Key Findings


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Hospitals

  • The average cost for an outpatient (OP) visit rose from $275 in 1995 to $500 in 2016, adjusting for inflation. In addition, the number of OP visits per 1,000 people increased from 1,817 in 1999 to 2,312 in 2016.
  • In 2017, U.S. hospitals treated nearly 8 million inpatient (IP) lipid disorder cases. Diabetes mellitus cases treated in the OP setting numbered 44.3 million.
  • For the majority of integrated delivery networks (IDNs), IP case counts for breast cancer, depression, diabetes mellitus, and lipid disorders climbed from 2016 to 2017.
  • In 2017, Medicare outpatient (OP) charges per case were highest for acute coronary syndromes (ACS) in 2017 ($10,618) across the 12 disease states shown; such charges for depression were second highest ($6,274).
  • Nationally in 2017, IDN lipid disorder patients were more likely than such non-IDN patients to be dispensed a statin (48.5% versus 46.4%).

Physicians

  • From 2009 to 2017, the number of new office visits per 1,000 Medicare-eligible patients surged nationally from 485 to 826. Among such patients with six or more comorbidities, this measure nearly doubled, from 558 to 1,008.
  • Hawaii (4.3) was the only state to receive an average group-level Star Rating above 4.0 for Diabetes: Eye Exam—National Quality Strategy, a notably higher rating than the national average (2.9).
  • The Midwest was the only region to record an increase in the share of patients with uncontrolled A1c levels from 2015 (15.9%) to 2017 (16.7%).
  • Across all regions in 2017, among lipid disorder patients with LDL-C levels ≥70 or ≥100 mg/dL, the shares of patients not on statins were higher than for those of such patients taking one statin.
  • Rheumatoid arthritis patients across the nation visited a rheumatologist (4.4 visits) more often than they did a primary care provider (3.9) in 2017.

ACOs

  • From 2016 to 2018, the numbers of Medicare Shared Savings Program Accountable Care Organizations (ACOs) and Next Generation ACOs both increased.
  • Across all Next Generation ACOs in performance year 2017 (PY 2017), nearly 16% of diabetes patients had A1c levels greater than 9.0%.
  • In PY 2017, 14 of the 25 largest Next Generation ACOs had all-cause unplanned admissions for diabetes patients that topped the national average (54.0).
  • Regionally in PY 2017, the Northeast had the fewest number of Next Generation ACOs, yet it had the largest proportion (31.2%) of the nation's
    1.2 million Medicare beneficiaries.
  • In this most recent performance year, the West region coordinated care for the lowest average number of beneficiaries per Next Generation ACO, but was the only region to experience losses—owing nearly $1 million to Medicare.

Long-Term Care

  • Total health expenditures for nursing care facilities and continuing care retirement communities climbed from $158.1 billion in 2015 to $166.3 billion in 2017, and are projected to surpass $200 billion in 2021.
  • Among common chronic conditions treated in the IP setting, multiple sclerosis cases were most likely to be discharged to skilled nursing facilities (SNFs) in 2017.
  • From 2015 to 2016, U.S. SNF averages for number of stays, length of stay, charges, and Medicare payment all declined.
  • Across the top 10 states with the most nursing homes, those in Missouri recorded the highest average share of long-stay residents who experienced a fall with major injury (4.3%) as of Q2 2018.
  • In 2018, more than one-quarter (25.4%) of nursing homes across the nation had at least one of the five deficiencies (F-tags) within the Necessary Care and Services group. For-profit nursing homes recorded the highest share (27.4%).

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