally, both home health care and skilled nursing facilities (SNFs) now receive payments based on episodes of care with scales designed specifically for those types of services. Pharmacy benefits, as well as managed care options through private insurance companies, have also been added to the Medicare program. This complicated Medicare payment structure supports a silo delivery system wherein each provider is focused on one episode of care within a defined period of time. For hospitals, the focus is on a single hospitalization.
Most beneficiaries lived in urban areas (76%), had annual household incomes between $15,000 and $25,000 (22%; CMS 2002), and had some form of supplemental insurance coverage (90%). Their chronic illnesses were arthritis (55%) and hypertension (55%), and they had no ADL or IADL limitations (CMS 2002). Medicare spent an average of $8,865 in 2006 for their health care services (MedPAC 2010b). 2. 2 Selected Characteristics of the Medicare Population Characteristic Gender Male Female Race Caucasian African American Hispanic Other Age Categories < 65 years 65–74 years 75–84 years 85+ years Not Married Less than high school Household income below poverty level Medicaid eligible Lives alone Lives in rural area Health rated fair/poor Chronic Illnesses Hypertension Arthritis Obesity Heart disease Pulmonary disease Cancer (any) Diabetes Osteoporosis Stroke Alzheimer’s disease Prior healthcare use Any ER visit 2+ ER visits Any hospital admission 2+ hospital admissions Percent of Population 44 56 78 9 8 5 15 42 31 13 44 27 15 16 28 24 30 55 55 31 30 22 21 18 15 11 4 23 9 33 6 Sources: CMS 2002; Federal Interagency Forum on Aging-Related Statistics 2008; NCHS 2010; MedPAC 2010b.
Different physicians, and some were warned by a pharmacist about a potentially harmful interaction between medications prescribed for them by one or more of their physicians. Poor communication patterns were prominent among providers and chronically ill adults and their caregivers (AARP 2009b). Common problems included that the provider did not have all the needed information when the patient arrived for the visit, the patient and/or caregiver did not understand what they had been told by the provider, and they were not told the purpose of or how to take a newly prescribed medication.