Frailty, Equity, and Medicare Costs
Authors: Mohammad Habibullah Pulok, Kenneth Rockwood
Journal: Annals of Internal Medicine (2020)

Editorials21 April 2020Frailty, Equity, and Medicare CostsMohammad Habibullah Pulok, PhD and Kenneth Rockwood, MDMohammad Habibullah Pulok, PhDNova Scotia Health Authority, Halifax, Nova Scotia, Canada (M.H.P.)Search for more papers by this author and Kenneth Rockwood, MDDalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (K.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-0873 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Fair payment for work is an intuitive idea, even if a disputed one. Procedures for paying fair value where market mechanisms do not fully operate must strive, among other goals, to offer nonarbitrariness. This includes mechanisms to offer greater reimbursement for patients with more complex needs. Such procedures must also stay alert to perverse incentives. These considerations inform efficient use of limited health care resources—a fiscal challenge for government that can stem from population aging (1). Medicare's multiple interests in value-based payment include paying equitably for complex care, minimizing disincentives to care for patients in greatest need, and promoting standards ...References1. Han L, Clegg A, Doran T, et al. The impact of frailty on healthcare resource use: a longitudinal analysis using the Clinical Practice Research Datalink in England. Age Ageing. 2019;48:665-671. [PMID: 31297511] doi:10.1093/ageing/afz088 CrossrefMedlineGoogle Scholar2. Johnston KJ, Wen H, Joynt Maddox KE. Relationship of a claims-based frailty index to annualized Medicare costs. A cohort study. Ann Intern Med. 2020;172:533-40. doi:10.7326/M19-3261 LinkGoogle Scholar3. Vaupel JW, Manton KG, Stallard E. The impact of heterogeneity in individual frailty on the dynamics of mortality. Demography. 1979;16:439-54. [PMID: 510638] CrossrefMedlineGoogle Scholar4. Fried LP, Tangen CM, Walston J, et al; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-56. [PMID: 11253156] CrossrefMedlineGoogle Scholar5. Rockwood K, Howlett SE. Age-related deficit accumulation and the diseases of ageing. Mech Ageing Dev. 2019;180:107-116. [PMID: 31002924] doi:10.1016/j.mad.2019.04.005 CrossrefMedlineGoogle Scholar6. Hajek A, Bock JO, Saum KU, et al. Frailty and healthcare costs—longitudinal results of a prospective cohort study. Age Ageing. 2018;47:233-241. [PMID: 29036424] doi:10.1093/ageing/afx157 CrossrefMedlineGoogle Scholar7. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323-36. [PMID: 12806071] CrossrefMedlineGoogle Scholar8. Rutenberg AD, Mitnitski AB, Farrell SG, et al. Unifying aging and frailty through complex dynamical networks. Exp Gerontol. 2018;107:126-129. [PMID: 28847723] doi:10.1016/j.exger.2017.08.027 CrossrefMedlineGoogle Scholar9. Ellis HL, Wan B, Yeung M, et al. Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results. CMAJ. 2020;192:E3-E8. [PMID: 31907228] doi:10.1503/cmaj.190952 CrossrefMedlineGoogle Scholar10. Ellis G, Gardner M, Tsiachristas A, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017;9:CD006211. [PMID: 28898390] doi:10.1002/14651858.CD006211.pub3 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (M.H.P.)Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (K.R.)Financial Support: Dr. Pulok receives support from the Canadian Frailty Network through program grant TG2015-24. Dr. Rockwood receives career support from the Dalhousie Medical Research Fund as the Kathryn Allen Weldon Professor of Alzheimer Research.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0873.Corresponding Author: Kenneth Rockwood, MD, 5955 Veterans' Memorial Lane, Suite 1421 Veterans' Memorial Building, Halifax, Nova Scotia B3H 2E1, Canada; e-mail, kenneth.[email protected]ca.Current Author Addresses: Dr. Pulok: 5955 Veterans' Memorial Lane, Suite 1314 Veterans' Memorial Building, Halifax, Nova Scotia B3H 2E1, Canada.Dr. Rockwood: 5955 Veterans' Memorial Lane, Suite 1421 Veterans' Memorial Building, Halifax, Nova Scotia B3H 2E1, Canada.This article was published at Annals.org on 7 April 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRelationship of a Claims-Based Frailty Index to Annualized Medicare Costs Kenton J. Johnston , Hefei Wen , and Karen E. Joynt Maddox Metrics Cited byClinical characteristics of older patients with COVID-19: a systematic review of case reportsClaims-based frailty index improves Medicare cost predictions 21 April 2020Volume 172, Issue 8Page: 562-563KeywordsAgingDisclosureFrailtyGeriatric rehabilitationHealth careMedicareMotivationPatientsRehabilitation medicineRunning ePublished: 7 April 2020 Issue Published: 21 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...