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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Christine E. Bishop, PhD1, Daniel Gilden, MS2, Rosemarie B. Hakim, PhD3, Jacobus Blom, PhD1, Joanna Kubisiak, MPH2, and Deborah W Garnick, ScD1. (1) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA 02454, 781/736-3942, bishop@brandeis.edu, (2) JEN Associates Inc., 5 Bigelow Street, Cambridge, MA 02139, (3) Office of Strategic Planning, Research & Evaluation Group, Div. of Beneficiary Research, Centers for Medicare and Medicaid Services, 7500 Security Blvd., Mail Stop: C3-19-07, Baltimore, MD 21244-1850
The potential impact of focused injury prevention efforts cannot be estimated without information on external cause of injury. Injuries are a major cause of morbidity, mortality and disability for persons aged 65 and older, and result in substantial expense to Medicare. Cause-of-injury information, from death certificates, emergency departments, and hospitals, relies on provider coding of cause of injury. For a random sample (N=1,428,770) of fee-for-service Medicare beneficiaries aged 65+, beneficiaries with incident injury diagnoses (ICD-9 800 to 995) were identified from 1998 Medicare claims for all provider types. Cause-of-injury codes (E codes) were identified for beneficiaries. Approximately two-thirds of the beneficiaries with injuries did not have any associated E code identifying a cause of injury. The rate of missing E codes is high for serious injuries (e.g. fracture of the femur, 54% missing) and hospitalized injuries as well as for less serious injuries. Although 37 states required E-codes on hospital discharge records in 1998, injury hospital claims from these states were only somewhat more likely to include an E code (62% vs. 51%). The rate of E code reporting differs by injury diagnosis for men and women. When claims for so many beneficiaries receiving injury-probable diagnoses do not report any cause of injury, estimates of incidence by cause that rely on the same provider sources are called into question. Improving the reporting of cause of injury would provide Medicare with the opportunity to target injury prevention by cause and beneficiary characteristics, and thus to contain Medicare expenditures.
Learning Objectives:
Keywords: Injury, Medicare
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.