Medical Care Cost of Medicare/Medicaid Beneficiaries with Vision Loss

We analyzed the public use data set of the Program of All-Inclusive Care for the Elderly (PACE) whose participants are all eligible for Medicaid and Medicare Parts A & B and are at least age 55 to determine if Medicare/Medicaid beneficiaries with vision impairment are at an increased risk for medical care cost than are similar beneficiaries without visual impairment. Hierarchical Condition Category (HCC) risk adjustors were calculated using diagnosis codes from the populations' inpatient admissions. Vision impairment was defined as “Cannot see at all or sees some light or shadows but vision is so poor that the participant is not able to see obstacles in his or her path” which means that to be considered visually impaired, a participant would most likely be legally blind. Other studies have shown that severe vision loss, whether itself, as comorbidity, or as sequelae of disease processes, increases healthcare cost. This analysis provides evidence that PACE participants with severe visual impairment are at an increased risk for healthcare cost. The increase in medical cost risk overall for visually impaired PACE participants was 10%, but rose to 13% for the non-institutionalized, community-based, cohort. For PACE participants in institutions i.e., nursing homes, the risk was about the same for those with and without, vision loss. Health care cost risk attributable to vision loss is probably not adequately captured by Medicare HCC risk adjustment method which may understate the excess health care cost by individuals with severe visual impairment.