A D A T A B O O K

Health Care Spending and the

Medicare Program

J U N E 2 0 1 1

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Introduction MedPAC’s Data Book is the result of discussions with congressional staff members regarding ways that MedPAC can better support them. It contains the type of information that MedPAC provides in publications like the March and June reports; it also combines data from other sources, such as CMS. The format is condensed into tables and figures with brief discussion. Website links to MedPAC publications and other websites are included on a “Web links” page at the end of each section. The Data Book provides information on national health care and Medicare spending as well as Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care in the Medicare program, and Medicare beneficiary and other payer liability. It also examines provider settings—such as hospitals and post-acute care—and presents data on Medicare spending, beneficiaries’ access to care in the setting (measured by the number of beneficiaries using the service, number of providers, volume of services, length of stay, or through direct surveys) and the sector’s Medicare profit margins, if applicable. In addition, it covers the Medicare Advantage program and prescription drug coverage for Medicare beneficiaries, including Part D. Several charts in this Data Book use data from the Medicare Current Beneficiary Survey (MCBS). We use the MCBS to compare beneficiary groups with different characteristics. The MCBS is a survey, so expenditure amounts that we show may not match actual Medicare expenditure amounts. Changes in aggregate spending among the fee-for-service sectors presented in this Data Book reflect changes in Medicare enrollment between the traditional fee-for-service program and Medicare Advantage. Increased enrollment in Medicare Advantage may be a significant factor in instances in which Medicare spending in a given sector has leveled off or even declined. In these instances, fee-for-service spending per capita may present a more complete picture of spending changes. We produce a limited number of printed copies of this report. It is, however, available through the MedPAC website: www.medpac.gov.

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Table of contents Introduction .............................................................................................................................. iii Sections 1 National health care and Medicare spending .............................................................. 1 1-1 Aggregate Medicare spending among FFS beneficiaries, by sector, 2000–2009 ................................... 3 1-2 Per capita Medicare spending among FFS beneficiaries, by sector, 2000–2009 .................................... 4 1-3 Medicare made up over one-fifth of spending on personal health care in 2009 ...................................... 5 1-4 Medicare’s share of total spending varies by type of service, 2009 ........................................................ 6 1-5 Health care spending has grown more rapidly than GDP, with public financing

making up nearly half of all funding ......................................................................................................... 7 1-6 Trustees project Medicare spending to increase as a share of GDP ........................................................ 8 1-7 Changes in spending per enrollee, Medicare and private health insurance ............................................. 9 1-8 Trustees and CBO project Medicare spending to grow at an annual average rate of

between 5.5 percent and 6 percent over the next 10 years .................................................................... 10 1-9 Medicare spending is concentrated in certain services and has shifted over time ................................ 11 1-10 FFS program spending is highly concentrated in a small group of beneficiaries, 2007 ...................... 12 1-11 Medicare HI trust fund is projected to be insolvent in 2024 under actuaries’

intermediate assumptions ...................................................................................................................... 13 1-12 Medicare faces serious challenges with long-term financing ............................................................... 14 1-13 Average monthly SMI premiums and cost sharing are projected to grow faster than

the average monthly Social Security benefit ......................................................................................... 15 1-14 Medicare HI and SMI program payments and cost sharing per beneficiary in 2009 ........................... 16

Web links ................................................................................................................................................. 17 2 Medicare beneficiary demographics ........................................................................... 19 2-1 Aged beneficiaries account for the greatest share of the Medicare population

and program spending, 2007 .................................................................................................................. 21 2-2 Medicare enrollment and spending by age group, 2007 ....................................................................... 22 2-3 Beneficiaries who report being in poor health account for a disproportionate share

of Medicare spending, 2007 ................................................................................................................... 23 2-4 Enrollment in the Medicare program is projected to grow rapidly in the next 20 years ...................... 24 2-5 Characteristics of the Medicare population, 2007 ................................................................................. 25 2-6 Characteristics of the Medicare population, by rural and urban residence, 2007 ................................. 26 Web links ................................................................................................................................................. 27 3 Dual-eligible beneficiaries ............................................................................................ 29 3-1 Dual-eligible beneficiaries account for a disproportionate share of Medicare spending, 2007 ........... 31 3-2 Dual-eligible beneficiaries are more likely than non-dual eligibles to be disabled, 2007 ................... 32

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3-3 Dual-eligible beneficiaries are more likely than non-dual eligibles to report poorer health status, 2007 ....................................................................................................................... 33

3-4 Demographic differences between dual-eligible beneficiaries and non-dual eligibles, 2007 .............. 34 3-5 Differences in spending and service use rate between dual-eligible beneficiaries

and non-dual eligibles, 2007 .................................................................................................................. 35 3-6 Both Medicare and total spending are concentrated among dual-eligible beneficiaries, 2007 ............ 36 Web links ...................................................................................................................................... 37 4 Quality of care in the Medicare program ................................................................... 39 4-1  Most in-hospital and 30-day postdischarge mortality rates improved from 2006 to 2009 .................. 41 4-2  Hospital inpatient patient safety indicators improved or were stable from 2006 to 2009 .................... 42 4-3  Most ambulatory care quality indicators improved or were stable from 2007 to 2009 ....................... 43 4-4  Risk-adjusted SNF quality measures show mixed results since 2000 .................................................. 44 4-5  Share of home health patients with positive outcomes has grown, but increases have leveled off ..... 45 4-6  Dialysis quality of care: Some measures show progress, others need improvement ........................... 46 4-7  Medicare Advantage quality measures were generally stable between 2009 and 2010 ...................... 47  Web links ................................................................................................................................................. 49 5 Medicare beneficiary and other payer financial liability ......................................... 51 5-1 Sources of supplemental coverage among noninstitutionalized Medicare beneficiaries, 2007 ........... 53 5-2 Sources of supplemental coverage among noninstitutionalized Medicare beneficiaries, by

beneficiaries’ characteristics, 2007 ........................................................................................................ 54 5-3 Total spending on health care services for noninstitutionalized FFS Medicare beneficiaries,

by source of payment, 2007 ................................................................................................................... 55 5-4 Per capita total spending on health care services among noninstitutionalized FFS

beneficiaries, by source of payment, 2007 ............................................................................................ 56 5-5 Variation in and composition of total spending among noninstitutionalized FFS beneficiaries,

by type of supplemental coverage, 2007 ............................................................................................... 57 5-6 Out-of-pocket spending for premiums and health services per beneficiary,

by insurance and health status, 2007 ...................................................................................................... 58

Web links ...................................................................................................................................... 59 6 Acute inpatient services ............................................................................................... 61

Short–term hospitals 6-1 Annual changes in number of acute care hospitals participating in the

Medicare program, 2000–2009 .............................................................................................................. 63 6-2 Percent change in hospital employment, by occupation, 2007–2009 ................................................... 64 6-3 Growth in Medicare’s FFS payments for hospital inpatient and outpatient services, 1999–2009 ...... 65 6-4 Proportion of Medicare acute care hospital inpatient discharges by hospital group, 2009 .................. 66 6-5 Major diagnostic categories with highest volume, fiscal year 2009 ..................................................... 67 6-6 Cumulative change in total admissions and total outpatient visits, 1999–2009 ................................... 68

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6-7 Cumulative change in Medicare outpatient services and inpatient discharges per FFS beneficiary, 2004–2009 .............................................................................................................................................. 69

6-8 Trends in Medicare inpatient and non-Medicare inpatient length of stay, 1999–2009 ........................ 70 6-9 Source of inpatient hospital admissions, 2000–2009 ............................................................................ 71 6-10 Share of Medicare Part A beneficiaries with at least one hospitalization, 2000–2009 ........................ 72 6-11 Hospital occupancy rates, 1999–2009 ................................................................................................... 73 6-12 Medicare inpatient payments, by source and hospital group, 2009 ...................................................... 74 6-13 Medicare acute IPPS margin, 1994–2009 ............................................................................................. 75 6-14 Medicare acute IPPS margin, by urban and rural location, 1994–2009 ............................................... 76 6-15 Overall Medicare margin, 1997–2009 ................................................................................................... 77 6-16 Overall Medicare margin, by urban and rural location, 1997–2009 ..................................................... 78 6-17 Hospital total all-payer margin, 1994–2009 .......................................................................................... 79 6-18 Hospital total all-payer margin, by urban and rural location, 1994–2009 ............................................ 80 6-19 Hospital total all-payer margin, by teaching status, 1994–2009 ........................................................... 81 6-20 Medicare margins by teaching and disproportionate share status, 2009 .............................................. 82 6-21 Financial pressure leads to lower costs .................................................................................................. 83 6-22 Change in Medicare hospital inpatient costs per discharge and private payer

payment-to-cost ratio, 1987–2009 ......................................................................................................... 84 6-23 Markup of charges over costs for Medicare services, 1998–2009 ........................................................ 85 6-24 Number of CAHs, 1999–2011 ............................................................................................................... 86

Specialty psychiatric facilities 6-25 Medicare payments to inpatient psychiatric facilities, 2001–2010 ....................................................... 87 6-26 Number of inpatient psychiatric facility cases has fallen under the PPS, 2002–2009 ........................ 88 6-27 Inpatient psychiatric facilities, 2003–2009 ............................................................................................ 89 6-28 One diagnosis accounted for almost three-quarters of IPF cases in 2009 ............................................ 90 6-29 IPF discharges by beneficiary characteristics, 2009 .............................................................................. 91 Web links ................................................................................................................................................. 92 7 Ambulatory care .......................................................................................................... 93

Physicians 7-1 Medicare spending per FFS beneficiary on physician fee-schedule services, 2000–2010 .................. 95 7-2 Volume growth has raised physician spending more than input prices and

payment updates, 2000–2009 ................................................................................................................. 96 7-3 Most beneficiaries report that they can always or usually get timely care, 2010 ................................. 97 7-4 Medicare beneficiaries report better ability to get timely appointments with physicians,

compared with privately insured individuals, 2007–2010 .................................................................... 98 7-5 Medicare and privately insured patients who are looking for a new physician report

more difficulty finding one in primary care, 2007–2010 ...................................................................... 99 7-6 Access to physician care is better for Medicare beneficiaries compared with privately insured

individuals, but minorities in both groups report problems more frequently, 2010 ........................... 100 7-7 Differences in access to new physicians are most apparent among minority Medicare

and privately insured patients who are looking for a new specialist, 2010 ........................................ 101 7-8 Continued growth in volume of physician services per beneficiary, 2000–2009 .............................. 102 7-9 Shifts in the volume of physician services, by type of service, 2004–2009 ....................................... 103 7-10 Changes in physicians’ professional liability insurance premiums, 2003–2010 ................................ 104

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Hospital outpatient services 7-11 Spending on all hospital outpatient services, 2000–2010 ................................................................... 105 7-12 Most hospitals provide outpatient services .......................................................................................... 106 7-13 Payments and volume of services under the Medicare hospital outpatient PPS, by type

of service, 2009 ..................................................................................................................................... 107 7-14 Hospital outpatient services with the highest Medicare expenditures, 2009 ...................................... 108 7-15 Medicare coinsurance rates, by type of hospital outpatient service, 2009 .......................................... 109 7-16 Effects of hold-harmless and SCH transfer payments on hospitals’ outpatient

revenue, 2007–2009 ............................................................................................................................. 110 7-17 Medicare hospital outpatient, inpatient, and overall Medicare margins, 2003–2009 ......................... 111 7-18 Number of observation hours has increased, 2006–2009 ................................................................... 112

Ambulatory surgical centers 7-19 Number of Medicare-certified ASCs increased by 41 percent, 2003–2010 ....................................... 113

Imaging services 7-20 Medicare spending for imaging services under the physician fee schedule, by type

of service, 2004 and 2009 .................................................................................................................... 114 7-21 Radiologists received nearly half of physician fee-schedule payments for

imaging services, 2009 ...................................................................................................................... 115 Web links .............................................................................................................................................. 116 8 Post-acute care ........................................................................................................... 119 8-1 Number of most post-acute care providers grew or remained stable in 2010 .................................... 121 8-2 Medicare’s spending on home health care and skilled nursing facilities fueled growth

in FFS post-acute care expenditures .................................................................................................... 122

Skilled nursing facilities 8-3 Since 2005, the share of Medicare stays and payments going to freestanding SNFs

and for-profit SNFs has increased ........................................................................................................ 123 8-4 Small declines in SNF days and admissions between 2008 and 2009 ............................................... 124 8-5 Case mix in freestanding SNFs shifted toward rehabilitation plus extensive services

RUGs and away from other broad RUG categories ............................................................................ 125 8-6 Freestanding SNF Medicare margins have exceeded 10 percent for seven years ............................. 126 8-7 Freestanding SNFs with relatively low costs and high quality maintained

high Medicare margins ......................................................................................................................... 127

Home health agencies 8-8 Spending for home health care, 1994–2010 ........................................................................................ 128 8-9 Provision of home health care changed after the prospective payment system started ...................... 129 8-10 Trends in provision of home health care ............................................................................................. 130 8-11 Margins for freestanding home health agencies .................................................................................. 131

Inpatient rehabilitation facilities 8-12 Most common types of inpatient rehabilitation facility cases, 2010 ................................................... 132 8-13 Volume of IRF FFS patients remained stable in 2009, after declining from 2004 to 2007 ............... 133 8-14 Overall IRFs’ payments per case have risen faster than costs, post-PPS ........................................... 134 8-15 Inpatient rehabilitation facilities’ Medicare margin by type, 2001–2009 ........................................... 135

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Long-term care hospitals 8-16 Top MS–LTC–DRGs made up more than half of LTCH discharges in 2009 ................................... 136 8-17 LTCH spending per FFS beneficiary has increased under PPS .......................................................... 137 8-18 LTCHs’ per case payment rose more quickly than costs in 2009 ....................................................... 138 8-19 LTCHs’ Medicare margins by type of facility .................................................................................... 139 8-20 LTCHs in the top quartile of Medicare margins in 2009 had much lower costs ................................ 140 Web links .............................................................................................................................................. 141 9 Medicare Advantage .................................................................................................. 143 9-1 MA plans available to virtually all Medicare beneficiaries ............................................................ 145 9-2 Access to zero-premium plans with MA drug coverage, 2006–2011 ............................................. 146 9-3 Enrollment in MA plans, 1994–2011 .............................................................................................. 147 9-4 Changes in enrollment vary among major plan types ..................................................................... 148 9-5 MA and cost plan enrollment by state and type of plan, 2011 ........................................................ 149 9-6 MA plan benchmarks, bids, and Medicare program payments relative to FFS spending, 2011 ... 150 9-7 Enrollment in employer group MA plans, 2006–2011 ................................................................... 151 9-8 Number of special needs plans continues to decline from 2008 peak ............................................ 152 9-9 Number of SNPs decreased while SNP enrollment rose from 2010 to 2011 ................................. 153 Web links .............................................................................................................................................. 154 10 Prescription drugs ...................................................................................................... 155 10-1 Medicare spending for Part B drugs administered in physicians’ offices or

furnished by suppliers .......................................................................................................................... 157 10-2 Top 10 Part B drugs administered in physicians’ offices or furnished by suppliers,

by share of expenditures, 2009............................................................................................................. 158 10-3 In 2010, about 90 percent of Medicare beneficiaries were enrolled in Part D plans or

had other sources of creditable drug coverage .................................................................................... 159 10-4 Parameters of the defined standard benefit increase over time ........................................................... 160 10-5 Characteristics of Medicare PDPs ....................................................................................................... 161 10-6 Characteristics of MA–PDs ................................................................................................................. 162 10-7 Average Part D premiums .................................................................................................................... 163 10-8 Number of PDPs qualifying as premium-free to LIS enrollees increased in 2011, even

as overall number of PDPs declined .................................................................................................... 164 10-9 In 2011, most Part D enrollees are in plans that charge higher copayments for

nonpreferred brand-name drugs ........................................................................................................... 165 10-10 In 2011, use of utilization management tools continues to increase for both PDPs

and MA–PDs ........................................................................................................................................ 166 10-11 Characteristics of Part D enrollees, 2009 ............................................................................................. 167 10-12 Part D enrollment trends, 2006–2009 .................................................................................................. 168 10-13 Part D enrollment by region, 2009 ....................................................................................................... 169 10-14 The majority of Part D spending is incurred by fewer than half of all Part D enrollees, 2009 .......... 170 10-15 Characteristics of Part D enrollees, by spending levels, 2009 ............................................................ 171 10-16 Part D spending and utilization per enrollee, 2009.............................................................................. 172 10-17 Part D risk scores vary across regions, by plan type and by LIS status, 2009 .................................... 173

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10-18 Part D spending varies across regions even after controlling for prices and health status, 2009 ....... 175 10-19 Top 15 therapeutic classes of drugs under Part D, by spending and volume, 2009 .......................... 176 10-20 Generic dispensing rate for the top 15 therapeutic classes, by plan type, 2009 .................................. 177 10-21 Generic dispensing rate for the top 15 therapeutic classes, by LIS status, 2009 ................................ 178 10-22 Pharmacies participating in Part D, 2009 ............................................................................................ 179 10-23 Prescriptions dispensed, by pharmacy characteristics and urbanicity, 2009 ...................................... 180 Web links .............................................................................................................................................. 182 11 Other services ............................................................................................................. 183

Dialysis 11-1 Number of dialysis facilities is growing and share of for-profit and freestanding

dialysis providers is increasing ............................................................................................................ 185 11-2 Medicare spending for outpatient dialysis services furnished by freestanding and

hospital-based dialysis facilities, 2004 and 2009................................................................................. 186 11-3 Dialysis facilities’ capacity increased between 2000 and 2010 .......................................................... 187 11-4 Characteristics of dialysis patients, by type of facility, 2009 .............................................................. 188 11-5 The ESRD population is growing, and most ESRD patients undergo dialysis .................................. 189 11-6 Diabetics, the elderly, Asian Americans, and Hispanics are among the fastest growing

segments of the ESRD population ....................................................................................................... 190 11-7 Aggregate margins vary by type of freestanding dialysis facility, 2009............................................. 191

Hospice 11-8 Medicare hospice use and spending grew substantially from 2000 to 2009 ...................................... 192 11-9 Hospice use increased across beneficiary groups from 2000 to 2009 ................................................ 193 11-10 Number of Medicare-participating hospices has increased, largely driven by for-profit hospices .... 194 11-11 Hospice cases and length of stay, by diagnosis, 2008 ........................................................................ 195 11-12 Long hospice stays are getting longer, while short stays remain virtually unchanged,

2000 and 2009 ...................................................................................................................................... 196 11-13 Hospice average length of stay among decedents, by beneficiary and hospice

characteristics, 2008 ............................................................................................................................. 197 11-14 Hospice aggregate Medicare margins, 2002–2008 ............................................................................. 198 11-15 Medicare margins are higher among hospices with more long stays, 2008 ....................................... 199 11-16 Hospices that exceeded Medicare’s annual payment cap, selected years ........................................... 200 11-17 Length-of-stay and live discharge rates for above- and below-cap hospices, 2008 ........................... 201 11-18 Hospice cap is unrelated to use of hospice services across states, 2008 ............................................. 202

Clinical laboratory 11-19 Medicare spending for clinical laboratory services, fiscal years 2000–2010 ..................................... 203 Web links .............................................................................................................................................. 204

 

 

S E C T I O N

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e spending

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sharing are projwith 2.8 percenanent productivlans.

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community, well as expenn all health cayment; it pay, an averagem the level inse living in in

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mployment iore than 5 m

employed b007 to 2009occupations

nce staff at hwth of this ocord systems

censed vocatin the numb

cent (8,540 Lemployed by

a shift toward

al emplo

Total Uemploy(May 2

5,174,

30,55,

182,57,95,

102,127,

1,492,13,

646,759,158,

ployment Statistic

we observed

ncreased 4.million individ

by the hospit9, at 11.1 pers, such as ra

hospitals incrccupation ms in hospitals

tional nursesber of individLPNs and LVy hospitals id nurses with

oyment, b

U.S. yment 2009)

,240

,490,180,870,230,250,230,820,000,970,110,580,390

cs data set as of

last year.

1 percent. Bduals.

tal industry inrcent. Growtadiology tec

reased rapiday be relate

s.

s (LVNs) weduals employVNs). Duringncreased 5.h a higher le

by

Percent chantotal employ

(2007–20

4.1%

11.110.2

8.88.68.48.16.55.95.51.91.6

–5.2

December 2010

By the end o

ncreased moth was also hnicians (6.5

dly from Mayed to the surg

ere among thyed by hospg the same t9 percent

evel of trainin

nge in yment 009)

%

0.

f this

ore

5

y ge in

he itals ime

ng.

Chart

Note: FF(Pbygrin

Source: C • Aggre

outpaincre

• A freespen2004beneMore

• Outpayearsspenspen

• Outpa

$590

0

20

40

60

80

100

120

140

160

180

200

Bill

ions

of d

olla

rs

6-3. Gin

FS (fee-for-servicPPS); psychiatricy the outpatient Prowth in spendingcluded in these a

MS, Office of the

egate Medicatient spendased about

eze in inpatiding growth but revertedficiaries swit

e rapid paym

atient spends. In 1999, oding; in 2009ding.

atient spend in 1999, a 9

95 9

18 1

1999 20

OutpatieInpatien

A

Growth innpatient

ce). Analysis inc, rehabilitation, lo

PPS; and other og was slowed in aggregate totals.

e Actuary.

care fee-for-sing was $362 percent, w

ent paymenfrom 1999 t

d to relativeltched from t

ment growth r

ding has incrutpatient sp9, outpatient

ding per FFS93 percent in

96 105

821

000 2001

entt

Data Book: He

n Medicaand outp

ludes inpatient song-term care, coutpatient service2006 by large in.

service (FFS6 billion in 20while outpatie

t rates in theto 2000. Spey slow growraditional FFresumed in 2

reased as a ending accot spending g

S beneficiaryncrease.

114 11

21 2

2002 20

ealth care spen

are’s FFSpatient s

ervices covered ancer, and childres. Payments inccreases in the nu

S) inpatient s009. From 20ent spending

e Balanced Bending increa

wth from 2005FS Medicare2008 for inpa

share of totaounted for algrew to more

y was about

19 126

2326

003 2004Calendar y

nding and the M

S paymenservices,

by the acute inpren’s hospitals aclude program ouumber of Medica

spending wa008 to 2009g increased

Budget Act oased substa5 to 2007 bee to the Medatient and o

al hospital-bmost 16 per

e than 20 pe

$1,133 in 20

133 13

29 2

2005 20year

Medicare progr

nts for h 1999–20

patient prospectivnd units; outpatieutlays and benefare Advantage en

as $142 billio, inpatient spabout 10 pe

of 1997 reduantially betweecause a laricare Advanutpatient se

based spendrcent of all hercent of tota

009, up from

34 135

29 31

006 2007

ram, June 2011

ospital 009

ve payment systeent services covficiary cost sharinnrollees, who are

on and pending ercent.

uced inpatieeen 2001 anrge number ontage prograrvices.

ding in the laospital

al hospital

m approxima

139 1

33 3

2008 20

1 65

em ered ng. The e not

nt nd of

am.

st 10

tely

42

36

009

66 Acute

Chart

Hospital g All PPS hand CAHs PPS hosp Urban

Large uOther u

Rural (exc

Rural reSole coMedicarOther ruOther ru

VoluntaryProprietarGovernme Major teacOther teacNonteach CAHs Note: PP

inmhoCto

Source: M • In 20

prospmoreprima

• Appro(ruraldepefacilitincre

• Abou2009

e inpatient serv

6-4. Pd

group

ospitals s

pitals

rban rban

cluding CAHseferral mmunity re dependentural <50 bedsural >50 beds

ry ent

ching ching ing

PS (prospective patient PPS alonillion. Major teac

ospitals have a rahart 6-24 for mor those with comp

edPAC analysis

09, 3,370 hopective payme than 0.4 miarily due to a

oximately 15l referral cenndent hospities account ased approx

ut 88 percent. Collectively

vices

roportioischarge

Numb

4,6

3,3

2,41,31,0

s) 913

t 1s 1s 1

1,985

27

2,3

1,2

payment systemng with CAHs. Mching hospitals aratio below 0.25. re information abplete hospital cos

of PPS impact f

ospitals provment systemillion dischara shift in serv

5 percent of nters, sole cotals (MDHs)for more tha

ximately 1 pe

t of rural hosy, these four

on of Medes by hos

Hospitals

ber Sh

660

370

402 310 092

968 124 394 195 102 153

969 824 577

269 762 339

290

m), CAH (critical aaryland hospitalsre defined by a rData are limited

bout CAHs. Numst reports in 2009

iles and Medicar

vided 10.4 m (IPPS) andrges. The nuvices from th

all hospitalsommunity ho)) intended toan 11 percenercent from

spitals were r types of ho

dicare acspital gr

hare of total

100.0%

72.3

51.628.123.4

20.82.78.54.22.23.3

42.317.712.4

5.816.450.2

27.7

access hospital).s are excluded. Latio of interns anto providers withbers may not su9.

re cost report dat

million discha 1,290 critica

umber of PPhe inpatient

s are coveredospitals (SCo help rural fnt of all disc2008 to 200

CAHs, SCHospitals prov

cute careroup, 200

Nu(thou

. Analysis includeLarge urban areand residents to beh complete cost rm to totals due t

ta from CMS.

arges under al access ho

PS dischargeto the outpa

d by three sCHs), and sm

facilities thacharges. The09.

Hs, MDHs, ovide 86 perce

e hospita09

Medicare dumber usands)

10,781

10,373

8,896 4,877 4,020

1,477 386 602 216

47 226

7,442 1,637 1,294

1,572 3,732 5,070

408

es all hospitals cas have populatioeds of at least 0.reports in the CMto rounding. Sam

Medicare’s ospitals (CAes declined fatient setting

pecial paymmall rural Me

t are not CAe number of

r rural referrent of all rura

al inpatie

discharges

Share of t

100.

96.

82.45.37.

13.3.5.2.0.2.

69.15.12.

14.34.47.

3.

covered by Medicons of more than.25. Other teachi

MS database. Semple of hospitals

acute inpatieHs) providedfrom 2008 g.

ment provisiodicare-

AHs; these these hospit

ral centers inal discharge

ent

total

.0%

.2

.5

.2

.3

.7

.6

.6

.0

.4

.1

.0

.2

.0

.6

.6

.0

.8

care’s n 1 ing

ee limited

ent d

ons

tals

n es.

Chart

MDC number 5 4 8 6 1 11 18 10 7 9 Note: M Source: M • In fisc

disch

• Circuperce

• Resp

• Musc

6-5. Mfis

MDC name

Circulatory

Respirator Musculoskand conne

Digestive Nervous s

Kidney an

Infectious

Endocrinemetabolic disorders

Hepatobiliand pancr Skin, subctissue, and

Total

DC (major diagn

edPAC analysis

cal year 200harges at hos

ulatory systeent of surgic

piratory syste

culoskeletal

A

Major diagscal yea

e

y system

ry system

keletal systemective tissue

system

system

d urinary trac

and parasitic

e, nutritional, adiseases and

ary system reas

cutaneous d breast

nostic category).

of MedPAR data

09, 10 major spitals paid

m cases accal cases.

em cases ac

system case

Data Book: He

gnostic car 2009

m

ct

c diseases

and d

Numbers may no

a from CMS.

diagnostic cunder the ac

counted for a

ccounted for

es accounted

ealth care spen

categori

Shadisc

ot sum to totals d

categories acute inpatien

about one-q

nearly 20 p

d for 34 perc

nding and the M

es with h

are of allcharges

25%

14

12

11

8

7

5

4

3

3

92

due to rounding.

accounted font prospectiv

quarter of me

ercent of me

cent of surgi

Medicare progr

highest v

Share of medical

discharges

23%

19

4

11

9

8

6

5

2

3

91

or 92 percentve payment

edical cases

edical discha

ical discharg

ram, June 2011

volume,

Sharesurg

discha

27

3

34

10

5

4

2

2

4

2

93

t of all system.

s and almost

arges.

ges.

1 67

e of ical

arges

7%

3

4

0

5

4

2

2

4

2

3

t 30

68 Acute

Chart

Note: C

ou Source: Am • Hosp

servicwhile

• Therehosp

• The cpoints

• The cfrom decre

0

5

10

15

20

25

30

35

Perc

ent

e inpatient serv

6-6. Co

umulative changutpatient visits at

merican Hospita

pital outpatiece use. Tota

e total admis

e were 641 mitals in 2009

cumulative ps from 2008

cumulative p2008 to 200

ease in the la

0.0

2

0.0

5

1999 20

ToTo

vices

Cumulativutpatien

e is the total pert about 5,000 com

l Association, AH

nt service usal hospital ousions grew n

million outpa9.

percent chan to 2009, or

percent chan09, or more tast 10 years

.3

4.5.3

8.7

000 2001

otal admissionotal outpatient

ve changt visits,

rcent increase frommunity hospital

HA Hospital Stati

se grew mucutpatient visinearly 10 pe

atient visits a

nge in total onearly 18 m

nge in inpatiethan 230,000s. Inpatient a

6.57

12.313

2002 20

nst visits

ge in tota1999–20

om 1999 throughls.

stics.

ch more rapits increased

ercent.

and nearly 3

outpatient vismillion visits.

ent admissio0 admissionadmission de

.58.4

3.715.4

003 2004Fiscal yea

al admis009

h 2009. Data are

pidly from 19d about 30 p

36 million ad

sits increase

ons decreass. It was theeclined only

8.9 9

18.0

21

2005 20ar

sions an

admissions (all

999 to 2009 tpercent from

missions to

ed by nearly

ed by 0.7 pee largest sing

slightly from

.3 9.2

1.0 21.8

006 2007

nd total

payers) to and

than inpatien 1999 to 200

community

4 percentag

ercentage pogle-year

m 2006 to 20

10.5 9

26.0

29

2008 20

nt 09,

ge

oint

007.

9.8

9.6

009

Chart

Note: FF

ho Source: M • From

benerelativ

• Fromthan

• Toge

settin

-10

-5

0

5

10

15

20

25

Perc

ent

6-7. Can20

FS (fee-for-servicospitals.

edPAC analysis

m 2004 to 200ficiary declinvely flat, but

m 2004 to 20023 percent.

ether these twng.

0.00.0

2004

OuFF

InpFF

A

Cumulativnd inpat004–200

ce). Data are for

of MedPAR and

09, the numned 4.2 perct beginning i

09, the num

wo trends su

4.1

0.3

2005

utpatient servFS beneficiary

patient dischaFS beneficiary

Data Book: He

ve changient disc9

short-term gene

d hospital outpati

ber of Mediccent. From 2n 2007, the

ber of outpa

uggest a shif

8

0

5 20

ices pery

arges pery

ealth care spen

ge in Medcharges

eral and surgical

ent claims data f

care inpatien004 to 2006volume of d

atient service

ft in services

.5

.2

006Calendar ye

nding and the M

dicare oper FFS

hospitals, includ

from CMS.

nt discharge6, inpatient vdischarges b

es per FFS b

s from the in

14.8

-1.1

2007ear

Medicare progr

utpatienbenefici

ding critical acces

es per fee-forvolume per began to dec

beneficiary in

npatient to th

18.2

-2.0

2008

ram, June 2011

t serviceiary,

ss and children’s

r-service (FFbeneficiary wcline.

ncreased mo

he outpatient

23.2

-4.2

2009

1 69

es

s

FS) was

ore

t

70 Acute

Chart

Note: Le

pr Source: M

• Leng

inpat

• Lengdays

• Lengbetwe

0

1

2

3

4

5

6

Inpa

tient

day

s

e inpatient serv

6-8. Tin

ength of stay is crospective payme

edPAC analysis

th of stay foients in 2009

th of stay foin 2009, dro

th of stay foeen 1999 an

5.41 5.3

3.97 3.96

1999 200

vices

rends innpatient

calculated from dent system. Excl

of Medicare cos

r Medicare i9.

r Medicare iopping at an

r all non-Mend 2009.

1 5.23

6 3.95

0 2001

Medicarlength o

ischarges and pudes critical acc

st report data from

npatients wa

npatients feaverage an

edicare inpat

5.20 5.1

3.95 3.9

2002 200

re inpatieof stay, 19

atient days for mess hospitals.

m CMS.

as nearly 1 d

ll nearly 12 pnnual rate of

tients remain

13 5.06

96 3.91

03 2004

Fiscal yea

ent and 999–200

more than 3,000 h

day longer th

percent, from1.2 percent

ned nearly u

5.00 4.

3.91 3.

2005 20

ar

non-Med09

hospitals covered

han for non-

m 5.41 dayst from 1999 t

nchanged a

.93 4.91

.90 3.91

006 2007

Medicare be

Non-Medicar

dicare

d by the acute in

-Medicare

in 1999 to 4to 2009.

at 3.96 days

4.89 4

3.95 3

2008 2

neficiaries

re beneficiarie

npatient

4.78

4.78

3.96

2009

es

Chart

Note: “Opr

Source: M

• Hosp

hospihospiphysic

• The sfrom a

• The sfrom a

• Desp

benefperce

• On a

184 pIn con2000 from a2000

0

10

20

30

40

50

60

70

80

90

100

2

Shar

e of

adm

issi

ons

(per

cent

)

6-9. Sou

Other” includes crovider, transfer f

edPAC analysis

itals report thtal emergenctalized patiencian. Note tha

share of Mediapproximately

share of Mediapproximately

ite accountingficiaries admitent, a 25 perce

per beneficiaper 1,000 benntrast, admissto 108 per 1,a transfer fromto 21 per 1,0

50.1

39.8

5.34.8

0

0

0

0

0

0

0

0

0

0

0

2000 200

Emergen

A

urce of in

linic referral, heafrom within the s

of MedPAR data

at most Medicy rooms or dnts were admat not all eme

care beneficiay 50 percent

care beneficiay 40 percent

g for a relativetted as transfent increase.

ary basis, admeficiaries in 2sions from dir000 beneficiam another ho00 beneficiar

01 2002

ncy room

Data Book: He

npatient

alth maintenanceame hospital, co

a from CMS.

care beneficiirectly from a itted through

ergency room

aries admittedto 58 percent

aries admittedto 30 percent

ely smaller shfers from othe

missions throu2000 to 205 prect physicianaries in 2009,ospital increasries in 2009, a

2003

Physician re

ealth care spen

hospital

e organization, traourt/legal, and no

aries they adreferring phythe emergen admissions a

d to the hospt from 2000 to

d to the hospt from 2000 to

hare of all admer acute care

ugh the emerger 1,000 bene

n referral decla 26.5 perce

sed from appra 20.3 percen

2004 2

Fiscal ye

eferral Ot

nding and the M

admissi

ansfer from skilleo information.

dmit as inpatieysician. In 200cy room and are emergenc

pital through tho 2009, nearly

pital through ao 2009, a 24

missions, thehospitals incr

gency room ieficiaries in 2ined from 147

ent decline. Inroximately 18nt increase.

2005 200

ear

ther Tran

Medicare progr

ions, 200

ed nursing facility

ents are admi09, nearly 58 30 percent thcy situations.

he emergency a 15 percen

a referring phypercent decre

share of Medreased from 4

ncreased from2009, an 11.4 7 per 1,000 b

n addition, adm8 per 1,000 be

06 2007

nsfer from oth

ram, June 2011

00–2009

y, transfer from o

itted through percent of

hrough a

cy room increant increase.

ysician declinease.

dicare 4.8 percent to

m approximapercent incre

beneficiaries imissions resueneficiaries in

5

3

66

2008

her hospital

1 71

other

ased

ned

o 6

ately ease. n ulting n

57.5

30.2

.3

.0

2009

72 Acute

Chart

Note: An

as Source: M

• The s

hosp2009cover

• Sincecare to thebene3.8 p

20.0

20.5

21.0

21.5

22.0

22.5

23.0

23.5

24.0

24.5

25.0

Perc

ent

e inpatient serv

6-10. So

nalysis excludess critical access h

edPAC analysis

share of Meditalization in , approximared under Pa

e 2005, the dmay be in p

e outpatient ficiary declinercent, resp

23.4

0

5

0

5

0

5

0

5

0

5

0

2000

vices

hare of Mne hosp

Medicare Advanhospitals and ho

of MedPAR data

dicare benefa given yeately 22 percart A.

decline in theart attributabsetting. In th

ned more rapectively.

23.4 23

2001 200

Medicareitalizatio

ntage claims andspitals located in

a from CMS.

ficiaries withar declined bent of Medic

e share of Mble to the raphe inpatient spidly than m

3.423.1

02 2003

e Part A on, 2000–

d claims for non–n Maryland.

h Part A coveby 1.5 percencare benefic

Medicare Parpid shift of ssetting, the

medical cases

23.42

2004 2Fiscal ye

benefici–2009

–inpatient prospe

erage who hntage points

ciaries had a

rt A beneficisurgical casenumber of ss from 2005

23.623.5

2005 2006ear

aries wit

ective payment sy

had at least os from 2005 t least one in

aries using ies from the isurgical case5 to 2009, at

23.0

6 2007

th at leas

ystem hospitals,

one inpatiento 2009. In npatient stay

inpatient hosnpatient sett

es per 9.3 percent

22.7

22.

2008 200

st

such

nt

y

spital ting

and

1

09

Chart

Note: PP

avstin en

Source: M • In the

perceperce

• Occuat 68differ

• Occu

includbed s

0

10

20

30

40

50

60

70

80

Occ

upan

cy ra

te (p

erce

nt)

6-11. H

PS (prospective vailable bed daysaffed for inpatieneach unit on a g

nd of 2009.

edPAC analysis

e aggregate,ent or 66 perent. Earlier in

upancy rates percent for

rence.

upancy ratesde outpatienspace.

64 65

49 50

61 61

1999 200

A

Hospital o

payment systems in the hospital ont service (i.e., thgiven day. Hospit

of data from the

, hospitals’ orcent each yn the decade

s are higher urban hosp

s may undersnt observatio

5 65

0 51

1 62

00 2001

Data Book: He

occupan

m). Hospital occupover the reportin

he units are opentals’ group desig

e American Hosp

occupancy rayear from 20e, hospital o

in urban thaitals and 49

state overallon cases, wh

67 68

51 52

63 64

2002 200

ealth care spen

cy rates

pancy rate is meg period. Bed da

n and operating),nations for the e

ital Association A

ates have be04 to 2009.

occupancy ra

n in rural hopercent for

facility occuhich are often

8 68

2 52

4 65

03 2004Fiscal yea

nding and the M

s, 1999–2

easured as total iays available are but the beds ma

entire 1999–2009

Annual Survey o

een relativelIn 2009, occ

ates hovered

ospitals; in 20rural hospita

upancy leveln placed in b

69 69

53 52

66 65

2005 200r

Medicare progr

2009

inpatient days ase based on beds ay not be staffed9 period are base

of Hospitals.

y stable at acupancy rated around the

009, occupaals, a 19 per

ls because tbeds counte

9 68

2 51

5 65

06 2007

URA

ram, June 2011

s a percent of totthat are set up a

d for a full patiented on their status

around 65 es were 65 e low 60s.

ancy rates strcentage poi

they do not ed as inpatie

69 68

50 49

66 65

2008 200

Urban PPSRural PPSAll hospitals

1 73

tal and t load s at the

tood int

ent

8

9

5

09

74 Acute

Chart

Hospital g All hospi Urban Rural Large urOther urbRural refSole comMedicareOther rurOther rur VoluntaryProprietaGovernm

Major teaOther teaNonteac

Note: IM

acgrin ho10*PPP

Source: M

• Medicathan $1hospitacare.

• Speciaadditioprograhospitapayme

• The SCthe subhospitaincreas

• Outlieroutlier plus ouannual

e inpatient serv

6-12. Mg

group

tals

ban ban ferral mmunity e dependent ral <50 beds ral >50 beds

y ary ment

aching aching hing

ME (indirect medicute inpatient proraduate medical 2009. Excludes

ospital categories00 percent due toPayments receivePS. A few sole c

edPAC analysis

are inpatient pay110 billion. Abouals. This figure d

al payments—whnal payments toms—account foals (14.3 percenents.

CH and MDH cabgroup of SCHsal payments wassed in 2009 as a

r payments accopayments uses

utlier payments. l goal of 5.1 perc

vices

Medicare roup, 20

Base

81.1%

80.5 85.7

78.8 82.8 89.1 81.9 85.2 91.5 90.6

81.6 84.3 74.6

66.3 83.0 87.4

ical education), Dospective paymeeducation paymecritical access h

s include facilitieo rounding. ed by sole commommunity hospit

of claims and im

yments in 2009 tut $99 billion (90does not reflect m

hich include indio rural hospitals r 19 percent of at). This definition

ategories above and MDHs paids higher, 20.7 pea result of the re

ounted for 3.6 pea different calcuMeasured in thi

cent.

inpatien09

Percent

IME

5.0%

5.50.7

6.63.91.10.90.00.20.4

5.31.37.0

16.13.70.0

DSH (disproportient system (PPS)ents. Simulated p

hospitals and thes paid at either t

munity and Medictals are located i

mpact file data fro

to hospitals cove0 percent) was pmore than $2.7 b

rect medical eduthrough the soleall inpatient paymn of special paym

include hospitald at the hospital-ercent for SCHs basing of cost-b

ercent of total inpulation, displayins way, CMS’s o

nt payme

of total paym

DSH

9.4%

9.85.4

10.39.27.92.57.87.37.0

8.5

11.112.5

12.29.37.9

onate share). An). Includes both opayments reflectir special paymehe special nonfe

care-dependent hn urban areas.

om CMS.

ered by the acutpaid to hospitals billion in paymen

ucation, disprope community hosments. This propments does not

s paid at either t-specific rate, theand 11.4 perce

based payment r

patient paymentng outlier paymeoutlier share ratio

ents, by s

ments

AdOutlier

3.6%

3.91.2

4.23.52.00.61.11.12.0

3.62.94.3

5.33.42.8

nalysis includes aoperating and cat 2009 payment r

ents. Sole commuederal rate or the

hospitals beyond

te inpatient proslocated in urbannts to critical acc

ortionate share,spital (SCH) andportion is higherinclude wage in

the hospital-spee share of paymnt for MDHs. Adrates to a more c

ts in 2009. The lents as a ratio ofo was 5.3 percen

source a

dditional rurahospital*

1.0%

0.3 7.0

0.1 0.7 0.0

14.2 5.9 0.0 0.0

1.0 0.5 1.6

0.1 0.6 1.9

all hospitals coveapital payments brules applied to aunity hospital and

e federal rate. Ro

d what would hav

spective paymenn areas and $11cess hospitals (C

, and outlier payd Medicare-deper for urban (19.5ndex adjustment

ecific rate or the ments described dditional rural hocurrent year.

egislative mandf outlier paymennt in fiscal year 2

and hosp

Total payme

(millio

$110,

98,11,

57,41,

3,5,1,

1,

80,15,14,

24,40,45,

ered by Medicarebut excludes direactual number ofd Medicare-depe

ows may not sum

ve been received

nt system totaled.4 billion went to

CAHs) for inpati

yments as well aendent hospital percent) than fo

ts or CAHs’ cost

federal rate. Amas additional ru

ospital payments

ate for the level ts to base paym2009, close to th

pital

al ents ns)

019

622 396

018 604 173 039 420 262 501

072 418 528

756 191 072

e’s ect f cases endent

m to

d under

d more o rural ent

s (MDH) or rural -based

mong ral

s

of ments he

Chart

Note: PP

onco

Source: M • Medi

Mediinfluedata how o

• The Mimpleover Medipoints

• Mediinpatthat wperfohad p

-10

-5

0

5

10

15

20

Mar

gin

(per

cent

)

6-13. M

PS (prospective n Medicare-allowovered by the ac

edPAC analysis

care’s acutecare’s inpati

enced by howfor all majoroverhead co

Medicare inpementation othe next 10 care paymes from 2008

care inpatienient marginswere –17.9 pormance betwpositive inpa

3.6

9.0

1994 1995

A

Medicare

payment systemwable costs and eute care inpatien

of Medicare cos

e inpatient mient hospitalw hospitals ar services caosts are alloc

patient margof the Balancyears as cosnts. In 2009.

nt margins vs that were 7percent or loween the top

atient Medica

14.7

18.01

1996 1997 1

Data Book: He

acute in

m). A margin is caexclude critical ant PPS.

st report data (Au

margin reflectprospective

allocate ovean we estimacated (see C

gin reached aced Budget Asts rose fast, the margin

vary widely. 7.9 percent oower. This rap and bottomare margins

15.9

13.712

1998 1999 20

ealth care spen

npatient P

alculated as reveccess hospitals.

ugust 2010) from

ts paymentse payment syrhead costs

ate MedicareChart 6-15).

a record highAct of 1997,ter than the

n was –2.4 p

In 2009, oneor higher, anange amountm quartiles inin 2009.

2.010.4

6.6

000 2001 200Fiscal ye

nding and the M

PPS mar

enue minus costsMedicare acute

m CMS.

s and costs fystem. The i across serv

e costs witho

h of 18.0 pe however, in3 percent avercent, up m

e-quarter of nd another qts to a 26 pen 2009. Fort

6

2.4

-0.3

02 2003 2004ar

Medicare progr

rgin, 199

s, divided by reveinpatient margin

for services cinpatient mavice lines. Oout the poten

ercent in 199npatient marverage annu

more than 2

hospitals hauarter had in

ercentage poty-two perce

-0.5-2.2

4 2005 2006

ram, June 2011

94–2009

enue. Data are bn includes service

covered by argin may benly by combntial influenc

97. After rgins declineual increase percentage

ad Medicare npatient maoint differenc

ent of hospita

-3.7-4.7

-

2007 2008 2

1 75

based es

e bining ce of

ed in

rgins ce in als

-2.4

2009

76 Acute

Chart

Note: PP

onco

Source: M • Urba

hospmarg

• The gOne fcontr2001margthe mresperesultnumbfrom

4

-

-10

-5

0

5

10

15

20

25

1

Mar

gin

(per

cent

)

e inpatient serv

6-14. Mru

PS (prospective n Medicare-allowovered by the ac

edPAC analysis

n hospitals hitals, but thisins are lowe

gap betweenfactor in thisrolling cost g to 2004, theins were slig

margins of ruectively. Thet of paymentber of criticathe prospec

4.0

9.5

15

0.3

4.4

9

994 1995 19

vices

Medicare ural loca

payment systemwable costs and eute care inpatien

of Medicare cos

historically hs difference er than those

n urban and s divergencegrowth, at leae difference ghtly higher

ural and urbae narrowing bt policies tarl access hos

ctive paymen

5.3

18.816

9.711.3

8.

996 1997 199

acute ination, 199

m). A margin is caexclude critical ant PPS.

st report data (Au

had much hignarrowed ea

e for rural ho

rural hospitae in this perioast partly in narrowed anthan those f

an hospitals between thergeted at raisspitals, whicnt system.

6.814.6

13.

36.0

4.1

98 1999 200

npatient P94–2009

alculated as reveccess hospitals.

ugust 2010) from

gher Medicaarlier in this ospitals.

als’ inpatienod is that urbresponse to nd from 200for urban honarrowed fu

ese two grousing rural hoh removed m

011.1

7.2

1 3.91.6

00 2001 2002Fiscal yea

PPS mar

enue minus costsMedicare acute

m CMS.

are inpatient decade and

t margins grban hospital pressures f

04 to 2008 ruspitals. In 20

urther, to –2.ups of hospitospital paymmany rural h

2.6

-0.40.6

0.5

2 2003 2004ar

rgin, by u

s, divided by reveinpatient margin

margins thad today urban

rew betweens had greatefrom manageural hospitals009, the diffe.2 percent antals from 200

ments and grohospitals with

-0.5-2.2

0.2-1.6

4 2005 2006

urban an

enue. Data are bn includes service

an rural n hospital

n 1994 and 2er success ined care. Fros’ inpatient erence betwnd –2.4 perc01 to 2004 isowth in the h low margin

-3.8-4.9

-2.8 -3.7

2007 2008 2

UrbRu

nd

based es

2000. n

om

ween cent, s the

ns

-2.4

-2.2

2009

banral

Chart

Note: A

exined

Source: M • The o

outpaservicavaila

• The o–5.2

• In 20anothdifferpointsperce

-10

-5

0

5

10

15

Mar

gin

(per

cent)

6-15. O

margin is calculaxclude critical accpatient psychiatrducation and bad

edPAC analysis

overall Mediatient, skilledces as well aable only sin

overall Medipercent.

09, one-quaher quarter hrence in perfs to 22 percent of hospit

11.9

8.5

1997 1998

A

Overall M

ated as revenue cess hospitals. Oric and rehabilitatd debts. Data on

of Medicare cos

care margind nursing, hoas direct grance 1997, bu

care margin

arter of hosphad marginsformance beentage poinals had posi

6.35

8 1999 20

Data Book: He

edicare

minus costs, divOverall Medicaretion unit, skilled noverall Medicare

st report data (Au

incorporateome health caduate medicut it follows a

in 1997 was

itals had oveof –17.3 pe

etween the tots but narrowitive overall

.3 5.2

000 2001 2

ealth care spen

margin,

vided by revenue margins cover tnursing facility, ae margins before

ugust 2010) from

es paymentscare, and inpcal educatioa trend simila

s 11.9 perce

erall Medicaercent or lowop and bottowed to 21 peMedicare m

2.2

-1.2

2002 2003Fiscal ye

nding and the M

1997–20

e. Data are basedthe costs and payand home health e 1997 are unava

m CMS.

s and costs fpatient psyc

on and bad dar to that for

ent. In fiscal

are margins ower. Betweenom quartile wercentage poargins in 20

-3.0 -3.0

2004 200ear

Medicare progr

009

d on Medicare-alyments of acute services as wel

ailable.

for acute inphiatric and r

debts. The or the inpatien

year 2009,

of 4.2 percen 2000 and 2widened fromoints in 200909.

0-4.6

-6

05 2006 20

ram, June 2011

llowable costs aninpatient, outpatl as graduate me

patient, rehabilitativeverall margint margin.

it was

nt or higher,2008, the m 17 percen9. About 36

6.0-7.1

007 2008

1 77

nd tient, edical

e n is

, and

tage

-5.2

2009

78 Acute

Chart

Note: A

exougr

Source: M • As w

hosphave

• The d199712.6 margPolicyAct orural

-10

-5

0

5

10

15

Mar

gin

(per

cent

)

e inpatient serv

6-16. Olo

margin is calculaxclude critical accutpatient, inpatieraduate medical

edPAC analysis

ith inpatient itals than forgradually be

difference in and 2000 bpercent, comin for urban y changes m

of 2003 targehospitals. F

12.6

9.4

6.2

1.7

1997 1998

vices

Overall Mocation,

ated as revenue cess hospitals. Ont psychiatric aneducation and ba

of Medicare cos

margins, ovr rural hospitegun to sligh

overall Medbut has sincempared with hospitals wa

made in the Meted to rural urther legisla

7.36.3

-1.4-2.2

1999 200

edicare 1997–20

minus costs, divOverall Medicared rehabilitation uad debts. Data o

st report data (Au

verall Medicatals, but sinchtly exceed t

dicare margie narrowed.

6.2 percentas –5.2 percMedicare Prhospitals heation to assi

3 6.0

2

2

-0.4

-2

00 2001 20

margin, 09

vided by revenue margins cover t

unit, skilled nursinon overall Medica

ugust 2010) from

are margins ce 2005 ovethose for urb

ns between In 1997, thet for rural hocent, comparescription Delped to imprist rural hosp

2.8

-0.9

2.3-3.9

002 2003Fiscal yea

by urban

e. Data are basedthe costs and payng facility, and hare margins befo

m CMS.

historically werall Medicarban hospital

urban and re overall marspitals. In 20red with –4.

Drug, Improvrove the relapitals was im

-3.0

-3.1-3.3

-2.8

2004 2005ar

n and ru

d on Medicare-alyments of acute ome health serv

ore 1997 are una

were higher re margins fos.

rural hospitargin for urba009, the ove9 percent fo

vement, and ative financiamplemented

-4.7-6.

-4.5-5.

2006 200

ral

llowable costs anhospital inpatienices as well as d

available.

for urban or rural hosp

als grew betwn hospitals

erall Medicaror rural hosp

Modernizatial position ofafter 2008.

0-7.2

-

3-6.3

-

07 2008 2

UrbRur

nd nt, direct

pitals

ween was re itals. ion f

-5.2

-4.9

009

banral

Chart

Note: A

al *T Source: M • The t

payeinpatnonpmarkcorremargreven

• The tpercelevel inpatagain

• In 20muchprospwhile10 pemarg

0

1

2

3

4

5

6

7

8

9

10

Mar

gin

(per

cent

)

6-17. H

margin is calculal payers, plus non

The significant dro

edPAC analysis

total hospitars⎯reflects ient, outpatieatient revenet resulted i

esponding dein and overa

nue.

total hospitaent in the 19in a decadeient prospec

n to 4.3 perc

09, 68 perceh less than thpective payme another oneercentage poins and a 21

4.6

5.8

1994 1995 1

A

Hospital t

ated as revenue mnpatient revenueop in total margin

of Medicare cos

l margin for the relationsent, post-acue such as n significantecline in totaall Medicare

l margin pea99–2002 pe

e. In 2008, thctive paymencent.

ent of hospithe Medicare

ment systeme-quarter haoints compa1 percentage

5.96.4

4

1996 1997 19

Data Book: He

total all-p

minus costs, divid. Analysis exclud

n includes investm

st report data (Au

all payers⎯ship of all houte, and noninvestment rt investment al margin. Ot

margin, are

aked in 1997eriod. From 2he total margnt system wa

tals had pose inpatient or hospitals ha

ad margins thred with a 2e point sprea

4.8

3.63.

998 1999 20

ealth care spen

payer ma

ded by revenue. Tes critical access

ment losses stem

ugust 2010) from

⎯Medicare, Mospital revennpatient servrevenues. Thlosses for h

ther types ofe operating m

7 at 6.4 perc2002 to 2007gin declined as implemen

itive total mar overall Medad total marhat were –16 percentagad for overa

.9 3.7 3.7

00 2001 200

Fiscal yea

nding and the M

argin, 19

Total margin inclus hospitals.

mming from the de

m CMS.

Medicaid, othnues to all hovices. The tohe 2008 dec

hospitals, whf margins wemargins that

cent, before d7, total margto 1.8 perce

nted. In 2009

argins. Howedicare margrgins that we.7 percent o

ge point sprell Medicare m

74.3 4.3

02 2003 2004

ar

Medicare progr

994–2009

udes all patient c

ecline of the U.S.

her governmospital costsotal margin acline of the Uhich resultede track, Med do not inclu

declining to gins increaseent, its lowes9, total marg

ever, the totin. In 2009,

ere 8.0 perceor lower, a spead for Medicmargins.

4.85.4

4 2005 2006

ram, June 2011

9

care services fund

stock market in 2

ment, and pris, including also includesU.S. stock d in a dicare inpatieude investme

less than 4 ed to the higst level sincegin increased

tal margin vaone-quarter

ent or higherpread of rougcare inpatien

6.0

1.8*

6 2007 2008

1 79

ded by

2008.

ivate

s

ent ent

ghest e the d

aried r of r, ghly nt

4.3

2009

*

80 Acute

Chart

Note: A by

*S Source: M • In 20

margrural fact tassocperfo

• In 20margby allthe Uin a cinpatinves

5

4

0

1

2

3

4

5

6

7

8

9

10

1

Mar

gin

(per

cent

)

e inpatient serv

6-18. Hlo

margin is calculay all payers, plusSignificant drop in

edPAC analysis

09, urban hoins were 4.3hospitals hahat urban hociated with u

ormance of th

08, both rurains in the lasl payers, plu

U.S. stock macorrespondinient margin

stment reven

5.5

6.87

4.5

5.7 5

994 1995 19

vices

Hospital tocation,

ated as revenue s nonpatient reven total margin inc

of Medicare cos

ospitals had 3 percent forave usually hospitals had urban hospithe U.S. stoc

al and urbanst 15 years.

us nonpatienarket resulteng decline inand overall

nue.

7.27.9

5.

5.86.2

4.

996 1997 19

total all-p1994–20

minus costs, divenue such as invecludes investmen

st report data (Au

higher totalr urban hosphad higher tohigher total als’ relativel

ck market tha

n hospitals eHospitals’ tot revenue su

ed in significan total marginMedicare ma

.65.1 5.1

.7

3.43.7

98 1999 200

payer ma09

vided by revenueestment revenuent losses resultin

ugust 2010) from

(all payer) mpitals and 3.8otal marginsmargins thay larger inveat year.

experienced otal margin iuch as invesant investmens. Other typargin, are op

14.5

3.9

7 3.6 3.6

00 2001 2002Fiscal yea

argin, by

e. Total margin ines. Analysis exclung from the U.S.

m CMS.

margins than8 percent for

s in aggregatan rural hospestment port

their lowest includes all stment revenent losses fopes of margperating mar

9

4.2

5.1

6

4.3

4.2

2 2003 2004ar

y urban a

ncludes all patienudes critical accestock market dec

n rural hospr rural hospite than urbapitals in 200tfolios and th

t level of totapatient care nues. The 20or hospitals, ins we trackrgins that do

5.7 5.9

4.75.3

4 2005 2006

and rural

nt care services fess hospitals. cline of 2008.

itals. Total tals. Historicn hospitals.9 may be he improved

al (all payer) services fun

008 decline which resul

k, Medicare o not include

5.9

2.5*

6.0

1.8*

2007 2008

RurUrb

l

funded

cally, The

nded of ted

e

3.8

4.3

2009

ralban

Chart

Note: M

horecr

*S Source: M • The p

Medihosphospcomp

• In 20moretrend

• The dhosptracknot in

-2

0

2

4

6

8

10

Mar

gin

(per

cent

)

6-19. H19

ajor teaching hoospitals have a raevenue. Total maritical access hosSignificant drop in

edPAC analysis

pattern of totcare inpatienitals have coitals. In 2009

pared with ot

07, major tee than two de

was interru

decline of thitals, which r, Medicare in

nclude inves

5.4

6.8

4.8

6.1

3.44.0

1994 1995 1

A

Hospital t994–200

spitals are defineatio of greater th

argin includes all spitals. n total margin inc

of Medicare cos

tal margins bnt and overaonsistently b9, the total mther teaching

eaching hospecades and pted by a st

e U.S. stockresulted in anpatient martment reven

7.0 7.0

56.7 6.9

5

3.4

5.0

3

996 1997 19

Data Book: He

total all-p9

ed by a ratio of inan 0 and less thapatient care serv

cludes investmen

st report data (Au

by teaching all Medicare been lower thmargin for mg hospitals a

pitals’ total (aincreased foeep decline

k market in 2a decline in hrgin and ove

nue.

5.34.6 4.

5.2

4.1 4.3.4

1.62.

998 1999 20

ealth care spen

payer ma

nterns and residean 0.25. A margivices funded by a

nt losses resultin

ugust 2010) from

status is themargins. Th

han those foajor teachinand nonteac

all payer) maor the fifth coin their inve

2008 resultedhospitals’ toterall Medicar

.6 4.9 4.8

.2 4.2 4.2

.4

1.3 1.4

00 2001 200Fiscal yea

nding and the M

argin, by

ents to beds of 0in is calculated aall payers, plus n

ng from the U.S.

m CMS.

e opposite ofhe total margor other teacg hospitals s

ching hospita

argins reachonsecutive yestment reve

d in significatal margins. re margin, a

8 5.1

4.62

4.9

5.0

4

2.53.0

02 2003 2004ar

Medicare progr

y teachin

0.25 or greater, was revenue minusnonpatient reven

stock market dec

f the patterngins for majohing and nostood at 2.4 als at 4.9 pe

hed their higyear. Howevenues.

ant investmeOther types

are operating

5.2 5.3

5.2

6.1

3.6

4.6

4 2005 2006

NoOtM

ram, June 2011

ng status

while other teachs costs, divided b

nue. Analysis exc

cline of 2008.

n for the or teaching nteaching percent

ercent each.

hest level iner, in 2008,

ent losses fos of margins g margins an

6.0

2.9*

6.7

2.3*

5.2

-0.4*

6 2007 2008

onteachingther teachingajor teaching

1 81

s,

ing by cludes

n this

or we

nd do

4.9

4.9

2.4

2009

82 Acute

Chart

Hospital g All hospita Major teacOther teacNonteach Both IME IME only DSH onlyNeither IM Note: IM Source: M • Majo

Theirfrom

• Hosp2009belowperce

e inpatient serv

6-20. Msh

group

als

ching ching ing

and DSH

ME nor DSH

ME (indirect medi

edPAC analysis

r teaching hr better finanthe indirect

pitals that rec, the Medica

w those of mentage point

vices

Medicare hare stat

Shahos

10

26

2

51

ical education), D

of 2009 Medicar

ospitals havncial performmedical edu

ceive neitheare inpatient

major teachints lower.

marginstus, 2009

are ofspitals

00%

9 21 69

26 5

53 16

DSH (disproporti

re cost report da

ve the highesmance is largucation (IME

r IME nor DSmargins of

ng hospitals a

s by teac9

Share of Medicareinpatientpayments

100%

253442

526

3110

onate share).

ta from CMS.

st Medicare ely due to th

E) and dispro

SH paymentthese hospitand overall

ching and

fe M

ins m

–

inpatient anhe additionaoportionate s

ts have the ltals were neMedicare m

d dispro

Medicare npatient margin

–2.4%

6.7–3.0–7.1

2.2–9.1–3.7

–18.1

d overall Meal payments share (DSH)

lowest Mediearly 25 percargins were

oportiona

Overal

Medicarmargin

–5.2%

–0.2–5.3–7.8

–2.4–10.3

–5.5–15.3

edicare margthey receive) adjustment

care margincentage poinmore than 1

ate

l re n

%

gins. e ts.

ns. In nts 15

Chart

Number o

FinancialNon-Medi (privateStandardi(as a shar Median Nonpro For-prof

Annual grdischarge Overall 20

Patient cTotal hospMedicare Medicaid Medicare Note: St

efco

Source: M

• HigheHospbe un

6-21. F

of hospitals

l characterisicare margin e, Medicaid, uzed cost per re of the natioof for profit afit hospital fit hospital

rowth in cost pe, 2006–2009

009 Medicare

haracteristicpital dischargshare of inpashare of inpacase mix ind

tandardized costffect of teaching aomplete cost repo

edPAC analysis

er financial ppitals with lownder financia

A

inancial

tics, 2009

uninsured) discharge

onal median) and nonprofit

per

e margin

cs (medians) es in 2009

atient days atient days ex

ts are adjusted foand low-income orts on file with C

of Medicare cos

pressure tenwer volume, al pressure.

Data Book: He

pressur

High(nonma

5

or hospital case mMedicare patien

CMS by August 2

st report and claim

nds to lead tolower case

ealth care spen

re leads tLevel of

h pressuren-Medicarergin ≤ 1%)

756

–3.8%

929292

4.3%

4.7%

5,11343%12

1.33

mix, wage index,ts on hospital co2010.

ms files from CM

o lower cost mix, and hig

nding and the M

to lower financial pres

Mepre

3

–

8,1

1

, outliers, transfeosts. The sample

MS.

growth and gher Medica

Medicare progr

costs ssure, 2004–2

ediumssure

390

2.7%

969692

4.2%

–1.1%

18342%11.45

er cases, intereste includes all hos

lower costsaid charges a

ram, June 2011

2008 Low pres(non-Medmargin >

1,747

10.7

104105

99

4.6

–10.2

7,2924310

1.45

t expense, and thspitals that had

s per discharare more like

1 83

ssure icare 5%)

7

7%

4 5 9

6%

2%

2 3% 0 5

he

rge. ely to

84 Acute

Chart

Note: Da

thpapa

Source: M

sy

• The pathe incbetwe

• Duringpatiencomplthese

• As HMpayer percen

• As prehospitgrowth

• In 200increalosses

9

1

-4

-2

0

2

4

6

8

10

12

19

Perc

ent c

hang

e in

cos

t per

dis

char

ge

e inpatient serv

6-22. Cd19

ata are for commird of observatio

ayment-to-cost raayment-to-cost ra

edPAC analysis ystem and Ameri

attern of growthcentives poseden 1987 and 2

g the first periodts (seen in the ete lack of presyears, more th

MOs and other payment-to-cont per year, wh

essure from prival cost growth h in private pay

09, the private pses. The slow

s and economic

9.2 9.4

.20

1.24

987 1989

Change i

vices

Change inischarge987−200

munity hospitals ans). Data for 200atio. The private atio for 2009 wou

of Medicare Coscan Hospital Ass

h in Medicare c by the rise an007.

d, 1987–1992, chart as a stee

ssure from privan 3 percentag

private insurersost ratio droppeich was more t

vate payers waexceeded grow

yer profit margi

payer paymentcost growth in c uncertainty. (

6.9

3.0

1.311.30

1991 1993

in Medicare a

n Medicae and pri9

and cover all hos06–2009 excludepayment-to-cost

uld be higher, at

st Report files frosociation Annual

costs per dischd fall of financi

private payersep increase in vate payers. Mege points a yea

s exerted moreed substantiallythan 2 percenta

aned after 1999wth in the markns slowed, and

t-to-cost ratio in2009 may refleSee Chart 6-17

-1.4

0.6

1.24

1.1

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Chart

APC Title Total All emergAll clinic vDiagnosticCT and CCataract pLevel I plaLower gasInsertion oLevel II exInsertion/rIMRT treaComputedTranscathCoronary Level II caLevel I upCT and CTranscathLevel II ecLevel II laMRI and mLevel III nRituximabMRI and m without Level II raAverage A Note: AP

(info

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7-14. HM

ency visits visits c cardiac cath

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adiation theraAPC

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S E C T I O N

Post-acute careSkilled nursing facilities Home health agencies

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Chart

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ow costs and goquality measure,erences in case ed community diary tract infectionto the communit

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y low costs a

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m, June 2011

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est third of the he other quality nt relative weighr five conditions nce) within 100 deases in culated for all fac

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127

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of users (in m

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Chart All Geograph Urban Rural Type of co For pro Nonpro Volume q First Second Third Fourth Fifth Source: M • In 20

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e margins a. HHAs are

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of 2008–2009 C

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agencies hahat Medicareciaries for bo

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had a weighterage margin

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ad positive me’s payment

oth rural and

As, which comand other fa

in 2009 hadatients had

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2009

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margins (notts are aboveurban home

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average maaverage mamargins the

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m, June 2011

encies Percent agencie

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131

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rm care hospy–long-term

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spendinns’ office

s administered incal equipment). Dfacilities.

ms data.

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ding

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in physician5 percent fro

eased at an e payment rof the avera

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another factopoetin alfa anearly $1 biFood and D

ed through odialysis facil

ospital outpanding and hougs in 2009.

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2002 2003

ding and the Me

art B drugnished b

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s’ offices or om the 2008

average raterate changedge sales pricn 2005. Sinc.3 percent p

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edicare program

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n 2010, awere enro

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CMS estimated tlans or had presf an employer a

ater in value than percent of each

ficiaries (nearly 2ble to receive Meecause they receecause they appf all Medicare beicare Advantage

nd-alone PDPs nare in MA–PDs

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about 90 olled in Pe drug co

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or military retireesbenefits whose v

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that 34 million oscription drug cogrees to provide

n that of Part D (h eligible individu

22 percent) receedicare and all Meive benefits throlied directly to theneficiaries) are e–Prescription D

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t

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M

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ory, February 16Coordination of B

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million, or 21 perc Medicare healtThose groups o

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ding and the Me

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Medicare Advantaprogram), VA (Dndents. or greater than t

, 2010; Office of Benefits Databas

Medicare benefiemployer-spons

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nd-alone prescrip–PDs).

cent of all Medicth plans. Individuof beneficiaries d

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airs, or current emhave other sourc

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enrollees in PDP17%

rollees in Ds

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edicare program

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age–Prescriptionepartment of Ve

that of the basic

Personnel Manase; CMS Credita

iciaries (73 percsored plans undetirees with an aedicare providesa specified range

y (LIS). Of theser state. Another

ogram or Supplen. Among all LISption drug plans

care beneficiarieuals whose empdirectly affect Me

not affect Medicthrough the Fedemployers becauces of creditable

.

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m, June 2011

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n Drug [plan]), Rterans Affairs).

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e individuals, 6.43.5 million qualimental SecurityS beneficiaries, s (PDPs) and 2 m

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care program eral Employees

use the individuae coverage.

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160 Pre

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uctible and then ches the initial coent of covered drsharing for the contal coverage filin

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h basic benebenefits—ba

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reduced costn the coverater of $2.50 t

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plans that haenefit structuurance. Or a

alent to a rateactuarially e

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fit increa

2010 2

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overed drug spenL). Before 2011, to the annual ou

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ase

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Chart

Total Type of or National Other Type of be Defined Actuaria EnhanceType of de Zero Reduced Defined Drugs cov Some ge no bran Some ge brand-n None Note: PD

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rganization *

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edPAC analysis

D drew about 3Plan sponsors

ngs is primarilyeen basic and e

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Plans

Number P

1,576

1,268 308

172 * 609

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629 374 573

ap

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35 1,268

drug plan). The xcluded plans ha

mbers of plans foially equivalent s0 and 2011.

of CMS landsca

30 percent fewes are offering 1y the result of renhanced benof all PDPs ar. Plans offeredng a slightly smand a slightly le as the definearially equivaleof PDPs includ

me gap coverag

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Data Book: Hea

ristics of 2010

EnroFeb

Numercent (in mill

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11 1.39 11.50 3.

40 6.24 2.36 8.

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PDPs and enrollve 1.6 million en

or organizations wstandard” and “ba

ape, premium, an

er stand-alone1,109 PDPs inegulations andefit plans.

re offered by spd by those natiomaller proportioarger proportio

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lth care spendi

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ollees as of bruary 2010

ber ions) Percent

6 100%

0 847 16

6 94 687 22

5 391 121 49

0 6

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lment described nrollees in 2011 a

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d guidance iss

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t Number

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464197448

259

106744

here exclude emand had 1.1 millio

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rage gap for 2-name drugs, c

o additional bection and Afforoinsurance in tme subsidy, wh

edicare program

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r Percent (

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mployer-only planon in 2010. Sum

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t have at least 2 percent of al

benefits (basic y equivalent be

nefit designs. M

2011 than in 20compared with

nefits in the cordable Care Acthe coverage ghich effectively

m, June 2011

1 Enrollees aFebruary 20

Numberin millions) Pe

17.0 1

13.9 3.0

1.3 12.6 3.0

7.3 2.1 7.6

2.2

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ns and plans offes may not add to

s.

eld for 2011 threduction in plamore clearly

1 PDP in eacll PDP enrollmplus supplemeenefits—havin

Most enrollees

010. Nearly a th about 1 in 10

overage gap. ct of 2010, gap (see Charty eliminates th

161

as of 011

ercent

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82 18

8 74 18

43 13 45

13

2 85

ered in o totals

han in an

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(74

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t 10-e

162 Pre

Chart Totals

Type of org Local HM Local PP PFFS Regional

Type of be Defined s Actuarial Enhance

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Drugs cove Some ge brand-n Some ge brand-n None Note: M

prplm

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ganization MO PO

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nefit standard ly equivalent*

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ered in the gapenerics but no name drugs enerics and somname drugs

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edPAC analysis

e are 15 percensors are offerine fee-for-servint in 2010 (seHMOs remain

nal preferred p

er share of MApare Chart 10-9 percent of M

MA–PD plans with no deducti

PDs are more ly for generics.rics but no bracoverage. Tho

s

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Number Pe

1,834 10

1,038 5

452 2304 140

78

105 1,651 9

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66 111

p

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e Advantage–Pretion), PFFS (privaed in U.S. territortals due to roundactuarially equivasic alternative” b10 and 2011.

of CMS landsca

nt fewer Medicng 1,566 MA–ce plans, make Chart 9-1). An the dominanprovider organ

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have no deduble attracted a

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ose plans acco

ristics of2010

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57 4.5 0.7 0.2 0.4

4 0.6 0.0 6.

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9 2.

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escription Drug [pate fee-for-servicries, 1876 cost pling. alent to Part D’s

benefits.

ape, premium, an

care Advantag–PDs compareking up 9 perceAlthough the n

nt kind of MA–Pizations remai

tand-alone pre10-5). In 2011,011, enhanced

ctible: 87 percabout 91 perce

Ps to provide percent of MA–g coverage andount for 54 per

f MA–PD

nrollees as of ebruary 2010

ber ions) Percent

0 100%

7 689 139 134 6

1 13 56 94

6 942 32 2

3 33

7 259 42

plan]), HMO (heace). The MA–PDlans, special nee

standard benefit

nd enrollment dat

ge–Prescriptioed with 1,834 tent of all (unwnumber of locaPD. The numbined stable be

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cent of MA–PDent of total MA–

some addition–PDs includedd 22 percent wrcent of MA–P

Ds

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t Number

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93644514639

51121

1,394

1,35812385

457

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alth maintenances and enrollmen

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t include what CM

ta.

on Drug plans the year before

weighted) offeral HMOs also ber of drug plaetween 2010 a

g plans (PDPsf all PDPs hadracted 92 perc

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nal benefits in d some gap cowith some gen

PD enrollment.

2011

ans

Percent (in

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92

38

89

8785

29

2248

e organization), Pt described herenstrations, and P

MS calls “actuari

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ans offered byand 2011.

s) offer enhancd enhanced becent of total M

011 and 90 pent in 2011.

the coverage overage—29 pnerics and som

Enrollees as oFebruary 201

Number n millions) Pe

8.6 1

5.7 1.7 0.5 0.7

0.1 0.6 7.9

7.8 0.5 0.2

3.0

1.6 3.9

PPO (preferred e exclude employPart B-only plans

ially equivalent

2011 than in 2t decrease wacompared with

ween 2010 andy both local an

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MA–PD enrollm

ercent in 2010.

gap, althoughpercent with some brand-nam

of 1

ercent

100%

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5 8

1 7

92

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36

19 46

yer-only s. Sums

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h 17 d d

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me

Chart

PDPs Basic co Enhance

covera Any cove MA–PDsincluding Basic co Enhance

covera Any cove All plans Basic co Enhance

covera Any cove

Note: PD

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overage ed age erage

s overage ed age erage

DP (prescription DPs and enrollmnrollment describnd Part B-only plReflects the portioffer Part D coveraenchmark and itsverage premiumsperation than MA

edPAC analysis

verage, Part$1 compare

average pres10—a 3 per

care Advantium attributalan’s paymealso enhancese ways, rePDPs.

portion of Meained flat (deper month.

A D

Average P

2010 nrollment n millions)

Av20w

13.0

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16.6

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24.7

drug plan), MA–ment described hebed here excludeans. on of Medicare Aage. MA–PD pres bid for providings for enhanced MA–PDs with basic

of CMS landsca

t D enrolleesed with 2010

scription drucent increas

tage–Prescrable to Part ent benchmace their Part esulting in mo

edicare Advaecrease of le

Data Book: Hea

Part D prerage monthly 010 premium weighted by

2010 enrollment

$34

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26

1314

33

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ug plan (PDPse.

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lth care spendi

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2011 enrollment (in millions)

13.9

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17.0

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25.6

Advantage–Prescloyer-only plans plans, plans offe

’ total monthly prebate dollars (75 rt B services) thalect a different m

and enrollment d

er month in 2

P) enrollee p

plans (MA–Pate dollars—id for providiith rebate doed offerings

miums attribuin 2011, with

ding and the Me

s

Average mo 2011 prem

weighted 2011

enrollme

$33

6338

27

1214

33

2630

cription Drug [plaand plans offerered in U.S. territo

remium attributapercent of the di

at were used to omix of sponsoring

data.

2011, with p

pays $38 per

PDs) can low—75 percent

ing Part A aollars. Many and lower a

utable to preh the averag

edicare program

onthly mium

by nt

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–0.

0.0.

an]), SNPs (speced in U.S. territorories, 1876 cost

ble to Part D benifference betwee

offset Part D premg organizations a

premiums inc

r month, com

wer the part of the differnd Part B seMA–PDs us

average prem

escription druge MA–PD e

m, June 2011

lar nge

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6 –

1

22

6

0

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9

2

ial needs plans).ries. The MA–PDplans, demonstr

nefits for plans then a plan’s paymmium costs. Lowand counties of

creasing by

mpared with

of their monrence betweeervices. MA–se rebate domiums comp

ug benefits enrollee pay

163

entage ge in hted rage

mium

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263

6

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–1

41

. The Ds and rations,

hat ent

wer

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$37

nthly en –PDs ollars pared

ing

164 Pre

Chart

PDP regio

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

26 27 28 29 30 31 32 33 34

Note: PD Source: M

• The nu2010 t

• Hawai

• In 201premiu

• Each r

escription drugs

10-8. Nenof

on State(s)

ME, NHCT, MANY NJ DC, DEPA, WVVA NC SC GA FL AL, TN MI OH IN, KY WI IL MO AR MS LA TX OK KS IA, MN, NE, SDNM CO AZ NV OR, WAID, UT CA HI AK Total

DP (prescription

edPAC based on

umber of stand-to 1,109 in 2011

i had the fewes

1, enrollees whum. In 2011, 33

region has at le

s

umber onrollees f PDPs d

)

H A, RI, VT

E, MD V

MT, ND, D, WY

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drug plan), LIS (

n 2011 PDP land

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st stand-alone P

ho receive Part 32 PDPs qualifie

east four PDPs

of PDPs qincrease

declined

Numbe

2010 2

43 48 50 47 45 55 44 47 47 45 49 46 46 46 44 48 46 45 49 45 45 50 46 46

46 47 48 46 46 44 48 47 41 41

1,576 1

(low-income sub

dscape file and L

tion drug plansnumber of plan

PDPs with 28; t

D’s low-incomeed to be premiu

available to LIS

qualifyined in 201

er of PDPs

2011 Differe

30 –134 –133 –133 –133 –138 –132 –133 –134 –132 –132 –134 –135 –134 –132 –132 –135 –132 –134 –132 –132 –133 –133 –133 –1

33 –132 –131 –130 –131 –132 –135 –133 –128 –129 –1

,109 –46

sidy).

LIS enrollment da

s (PDPs) declinens offered in eac

the Pennsylvan

e subsidy (LIS) um-free to thos

S enrollees at n

ng as pre11, even

Nu

ence 20

13 14 17 14 12 17 12 14 13 13 17 12 11 12 12 16 11 13 15 13 13 17 13 13

13 15 17 16 15 12 13 14 13 12 67 3

ata provided by C

ed by 30 percech region is 33

nia–West Virgin

have more optse enrollees, co

no premium.

emium-fras overa

umber of PDPs tpremium for LIS

010 2011

4 7 13 12 11 11

6 6 11 12 11 12 11 10

8 11 13 15

8 14 5 4 9 11 9 12 5 8 9 14

10 10 10 10 13 5 15 17 10 14 13 10 11 12 10 10

9 12

8 10 8 8 6 7 8 9 5 4 9 8 9 11 7 5 7 6 6 5

307 332

CMS.

ent around the ccompared with

nia region had t

tions for PDPs ompared with 30

ree to LISall numb

that have zero S enrollees

Difference

3 –1

0 0 1 1

–1 3 2 6

–1 2 3 3 5 0 0

–8 2 4

–3 1 0 3

2 0 1 1

–1 –1

2 –2 –1 –1 25

country, from 1h 46 in 2010.

he most with 38

in which they p07 in 2010.

S ber

,576 in

8.

pay no

Chart

Note: PD

enex

Source: M

su • In 20

betwewith tin pla(MA–

• For edrugsbrandmediagene

• Most all dror moand 3speci

22

18

59

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

20

10-9. Inchb

DP (prescription nrollment. All calcxclude demonstra

edPAC-sponsoreubmitted to CMS

11, 80 perceeen preferretwo generic ans with such–PD) plan en

enrollees in Ps, the mediad. The mediaan copay is ric drug.

plans, exceugs, also usore. In 201133 percent aialty tiers.

2% 19%

8%11%

9%69%

1% 1%

006 2007

A D

n 2011, mharge hirand-nam

drug plan), MA–culations excludeation programs,

ed analysis by N.

ent of prescred and nonpand two brah distinctionnrollees are

PDPs that din copay in 2an copay for$40 for a pr

ept those thase a specialty, median cos

among MA–P

17%10%

4%

1

79%87%

3%<1% <1%

2008 2009PDP enrolle

Other Two geGenerGener25% c

Data Book: Hea

most Partgher copme drugs

–PD (Medicare Ae employer-only special needs pl

NORC/Georgetow

ription drug preferred brand-name ties. Over 90 pin such plan

istinguish be2011 is $42 fr generic drureferred bran

at use the dey tier for drust sharing foPDs. Enrolle

9% 8%% 3%

81%80%

6%11%

<1%

2010 2011ees

tier structureeneric and two bic, preferred branic and brand-namoinsurance

lth care spendi

t D enrolpayments

Advantage–Prescgroups and planans, and 1876 c

wn University/Soc

plan (PDP) end-name dru

ers. In 2006, percent of Mns in 2010, u

etween prefefor a preferreugs is $7. Fond, $80 for a

efined standags that have

or a specialtyees may not

2%

24

%

73

%2% 1%

1 20

brand-name tiersnd, and nonprefeme tiers

ding and the Me

llees arets for no

cription Drug [plans offered in U.Scost plans. Sums

cial and Scientifi

enrollees areugs; anotheonly 59 peredicare Adv

up from 73 p

erred and noed brand an

or MA–PD ena nonpreferre

ard benefit’se a negotiatey tier drug isappeal cost

1% 1%

4%

8%

3%

87%

3% 5%

006 2007M

erred brand-nam

edicare program

e in plansnpreferr

an]). Calculations. territories. In ad may not add to

ic Systems analy

e in plans thr 11 percent

rcent of PDPvantage–Preercent in 20

onpreferred bnd $78 for a nrollees, in 2ed brand, an

s 25 percent ed price of $

s 30 percent t sharing for

1% 19% 8%

85% 83%

6%% 1% 2

2008 2009MA-PD enrollees

me tiers

m, June 2011

s that red

s are weighted byddition, MA–PDstotals due to rou

ysis of formularie

hat distinguist are in plans

P enrollees wescription Dr06.

brand-namenonpreferre2011, the nd $6 for a

coinsurance$600 per moamong PDPdrugs in

% 1%8% 7%

80% 77%

10% 14%2% 1%

2010 2011

165

y s unding.

es

sh s

were rug

e d

e for nth

Ps

%

%

1

166 Pre

Chart

Note: PDenexenenspav

Source: M

su • The n

acces(preaparticmust For ewhichon-foauthothat a

• In 20utiliza28 pecommthen

0%

5%

10%

15%

20%

25%

30%

35%

au

escription drugs

10-10. Inco

DP (prescription nrollment. All calcxclude demonstrantities that are sunrollee must get pecified drugs firsvailable to the en

edPAC-sponsoreubmitted to CMS

number of drss to medica

approval fromcular drug cotry specified

example, unlh may be rel

ormulary drugorization reqare no longe

11, the averation managercent for themon utilizatiostep therapy

Priorthorization

Stethera

2007 2008

s

n 2011, uontinues

drug plan), MA–culations excludeation programs,

ubject to utilizatiopreapproval fromst before movingnrollee in a given

ed analysis by N.

rugs listed oations. Plansm plan beforovered in a gd drugs befoisted drugs latively easygs may not buest. Also, a

er used in co

rage enrolleegement for 32e average Mon managemy.

epapy

Quantitylimits

8 2009 201

PDPs

use of utis to incre

–PD (Medicare Ae employer-only special needs pl

on management,m the plan beforeg to other drugs. time period.

NORC/Georgetow

on a plan’s fos’ processesre coverage)given time peore moving tomay be cove

y for some plbe covered ia formulary’s

ommon pract

e in a stand-2 percent of

Medicare Advment tool is q

Anyutilization

management

10 2011

ilizationease for

Advantage–Prescgroups and planans, and 1876 cweighted by pla

e coverage. StepQuantity limits m

wn University/Soc

ormulary does for nonform), quantity limeriod), and so other drugered throughlans and moin cases in ws size can betice.

-alone prescf drugs listedvantage–Prequantity limit

0%

5%

10%

15%

20%

25%

30%

35%

Prauthor

manageboth PD

cription Drug [plans offered in U.Scost plans. Valuean enrollment. Prp therapy refers tomean that plans li

cial and Scientifi

es not necesmulary excepmits (plans listep therapy

gs) can affech the nonforore burdensowhich a plane deceptivel

cription drug d on a plan’sescription Drts, followed b

riorrization

Steptherapy

2007 2008

MA

ment tooDPs and M

an]). Calculations. territories. In ads reflect the perc

rior authorizationo a requirement imit the number o

ic Systems analy

ssarily repreptions, prior imit the numy requiremenct access to rmulary exceome for othen does not apy large if it in

plan faces ss formulary, rug plan enrby prior auth

Quantitylimits u

ma

2009 2010

A-PDs

ols MA–PDs

s are weighted byddition, MA–PDscent of listed che means that the that the enrolleeof doses of a dru

ysis of formularie

esent beneficauthorizatio

mber of dosesnts (enrolleecertain drug

eptions proceers. Alternatipprove a prioncludes drug

some form ocompared w

rollee. The mhorization, a

Anyutilizationanagement

2011

s

y s emical

e try ug

es

ciary n s of a

es s. ess, ively, or gs

of with most nd

Chart BeneficiariePercent o

Gender Male Female

Race/ethn White, no African A

non-His Hispanic Asian Other

Age (years <65 65–69 70–74 75–79 80+

Urbanicity Metropol Micropoli Rural

Average ris Percent re Note: PD

m *F

A sw

**cothba

†Pbe

Source: M

• In 200them (Prescr

• CompMA–Pcompaunder

• Patterpercen

• The avwhile t

10-11. C

es* (in millionsof all Medicare

icity on-Hispanic

American, spanic

s)

y** itan itan

sk score† elative to all Pa

DP (prescription ay not sum to 10

Figures for Medicbeneficiary is cla

witch plan types dUrbanicity based

ore urban area ofan 50,000) popu

ased statistical aPart D risk scoreefore 2006. Risk

edPAC analysis

09, 28.7 million (18.7 million) wription Drug pla

ared with the oD enrollees are

ared with PDP age 65 compa

ns of enrollmennt in metropolit

verage risk scothe average ris

A D

Character

All Medicare

) 48.8 100%

45% 55

78

10 8 3 2

21 24 18 15 22

79 12

8

1.049 rt D

drug plan), MA–00 percent due tocare and Part D iassified as LIS if during the year, d on the Office off 50,000 or more

ulation. Fewer tharea designation.

es are calculated scores shown he

of Medicare Par

Medicare benewere in stand-alans (MA–PDs).

overall Medicare less likely to enrollees; LIS

ared with non-L

nt by urbanicityan areas, 12 p

ore for PDP enrsk score for MA

Data Book: Hea

ristics of

Part D

28.7 59%

41% 59

74

11 10

3 2

23 22 18 15 22

79 12

9

1.101 100%

–PD (Medicare Ao rounding. nclude all benefithat individual reclassification intof Management a

e population, andan 1 percent of M by CMS using there are not adjus

rt D denominator

eficiaries (59 plone prescriptio. About 11 milli

re population, Pbe disabled beenrollees are m

LIS enrollees.

y for Part D enrercent in micro

rollees is higheA–PD enrollees

lth care spendi

f Part D e

PDP

18.7 38

40%

60 76

11 8 3 2 27 20 17 14 23 74 15 11 1.123

102%

Advantage–Presc

iciaries with at leeceived Part D’s o plan types is band Budget’s core a micropolitan a

Medicare benefic

he prescription dsted for LIS or in

r and enrollment

ercent) enrolleon drug plans (on enrollees re

Part D enrolleeeneficiaries undmore likely to b

rollees were simopolitan areas,

er (1.123) than s is lower (1.06

ding and the Me

enrollees

Plan type MA–PD

7 10.0 8% 21% % 43%

0 57

6 72

10 8 14 3 3 2 1

7 16 0 26 7 20 4 16 3 21

4 89 5 7

4

3 1.060 % 96%

cription Drug [pla

east one month oLIS at some poi

ased on a greatee-based statisticaarea contains anciaries were exclu

drug hierarchical stitutionalized st

files from CMS.

ed in Part D at s(PDPs), with 10eceived Part D

s are more likeder age 65 andbe female, non-

milar to the oveand the remai

the average fo).

edicare program

s, 2009

SD L

10.9

% 2 3 6 5

2 1 4 1 1 1 2 7 1 1 1.20

109

an]), LIS (low-inco

of enrollment in thint during the yeaer number of moal area. A metrop urban core of atuded due to an u

condition categotatus (multipliers)

some point in t0 million in Med’s low-income

ely to be femaled more likely to -White, and dis

erall Medicare ning 9 percent

or all Part D en

m, June 2011

Subsidy statusIS Non-L

9 17.82% 37

9% 4261 58

59 84

0 64 75 22 1

42 124 263 211 170 24

77 803 110 8

01 1.0419% 95%

ome subsidy). To

he respective proar. For individualnths of enrollmepolitan area contt least 10,000 (buunidentifiable cor

ory model develo).

the year. Most dicare Advantasubsidy (LIS).

e and non-Whibe Hispanic

sabled benefici

population within rural areas.

rollees (1.101)

167

LIS

8 7%

2% 8

4

6

7 2

2 6

7 4

0 1 8

%

otals

ogram. ls who nt. tains a ut less re-

oped

of age–

te.

aries

h 79

),

168 Pre

Chart

Part D en Total

By plan t PDP MA–PD

By subsid

LIS Non-LI

By race/e

White, African Hispan Other

By age (y

<65 65–69 70-79 80+

Enrollme Total By plan t

PDP MA–PD

By subsid

LIS Non-LI

By race/e

White, African Hispan Other

By age (y

<65 65–69 70–79 80+

Note: PD *F

reduN

Source: M

• Betweper yesame numbe

escription drugs

10-12. P

nrollment, in m

type

D

dy status

S

ethnicity non-Hispanic

n American, nonic

years)

ent growth, in

type

D

dy status

S

ethnicity non-Hispanic

n American, nonic

years)

DP (prescription Figures include aeceived Part D’s uring the year, thumbers may not

edPAC analysis

een 2006 and 2ear, compared wperiod, the numer of non-LIS e

s

art D en

millions*

n-Hispanic

percent

n-Hispanic

drug plan), MA–all beneficiaries wLIS at some poin

hat individual wassum to totals du

of Medicare Par

2009, Medicarewith growth ratmber of enrolleenrollees grew b

rollment200

24.

17.6.

10.14.

17.2.2.2.

5.5.8.5.

–PD (Medicare Awith at least one mnt during the yeas classified into tue to rounding.

rt D denominator

e Advantage–Ptes of less thanees receiving thby 10 percent i

t trends, 06

.5

.7

.8

.2

.3

.2

.6

.2

.5

.6

.0

.3

.6

Advantage–Prescmonth of enrollmr. If a beneficiaryhe type of plan w

r and enrollment

rescription Drun 5 percent per he low-income in 2007, 8 perc

2006–202007

26.1

18.3 7.8

10.4 15.7

19.4 2.9 2.5 1.3

6.1 5.4 8.7 6.0

7%

4 14

2 10

13 13 14

–49

8 8 5 7

cription Drug [plament. A beneficiay was enrolled inwith a greater nu

files from CMS.

ug plan enrollmyear for prescsubsidy (LIS) r

cent in 2008, an

009 2008

27.5

18.6 8.9

10.7 16.9

20.5 3.1 2.7 1.3

6.4 5.9 9.0 6.3

5%

2 14

2 8

5 5 6 6

6 8 4 4

an]), LIS (low-incory is classified as

n both a PDP andmber of months

ment grew by mcription drug plaremained relatind 6 percent in

2009

28.7 18.7 10.0 10.9 17.8 21.4 3.2 2.8 1.3 6.6 6.3 9.3 6.4 4% <1 12 2 6 4 4 6 <1 4 7 4 3

ome subsidy). s LIS if that indivd an MA–PD planof enrollment.

more than 10 peans. During thevely flat, while

n 2009.

vidual n

ercent e

the

Chart

PDP region 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

26 27 28 29 30 31 32 33 34

Note: PD

(lo Source: M • Among

D. BensubsidMedicpercen

• A wideMedicis gen

• The sh(Iowa,(Alaskregionenrollm

10-13. P

State(s) ME, NH CT, MA, RI, VT NY NJ DE, DC, MD PA, WV VA NC SC GA FL AL, TN MI OH IN, KY WI IL MO AR MS LA TX OK KS IA, MN, MT, NE ND, SD, WY NM CO AZ NV OR, WA ID, UT CA HI AK Mean Minimum Maximum

DP (prescription ow-income subsi

edPAC analysis

g Part D regionneficiaries weredy (RDS) was oare beneficiarient or fewer ben

e variation wasare Advantageerally consiste

hare of Part D e Minnesota, Mo

ka). In 26 of thes (Region 20 (

ment.

A D

art D enP

Medica

Part D 55% 5859534563525954606062545456545562616562576061

, 66625961565757696639

593969

drug plan), RDSdy). Definition of

of Part D enrollm

ns, in 2009, bete more likely toobserved. For ees enrolled in P

neficiaries enro

seen in the she–Prescription Dnt with enrollm

enrollees receiontana, North D

e 34 PDP regioMississippi) an

Data Book: Hea

rollmentPercent of are enrollment

RDS 13% 1819221913111616111312252518151912

96

1315

87

98

131213111110

425

144

25

S (retiree drug suf regions based o

ment data from C

tween 39 perceo enroll in Part example, in RePart D were 69lled in employe

hares of Part DDrug (MA–PD)ent in Medicare

iving the low-inDakota, Nebrans, LIS enrolle

nd Region 34 (A

lth care spendi

t by regio

P865885877756668687896788

7644465549

649

ubsidy), MA–PD (on PDP regions u

CMS.

ent and 69 percD in regions w

egion 32 (Califo percent and 6

er-sponsored p

enrollees who) plans across Pe Advantage p

ncome subsidy ska, South Dak

ees account for Alaska)), LIS e

ding and the Me

on, 2009Perce

Plan type

PDP MA–88% 169 357 481 185 153 480 275 279 279 254 467 363 365 383 166 387 171 283 190 167 371 280 285 1

74 263 349 543 547 560 459 452 448 597

65 34397 5

(Medicare Advanused in Part D.

cent of all Medwhere a low takeornia) and Reg66 percent, respplans that recei

o enrolled in prePDP regions. T

plans.

(LIS) ranged fkota, and Wyor 30 percent to enrollees accou

edicare program

nt of Part D enro

–PD

2% 31 43

9 5

47 20 25 21 21 46 33 37 35

7 34

3 29

7 0

33 29 20

5

26

37 51 57 53 40 41 48 52

3

35 3

57

ntage–Prescriptio

dicare beneficiae-up rate for thion 33 (Hawaiipectively. In theved the RDS.

escription drugThe pattern of M

from 27 percenming) to 61 pe50 percent of e

unt for more tha

m, June 2011

ollment Subsidy statu

LIS Non49% 542 546 535 641 533 638 643 545 544 534 647 534 636 641 533 638 635 645 554 449 545 538 629 7

27 739 629 731 628 731 628 739 629 761 3

38 627 361 7

on Drug [plan]), L

aries enrolled inhe retiree drug ), the shares oese two region

g plans (PDPs)MA–PD enrollm

t in Region 25 ercent in Regionenrollment. In tan half of Part

169

s

n-LIS51% 5854655967625755566653666459676265554651556271

73617169726972617139

623973

LIS

n Part

f ns, 10

and ment

n 34 two D

170 Pre

Chart

Note: N Source: M • Medi

percewere $6,15of tot

• The c

thresspenlow-inthan accoucostli

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent

escription drugs

10-14. Tth

umbers may not

edPAC analysis

care Part D ent of Part Dresponsible

53.75 under tal Part D sp

costliest 9 pehold under tding. Roughncome subsMedicare Paunted for 38iest quartile

%

%

%

%

%

%

%

%

%

%

%

Percen

s

he majohan half

sum to 100 perc

of Medicare Par

spending is D enrollees he for 100 perthe defined ending.

ercent of bethe defined shly three-quaidy (see Chaart A and Pa percent of aaccounted f

22%

48%

21%

5%4%

nt of beneficia

rity of Paof all Pa

cent due to round

rt D prescription

concentratehad annual srcent of the cstandard be

neficiaries, tstandard benarters of benart 10-15). Sart B spendinannual Medifor 81 percen

aries

art D spert D enro

ding.

drug event data

ed among a spending of $cost of the denefit. These

those with drnefit, accouneficiaries wi

Spending on ng. In 2009, care fee-fornt of Medica

25%

31%

16%

27%

Percent of sp

ending isollees, 20

from CMS.

subset of be$2,700 or m

drug until thee beneficiarie

rug spendinnted for 43 pith the highe prescriptionthe costlies

r-service (FFare FFS spen

pending

s incurre009

eneficiaries. ore, at whic

eir spending es accounte

g above thepercent of toest spendingn drugs is lest 5 percent o

FS) spendingnding

1%

≥ $10$6,15$2,70$295$0-$2

74%

Annualprescr

ed by few

In 2009, 30h point enroreached

ed for 74 per

catastrophiotal Part D receive Parss concentraof beneficiarg and the

0,00053.75-$9,99900-$6,153.74-$2,699295

spending onription drugs

wer

llees

rcent

c

rt D’s ated ries

n

Chart

Sex Male Female

Race/ethn White, n African A Hispanic Other

Age (year <65 65–69 70–74 75–80 80+

LIS status LIS Non-LIS

Plan type PDP MA–PD

Note: LI

nuto

*A **

of Source: M • In 20

femacomp

• Benebenewith a

• Most prescPresc$2,70highethat m

10-15. Cle

nicity non-Hispanic American, noc

rs)

s*

S

e**

S (low-income sumber of benefic rounding.

A beneficiary is aIf a beneficiary wf plan with a grea

edPAC analysis

09, beneficiale than bene

pared with 58

eficiaries withficiaries undannual spen

beneficiariecription drugcription Drug00, on the oter annual spmost LIS enr

A D

Characterevels, 20

n-Hispanic

ubsidy), PDP (prciaries were exclu

assigned LIS statwas enrolled in boater number of m

of Medicare Par

aries with aneficiaries wit8 percent).

h annual speder age 65 anding below $

es with spend plans (PDP

g plans (MA–ther hand, aending (39 prollees are m

Data Book: Hea

ristics of09

<$

rescription drug puded from the an

us if that individuoth a PDP and a

months of enrollm

rt D prescription

nnual drug sh annual sp

ending greatnd receive t$2,700.

ding greaterPs) (81 perce–PDs) (19 pre more likepercent commore costly o

lth care spendi

f Part D e

$2,700

42%58

7411105

2124191522

3169

6139

plan), MA–PD (Mnalysis because o

ual received Partan MA–PD plan d

ment.

drug events data

spending of mending below

ter than $6,1he low-incom

r than $6,153ent) compareercent). Benly to be in M

mpared with 1on average a

ding and the Me

enrollees

Annual drug$2,700–$6,1

38%62

761194

2119181627

4555

7129

Medicare Advantaof missing data.

t D’s LIS at someduring the year, t

a and Part D den

more than $w $2,700 (6

153.75 are mme subsidy

3.75 are enred with Medneficiaries w

MA–PDs com19 percent). and are in P

edicare program

s, by spe

g spending 153.75

age–PrescriptionTotals may not s

e point during thethat individual wa

nominator file from

2,700 were 2 percent an

more likely to(LIS) compa

rolled in standicare Advanwith annual smpared with

This findingPDPs.

m, June 2011

ending

>$6,153.75

39%61

72 13 10 5

44 14 13 11 19

76 24

81 19

n Drug [plan]). A sum to 100 perce

e year. as classified in th

m CMS.

more likely tnd 61 percen

o be disabledared with tho

nd-alone ntage–pending belothose with

g reflects the

171

small ent due

he type

to be nt

d ose

ow

e fact

172 Pre

Chart Total gro Total num

(million Average Per enro Total s Out-of- Plan lia Low-inc Numbe

Note: PD

apondest

*N ** †P Source: M • In 200

quarte(PDPsmillion

• The nmillionfor ab

• MedicenrolleAdvan

• The aenrolletypes MA–P

• Averaenrollecompthan navera

escription drugs

10-16. P

oss spending

mber of prescns)

spending pe

ollee per monpending -pocket spendability† come cost sh

er of prescript

DP (prescription pplicable). Part Dn each record. Foenominator file watus. Numbers m

Number of prescrOut-of-pocket (OPlan liability inclu

edPAC analysis

09, gross speners ($54.6 billis). Part D enrn) of the total.

number of presn) accounted fbout 45 percen

care beneficiaees have highntage–Prescri

average monthees ($150), wof plans ($36

PD enrollees (

age monthly see ($163), whared with 3.6 non-LIS enrollging $140 pe

s

art D spe

(billions)

criptions*

r prescription

nth

ding**

haring subsidy

tions*

drug plan), MA–D prescription druor purposes of cl

was used. Estimamay not sum to toriptions standard

OOP) spending inudes plan payme

of Medicare Par

nding on drugion) accounterollees receivin

scriptions fillefor by PDP ennt (598 million

aries enrolled iher average miption Drug (M

hly plan liabilitwhile average 6 vs. $41). The($21) compare

pending per ehile the averagfor a non-LISlees ($8 vs. $r month.

ending a

Part D

$73.8

1,338

n $55

$22839

136y 52

4.1

–PD (Medicare Aug event (PDE) rlassifying the PD

ates are sensitiveotals due to rounized to a 30-day

ncludes all payments for both cove

rt D PDE data an

gs for the Parted for by Meding the low-inc

d by Part D enrollees. The n) of the total n

in Part D planmonthly spendMA–PD) plan e

ty for MA–PD monthly out-oe average moed with PDP e

enrollee for ange number of enrollee. LIS58). Part D’s

and utiliz

D PD

$54

91

$6

$264

156

4

Advantage–Prescrecords are classDE records by LISe to the method unding. y supply. ents that count tered and noncov

nd denominator f

t D program tocare beneficiacome subsidy

nrollees totale38 percent of number of pre

ns fill 4.1 prescding and moreenrollees.

enrollees ($1of-pocket (OOonthly low-incoenrollees ($68

n LIS enrollee prescriptions

S enrollees havLIS pays for m

zation pePlan type

DP MA–P

.6 $19.2

15 423

60 $45

60 $16941 3650 1168 2

.4 3.7

cription Drug [plasified into plan tyS status, monthlyused to classify P

toward the annuavered drugs.

file from CMS.

otaled $73.8 baries enrolled

y (LIS) accoun

ed 1.34 billionf enrollees whescriptions fille

criptions at $2e prescriptions

111) is consideOP) spending iome cost shar8).

($339) is mofilled per monve much lowemost of the co

er enrolle

PD

2 $

3

5

9 $6 1 1

7

an]), LIS (low-incoypes based on thy LIS eligibility inPDE records to e

al OOP spending

billion, with rou in prescriptio

nted for about

n, with nearly 7ho received theed.

228 per months filled compa

erably lower tis similar for ering subsidy is

re than doublnth by an LIS er OOP spendost sharing for

ee, 2009LIS status

LIS No

$40.5 $3

598 7

$68 $

$339 $8

192 140 N

5.0

ome subsidy), N/e contract identif

nformation in Pareach plan type an

g threshold.

ughly three-on drug plans

55 percent ($

70 percent (9e LIS account

h on average.ared with Med

than that of PDenrollees in bos much lower

e that of a noenrollee is 5.

ding, on averar LIS enrollees

n-LIS

33.2

740

$45

16358

104N/A

3.6

/A (not fication rt D’s nd LIS

$40.5

15 ted

PDP icare

DP oth for

n-LIS 0

age, s,

Chart

PDP region All regions 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

26 27 28 29 30 31 32 33 34

Note: LI

(pdenoPDm

Source: M (Chart con

10-17. Pan

State(s)

ME, NH CT, MA, RI, VTNY NJ DE, DC, MD PA, WV VA NC SC GA FL AL, TN MI OH IN, KY WI IL MO AR MS LA TX OK KS IA, MN, MT, N ND, SD, WY NM CO AZ NV OR, WA ID, UT CA HI AK Mean Minimum Maximum

S (low-income sprescription drug eveloped before ormalized so thatDP and an MA–Ponths of enrollm

edPAC analysis

ntinued next p

A D

art D risnd by LIS

PercenrollePDPsMA–P

T

E,

ubsidy), PDP (prhierarchical cond2006. Risk scoret the average acPD plan during thent.

of Medicare enr

page)

Data Book: Hea

k scoresS statuscent ed in s vs. PDs

PercPa

enroreceiv

88%69 57 81 85 53 80 75 79 79 54 67 63 65 83 66 87 71 83 90 67 71 80 85

74 63 49 43 47 60 59 52 48 97

65 43 97

rescription drug pdition category). es shown here aross Part D enrohe year, that indi

rollment files from

lth care spendi

s vary ac, 2009

cent of art D ollees ving LIS Pa

1

49% 042 146 135 141 133 138 143 145 144 134 147 134 136 141 133 038 035 145 054 149 145 138 029 0

27 039 029 031 028 031 028 039 029 061 0

38 127 061 1

plan), MA–PD (MPart D risk scorere not adjusted f

ollees in each grovidual was class

m CMS.

ding and the Me

cross reg

Aver

art D PDAve

.101 1.1Average nor

0.983 0.9.010 1.0.033 1.0.042 1.0.035 1.0.011 1.0.004 0.9.015 1.0.026 1.0.031 1.0.054 1.0.043 1.0.001 1.0.030 1.0.020 1.0

0.958 0.90.989 0.9.002 1.0

0.996 0.9.006 0.9.019 1.0.031 1.0

0.993 0.90.962 0.9

0.913 0.90.929 0.90.919 0.90.961 0.90.951 0.90.919 0.90.913 0.90.955 0.90.935 0.90.929 0.9

.000 1.00.913 0.9.054 1.0

Medicare Advantaes are calculatedfor LIS or institutioup equals 1.0. Ifsified in the type

edicare program

gions, by

rage risk score

DP MA–PDrage absolute 23 1.060 rmalized risk sc

973 0.949 010 1.004 056 1.011 042 0.987 021 1.034 020 1.016 996 0.992 013 0.997 009 1.057 020 1.031 065 1.056 031 1.065 030 0.953 041 1.008 014 0.989 966 0.939 980 0.955 008 0.973 983 1.003 990 1.012 022 1.008 027 1.030 986 0.980 952 0.945

908 0.908 921 0.946 914 0.941 929 1.009 956 0.965 910 0.939 912 0.924 967 0.956 926 0.962 911 0.931

000 1.000 908 0.908 065 1.065

age–Prescriptiond by CMS using ionalized status f a beneficiary wof plan with a gre

m, June 2011

y plan ty

e (RxHCC)

D LIS risk score

1.201core (mean = 1

0.963 1.013 1.019 1.036 1.034 1.011 1.005 1.019 1.008 1.018 1.060 1.028 1.026 1.056 1.018 0.992 0.987 1.027 0.972 0.968 0.992 1.022 0.988 0.980

0.950 0.907 0.945 0.959 0.958 0.921 0.929 0.943 0.905 0.896

1.000

0.896 1.060

n Drug [plan]), Rxthe RxHCC mod(multipliers) and

was enrolled in boeater number of

173

pe

Non-LIS

1.041 1.0)

0.970 0.998 1.022 1.052 1.026 1.022 1.004 0.998 1.023 1.025 1.059 1.030 0.994 1.017 1.012 0.950 0.991 0.993 0.998 1.004 1.015 1.018 0.996 0.973

0.918 0.942 0.924 0.977 0.967 0.930 0.926 0.960 0.967 0.902

1.000 0.902 1.059

xHCC del

are oth a

174 Pre

Chart

• UndeAdvaenrol(RxHstatusadjusmodemorediagn

• In 2025 anrangenatio

• The oenrolwhererisk sdiffer4), M

• The ois higcontrregio33), w

escription drugs

10-17. Pan

er Part D, paantage–Preslees’ expectCC) model ds, and medic

stment modeel may also pe opportunitienoses among

09, the normnd Region 3ed from abounal average

overall averalees (1.06) ae most (57 p

scores for borence exceedichigan (Reg

overall averagher than tharast, normalizns, with the where a rela

s

art D risnd by LIS

ayments to scription Drugted costs usdeveloped bcal diagnosiel, the RxHCproduce highes to make dg other facto

malized aver1) to 1.054 (ut 8.7 perceacross regio

age risk scorand is consispercent) Paroth PDP andding 0.05 (5gion 13), an

age risk scorat of non-LISzed risk scodifference e

atively small

k scoresS status

tand-alone pg plans (MAing the pres

before 2006.s to predict

CC model doher scores indiagnoses inors in its sco

rage risk sco(Region 11),nt below theons.

re for PDP estently so acrt D enrolleesd MA–PD en

percentaged Arizona (R

re for enrolleS enrollees (ores for both exceeding 0.share of enr

s vary ac, 2009 (c

prescription A–PDs) are a

cription drug The RxHCCPart D bene

oes not explan areas withn those areaore.

ores for Part meaning th

e national av

enrollees (1.cross all regis are enrollerollees are s

e points) in oRegion 28).

ees receiving1.041) and iLIS and non05 (5 percenrollees recei

cross regcontinue

drug plans (adjusted to ag hierarchicaC model useefit spendingain all variatih high services and the Rx

D enrolleeshat average everage to ab

123) is higheions, excepted in MA–PDsimilar in moonly three reg

g the low-incis consistentn-LIS enrollentage pointsive the LIS (

gions, byd)

(PDPs) and account for dal condition ces age, gendg. As is true fion in future e use becauxHCC mode

s varied fromexpected coout 5.4 perc

er than that t in Arizona (Ds. In contraost regions, wgions: New J

come subsidtly so acrossees are simis) only in Ha29 percent).

y plan ty

Medicare differences incategory der, disabilityfor any risk-payments. T

use there areel uses

m 0.913 (Regosts per enrocent above th

of MA–PD (Region 28)

ast, normalizwith the Jersey (Reg

dy (LIS) (1.2s all regions.lar in most

awaii (Region.

pe

n

y

The e

gion ollee he

, zed

gion

01) . In

n

Chart

PDP region 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

26 27 28 29 30 31 32 33 34

National ave Note: PD *S

ar **A

dihi

Source: Ac • Averag

The naaveragpercen

• Adjustivariatio0.55 (1spendi

10-18. Pco

State(s) ME, NH CT, MA, RI, VT NY NJ DE, DC, MD PA, WV VA NC SC GA FL AL, TN MI OH IN, KY WI IL MO AR MS LA TX OK KS IA, MN, MT, NE ND, SD, WY NM CO AZ NV OR, WA ID, UT CA HI AK Mean Minimum Maximum

erage spending

DP (prescription Spending includere for beneficiarieAdjusted spendisability, and LIS erarchical condit

cumen, LLC, ana

ge per capita drational average ge per capita spnt (1.33) in Alask

ing per capita don across PDP 1.33 minus 0.78ing ranges from

A D

art D speontrollin

Pen

,

drug plan), LIS (es payments for ies residing in a cng controls for restatus), and ben

tion categories.

alysis for MedPA

ug spending forper capita spenending ranges fka (Region 34).

rug spending foregions: After th

8) to 0.37 (1.23 m 86 percent (0.8

Data Book: Hea

ending vng for pri

Percent nrolled in PDPs

P

88% 69 57 81 85 53 80 75 79 79 54 67 63 65 83 66 87 71 83 90 67 71 80 85

74 63 49 43 47 60 59 52 48 97

65 43 97

(low-income subngredient costs a

community settingegional differenceneficiaries’ health

AC.

r drugs under Panding was $2,62from 78 percent

or regional differhe adjustment, tminus 0.86). Re86) in New Mex

lth care spendi

varies acces and

Percent of Part Denrollees

receiving LIS 49% 4246354133384345443447343641333835455449453829

27392931283128392961

382761

sidy), N/A (not avand dispensing fg only. Per capites in prices, dem

h status as meas

art D varies wid29 in 2009. Relat (0.78) in New

rences in pricesthe difference belative to the natico (Region 26)

ding and the Me

cross reghealth s

D Relative av

vailable). fees. Figures (peta based on full-ymographic characsured by medical

dely across presative to the natioMexico (Region

s and beneficiaribetween minimutional average, ) to 123 percent

edicare program

gions evestatus, 20verage Part D sp

Unadjusted 1.021.041.221.241.111.041.001.111.101.060.981.071.021.011.070.950.971.010.941.031.081.011.030.94

0.830.780.840.780.800.880.890.930.931.33

1.000.781.33

$2,629

er capita spendinyear equivalent ecteristics (such a diagnoses used

scription drug plonal average, thn 26) and Arizon

ies’ health statuum and maximu

the adjusted avt (1.23) in Alask

m, June 2011

en after 009 pending per capi

Adjuste0.91.01.11.10.91.00.91.00.90.90.90.90.91.01.021.040.91.00.90.91.020.921.021.02

1.00.81.00.80.921.01.00.91.121.2

1.00.81.2

N/A

ng and index valuenrollment. as age, gender, d for prescription

an (PDP) regionhe unadjusted rena (Region 28) t

us reduces the m decreases froverage per capitka (Region 34).

175

ta*

ed**715898859617602461032222

0609215823

063

A

ues)

drug

ns. egional to 133

om ta

176 Pre

Chart

Top 15

AntihyperliAntipsychoDiabetic thAntihypertePeptic ulceAsthma/COAntidepresPlatelet agAnalgesicsCognitive d(antidemenAnticonvulAntivirals

Calcium & metabolisAnalgesicsantipyretic,Antibacteri Subtotal, t Total, all c Note: CO

Th Source: M

• In 20The t

• Moreclass

• EleveCentrdomicardiadrenaccou

escription drugs

10-19. TP

5 therapeutic

pidemics otics herapy ensive therapy er therapy OPD therapy ssants ggregation inhis (narcotic) disorder therapntia) sant

bone m regulators

s (anti-inflamma, non-narcotic) ial agents

top 15 classes

classes

OPD (chronic obherapeutic classi

edPAC analysis

09, gross sptop 15 therap

e than 1.3 bilses by volum

en therapeutral nervous snate the list ovascular agnergic blockeunting for ne

s

op 15 thart D, by

c classes by

Bill

agents

agents

bitors

py

atory/

s

bstructive pulmonification based o

of Medicare Par

pending on ppeutic classe

lion prescripme accountin

tic classes asystem agenby spending

gents (antihyers, calciumearly 50 perc

erapeutiy spendin

spending Dollars

ions Percen $6.5 8.7%5.9 8.05.5 7.54.9 6.64.6 6.34.3 5.83.0 4.13.0 4.02.9 3.9

2.7 3.72.6 3.52.4 3.3

1.8 2.5

1.7 2.3

1.5 2.0

53.3 72.3

73.8 100.0

nary disease). Von the First DataB

rt D prescription

prescription des by spend

ptions were dng for about

are among thnts (antipsycg, accountingyperlipidemi channel blocent of the p

c classeng and v

T

nt

% Antihypagent

Antihyp Beta ad Diabeti

Diuretic Antidep Peptic Analge Calcium

Thyroid Antibac Asthma

Anticon Calcium

regul Analge

antipy

Subtot Tota

olume is the numBank Enhanced T

drug event data

drugs coverding account

dispensed in73 percent o

he top 15 bachotics, anticg for over oncs, antihype

ockers, and dprescriptions

es of druvolume, 2

Top 15 therap

pertensive therts perlipidemicsdrenergic blocic therapy cs pressants ulcer therapy

esics (narcotic)m channel blocd therapy cterial agents a/COPD theranvulsants m & bone metaators

esics (anti-inflamyretic, non-nar

tal, top 15 clas

al, all classes

mber of prescriptiTherapeutic Clas

from CMS.

red by Part Dted for about

n 2009, with of the total.

ased on bothconvulsantsne-fifth of theertensive thediuretics) do in the top 1

gs unde2009

peutic classe

rapy

ckers

) ckers

apy agents

abolism

mmatory/ rcotic)

sses

ions standardizessification System

D plans totalt 72 percent

the top 15 t

h spending a, and antidee spending,

erapy agentsominate the 5 therapeut

er

es by volumePrescriptio

Millions Pe

138.7 10126.1 984.6 683.3 675.8 571.9 564.3 463.5 456.3 446.5 337.8 236.9 235.3 2

27.9 225.6 1

974.5 72

1,337.9 100

d to a 30-day sum 1.0.

ed $73.8 bilt of the total.

therapeutic

and volume. pressants) while

s, beta list by volumic classes.

e ns ercent

0.4% 9.4 6.3 6.2 5.7 5.4 4.8 4.7 4.2 3.5 2.8 2.8 2.6

2.1

1.9

2.8

0.0

pply.

lion.

me,

Chart

By order o AntihyperAntipsychDiabetic thAntihypertPeptic ulcAsthma/CAntideprePlatelet agAnalgesicCognitive (antidemeAnticonvuAntivirals Calcium &Analgesic

antipyreAntibacter All therap

Note: PDpucladere

Source: M

• In 200percedisproanticoincom

• Overafollowwith 7

• The G74 petherawith t

• There

antihyin theLIS e10-21

10-20. Gcl

of aggregate

lipidemics hotics herapy tensive thera

cer therapy COPD therapy

ssants ggregation in

cs (narcotic) disorder ther

entia) ulsant

& bone metabcs (anti-inflametic, non-narcrial agents

peutic classesDP (prescription ulmonary diseaseassification is baefined as the proecords are classif

edPAC analysis

09, Part D enent of prescrioportionatelyonvulsants, a

me subsidy (L

all, analgesicwed by antiba70 percent ac

GDR for PDPercent for Mepeutic classethe exception

e were large yperlipidemice GDRs reflecnrollees are

1).

A D

Generic dlasses, b

spending

py agents

y agents

hibitors

rapy

bolism regulatmatory/ otic)

s drug plan), MA–

e). Shares are caased on the First oportion of generified as PDP or M

of Medicare Par

nrollees in staptions dispen

y high share oand antiviralsLIS) beneficia

cs (narcotic) acterial agentcross all ther

P enrollees avedicare Advanes, GDRs forn of agents fo

differences ics and antivircts the fact thless likely to

Data Book: Hea

dispensinby plan t

PDP spres

tors

–PD (Medicare Aalculated as a peDataBank Enhaic prescriptions d

MA–PD records b

rt D prescription

and-alone prnsed under Pof prescriptio

s. Most of thearies, of who

have the higts (88 percenrapeutic class

verages 69 pntage–Prescr PDP enrolleor asthma/ch

n GDRs for Prals, with a 1hat most bentake a gene

lth care spendi

ng rate foype, 200share of all scriptions

64%8466646972726973

75767766

6770

68Advantage–Prescercent of all prescnced Therapeutidispensed within based on the con

drug event data

rescription drPart D. PDP eons for classee prescriptionom more than

hest generic nt) and non-nses.

percent acroscription Drug ees were genronic obstruc

PDPs and MA3 percentage

neficiaries recric medicatio

ding and the Me

or the to09

GenAll

61%386072719

778

93

4802558

8188

70cription Drug [placriptions standaric Classification Sa therapeutic cla

ntract identificatio

from CMS.

rug plans (PDenrollees acces such as ans in these cln 80 percent

dispensing rnarcotic anal

ss all therape(MA–PD) pla

nerally lower ctive pulmon

A–PDs. The e point differeceiving the Lon in a given

edicare program

op 15 the

neric dispensPDPs

56% 37 58 70 67 10 75 7

93

3 79 22 56

79 87

69

an]), COPD (chrordized to a 30-daSystem 1.0. Genass. Part D prescon on each recor

DPs) accouncounted for antipsychoticsasses were tare enrolled

rate (GDR) (9gesics (81 pe

eutic classesan enrollees.than for MA–ary disease

largest diffeence. Some

LIS are in PDtherapeutic

m, June 2011

erapeutic

sing rate MA–PD

69%396676797

819

94

4833564

8589

74onic obstructive ay supply. Therapneric dispensing cription drug everd.

ted for 68 a s, taken by lowin PDPs.

93 percent), ercent) comp

s, compared w. Across the –PD enrolleetherapy.

rences wereof the differePs. On averaclass (see C

177

c

s

%

peutic rate is

ent

w-

pared

with 15

es

for ence age,

Chart

178 Pre

Chart

By order o AntihyperAntipsychDiabetic thAntihypertPeptic ulcAsthma/CAntideprePlatelet agAnalgesicCognitive (antidemeAnticonvuAntivirals Calcium &regulatorsAnalgesic

antipyreAntibacter All therap Note: LI

prThdireus

Source: M • In 20

of prespenperce

• The gtheratherabeneagen

• ThereThe lGDRthe tw

escription drugs

10-21. Gcl

of aggregate

lipidemics hotics herapy tensive thera

cer therapy COPD therapy

ssants ggregation in

cs (narcotic) disorder ther

entia) ulsant

& bone metabs cs (anti-inflametic, non-narcrial agents

peutic classes

S (low-income srescriptions standherapeutic Classspensed within a

ecords based on sed to classify PD

edPAC analysis

09, Part D eescriptions dding, the shaent, and in 3

generic dispapeutic classapeutic classficiaries in ats).

e are large dargest differs for this thewo groups.

s

Generic dlasses, b

spending

py agents

y agents

hibitors

rapy

bolism

matory/ otic)

s

ubsidy), COPD (dardized to a 30-

sification system a therapeutic clasmonthly LIS eligDE records as LI

of Medicare Par

enrollees recdispensed unare of presc classes the

ensing rate ses, compareses, GDRs foall but one cla

differences inrence is for aerapeutic cla

dispensinby LIS st

LIS shaprescrip

384355545

5646

34

44

4

(chronic obstruct-day supply. The1.0. Generic dispss. Part D prescribility informationIS or non-LIS.

rt D prescription

ceiving the londer Part D.riptions disp

e share was

(GDR) for noed with 68 por non-LIS bass (asthma

n GDRs acroantivirals (27ass likely refl

ng rate fotatus, 20

are of ptions

5%38618339

147

4

95

5

tive pulmonary dierapeutic classificpensing rate is dription drug evenn in Part D’s den

drug event data

ow-income s In 10 of 15

pensed to LISgreater than

on-LIS beneercent for LI

beneficiaries a/chronic obs

oss classes 7 percentagelects differen

or the to09

GenerAll

61%386072719

778

93

48025

58

8188

70

isease). Shares cation is based o

defined as the pront (PDE) records ominator file. Es

and Part D deno

subsidy (LIS)therapeutic S beneficiarn 60 percent

eficiaries aveIS beneficiaare higher t

structive pul

between LISe points). Sonces in the m

op 15 the

ric dispensingLIS

56% 37 53 70 66 11 74 7

92

3 78 16

53

82 86

68

are calculated aon the First Dataoportion of geneare classified as

stimates are sens

ominator file from

) accounted classes ran

ries was great.

erages 72 peries. Across than those fomonary dise

S and non-Lome of the dmix of drugs

erapeutic

g rate Non-LIS

63%406773766

809

95

58343

61

8189

72

s a percent of alBank Enhanced ric prescriptions s LIS or non-LIS sitive to the meth

m CMS.

for 45 perceked by ater than 45

ercent acrosthe top 15

or LIS ease therapy

LIS beneficiaifference in taken betwe

c

S

l

hod

ent

ss all

y

aries. the een

Chart Totals Pharmacy Chain ph Indepen Franchis Governm Alternate Other**

Pharmacy Retail† Long-ter Mail ord Physicia Institutio MCO ph Clinic Specialt Other††

Note: M

otNa

*A **

be †R ††

mNan

Source: M • In 200

enrollindep

• Chain

indepspend

• Retai

prescbut abaccoupresc

• In 200

spend

10-22. P

y class harmacy dent pharmac

se pharmacy ment pharmace dispensing

y type

rm care er

an’s office on harmacy

y pharmacy

CO (managed cather data issues. ational Council fo

Alternate dispensNumber of prescecause of missinRetail includes a†Other type incluilitary/U.S. Coasumber of prescrind other data iss

edPAC analysis

09, more thaled in Part D

pendent phar

n pharmaciespendent pharding.

l pharmaciescriptions and bout 9 perceunt for less thcriptions and

09, specialtyding, compar

A D

harmaci

cy

cy site*

are organizationPrescription size

or Prescription Ding site includes criptions and speg and other datall community pha

udes the Indian Hst Guard pharmacptions and spendues.

of Medicare Par

an 65,000 pha. Most pharm

rmacies (32.6

s account forrmacies acco

s account forspending. Lont of prescriphan 1 percenabout 6 perc

pharmaciesred with fewe

Data Book: Hea

es particPharmacie

65,283

61.7%32.61.21.03.4N/A

91.4%2.70.21.01.10.21.40.21.8

), N/A (not availae is standardized

Drug Programs clphysician offices

ending for other ca issues. armacies, grocerHealth Service, Dcies, compoundiding for other typ

rt D prescription

armacies dismacies (61.7 6 percent).

r about 60 peount for abou

r more than 9ong-term carptions and nent of pharmaccent of spend

account for er than 1 perc

lth care spendi

cipating s

%

%

able). Some phard to a 30-day suplassification. , emergency depclass include inst

ry pharmacies, anDepartment of Veng pharmacies, ape include pharm

drug event data

spensed prespercent) are

ercent of prest 34 percent

90 percent of re pharmacieearly 11 perccies but accoding.

over 2 percecent of presc

ding and the Me

in Part DPrescriptions

1,337.9 millio

61.2%33.81.10.43.20.3

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rmacies could nopply. Pharmacy c

partments, urgenttitutions and pha

nd department seterans Affairs hoand facilities spe

macies that could

from CMS.

scription drug chain pharm

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ptions and nspending in

m, June 2011

oss spending

$73.8 billion

58.6%37.01.10.42.60.3

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because of missinre based on 200

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re beneficiarwed by

while percent of

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179

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S E C T I O N

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e number of facilities de

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e rate servicme, expendnditures for

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