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U.S. Department of HealthandHumanServices KathleenSebelius,Secretary & CentersforMedicare MedicaidServices CharleneM.Frizzera,ActingAdministratorandChief OperatingOfficer Michelle Snyder,Acting DeputyAdministratorand DeputyChiefOperatingOfficer OfficeofResearch,Development,andInformation TimothyP.Love,Director ThomasW.Reilly,DeputyDirector InformationandMethodsGroup FrankJ Eppig Director . , JohnR.Gamer,DeputyDirector PublicationCoordinators MariaDiacogiannis CaraPetroski Press inquiries should be directed to the CMSPressOffice,(202)690-6145. Nationalhealthexpenditureinquiries: [email protected] Dataavailability: www.cmsJihs.gov/home/rsds.asp Questions on this publication: [email protected] A/4 c3 Preface This referencebookletprovides significantsummaryinformationabout health expenditures and Centers for Medicare&MedicaidServices(CMS) programs. The informationpresented was the mostcurrent available at the timeofpublication. Significanttime lags may occurbetweenthe end ofa datayear and aggregation ofdata for thatyear. Similarreportedstatistics maydifferbecauseofdifferences in sources and/or methodology The data are organized as follows: Page Highlights-GrowthinCMSPrograms andHealthExpenditures 1 I. Populations 5 H. Providers/Suppliers 17 ni. Expenditures 25 IV. Utilization 35 V. Administrative/Operating 43 Reference 49 Glossary ofAcronyms for Data SourceAttribution CMM Center for Medicare Management CMS Centers for Medicare & Medicaid Services CMSO Center for Medicaid and State Operations OACT Office oftheActuary ORDI Office ofResearch, Development, and Information SSA Social Security Administration ii Highlights GrowthinCMSprogramsand healthexpenditures Populations • Persons enrolled forMedicare coverage increased from19.1millionin 1966toaprojected45.9million in2009,a 140percentincrease. • Onaverage,thenumberofMedicaid monthly enrolleesin2009isestimatedtobeabout51.1 million, thelargestgroupbeingchildren(24.9millionor48.7 percent). • In2006,about20.1 percentofthepopulationwasat somepointenrolledintheMedicaidprogram. • Medicare enrollees with end-stage renal disease increasedfrom66.7thousandin1980to410.6 thousandin2008,anincreaseof516percent. • Medicare Statebuy-inshave grownfromabout2.8 millionbeneficiariesin1975to7.5millionbenefi- ciariesin2008,anincreaseofabout 168percent. 1 . • By2009 nearly26.8millionMedicareenroUeeshad , D Part drug coverage,58.1 percentofallenrollees, andanadditional6.4millionhadRDS • About8.0millionpersonswereduallyeligibleforboth MedicareandMedicaidasofJuly 1,2007. • AsofMarch2009 theproportionoffemaleMedicare , D Part enrolleesaged85years andoverwas 14.4 percent,nearlydouble thatofthe 7.6percent proportionofmaleMedicarePartDenrolleesaged 85 years andover. Providers/Suppliers • Thenumberofinpatienthospital facilities decreased from6,770inDecember1975to6,171 inDecember 2008. Total inpatienthospitalbedshavedropped from46.5bedsper1,000enrolledin1975to20.6in 2008,adecreaseof56percent. • The total numberofMedicare certifiedbeds in short- stayhospitals showed a steady increase fromless than 800,000 at the beginning oftheprogram and peaked at 1,025,000 in 1984-86. Sincethattime,the numberhasdroppedtoabout792,000. (NOTE: This includes a reclassification ofsome short-stay hospitals as critical access hospitals. There were about30,000criticalaccesshospitalbedsin2008.) • Thenumberofskillednursingfacilities (SNFs) increased rapidly duringthe 1960s, decreased during thefirsthalfofthe 1970s,generallyincreasedthere- aftertoover15,000inthelate 1990s,and remains currentlyatthis level. 2 2 • Thenumberofparticipatinghomehealth agencieshas fluctuated considerably overthe years, almost doublinginnumberfrom1990toalmost11,000in1997, whenthe Balanced BudgetAct was passed. The nimiberdecreased sharplybuthas since stabilized, reaching9,407in2008. Expenditures • Nationalhealthexpenditures(NHE)were$2,241 billionin2007,comprising 16,2percentofthegross domesticproduct(GDP). Comparably,NHEamounted GDP to$1,9733billion,or15.9percentofthe in2005. • In2008 totalnetFederaloutlaysforCMSprograms , were $599.5billion,20.1 percentoftheFederalbudget. • Medicare skillednursing facilitybenefitpayments m increasedfrom$22.6billion 2008toabout$25.5 bilUonin2009. • Medicare home health agency benefit payments increasedslightlybetween2008and2009from$16.4 billionto$17.3billion. • Nationalhealthexpendituresperpersonwere $211 in 1965andgrewsteadilytoreach$7,421 by2007. UtilizationofMedicareandMedicaidservices • Between 1990and2007,thenimiberofshort-stay hospitaldischargesincreasedfi*om 10.5millionto 12.3million,anincreaseof17percent. • The PPS short-stayhospital average length ofstay decreasedsignificantlyfrom9.0daysin 1990to5.3 daysin2007,adecreaseof41 percent. 3 . . . Likewise,the average lengthofstay forexcluded unitsdecreasedsignificantlyfrom 19.5 daysin 1990to 11.8daysin2007,adecreaseof39percent. About32.4millionpersonsreceivedareimbursed serviceunderMedicarefee-for-serviceduring2007. Comparably,almost57.5millionpersonsused Medicaid servicesorhad apremiumpaidontheir behalfin2006. The ratio ofMedicare agedusers ofanytype of coveredservicehasgrownfrom367per1,000 enrolledin 1967to921 per1,000enrolledin2007 7.3millionpersonsreceivedreimbursablefee-for- service inpatienthospital services under Medicare in2007. 31.5millionpersonsreceivedreimbursablefee-for- service physician services under Medicare during 2007. 23.1 millionpersonsreceivedreimbursable physicianservicesunderMedicaidduring2006. 23.6millionpersonsreceivedreimbursablefee-for- service outpatient hospital services under Medicare during2007 During2006,15.8millionpersons . received Medicaid reimbursable outpatienthospital services. Over1.8millionpersonsreceivedcareinSNFs coveredbyMedicareduring2007. 1.7millionpersons receivedcareinnursingfacilities,whichinclude SNFs and all othernursing facilities otherthan mentally retarded coveredbyMedicaidduring2006 , Over27millionpersonsreceivedprescribeddrugs underMedicaidduring2006 Populations Informationaboutpersonscovered byMedicare,Medicaid,orCHIP For Medicare, statistics arebased onpersons enrolled for coverage. Historically,forMedicaid,recipient(benefi- ciary) counts were used as a surrogate ofpersons eligible forcoverage,as well as forpersons utilizing services. Currentdata systems nowallowthe reporting oftotal eligiblesforMedicaidandforChildren's HealthInsurance Program(CHIP). Statisticsareavailablebymajorprogram categories, bydemographic and geographic variables, and asproportionsofthe U.S.population. Utilizationdata organizedbypersons servedmaybe found inthe Utiliza- tion section. 5 Table I.l Medicare enrollment/trends Total Aged Disabled persons persons persons July Inmillions 1966 19.1 19.1 1970 20.4 20.4 1975 24.9 22.7 2.2 1980 28.4 25.5 3.0 1985 31.1 28.1 2.9 1990 34.3 31.0 3.3 1995 37.6 33.2 4.4 Average monthly 2000 39.7 34.3 5.4 2006 43.4 36.3 7.1 9007 'Xl o 1.J 2008 AS2 37.8 7A 2009 45.9 38.3 7.6 NOTES: RepresentsthoseenrolledinHI(PartA)and/orSMI(PartBandPartD) ofMedicare. Datafor1966-1995areasofJuly. Datafor2000-2009represent averageactualorprojectedmonthlyenrollment. Numbersmaynotaddtototals becauseofrounding. Based onFY2010President'sBudget. SOURCE: CMS,OfficeoftheActuary. Table 1.2 Medicare enrollment/coverage HI HI and/or SMI and HI SMI SMI HI Part B Part D SMI only only Inmillions All persons 45.7 45.4 42.3 32.9 42.0 3.4 0.4 Aged persons 38.2 37.9 35.7 - 35.3 2.6 0.4 Disabled persons 7.5 7.5 6.7 6.7 0.8 0.0 NOTES: Projectedaveragemonthlyenrollmentduringfiscalyear2009. Aged/ disabledsplitofPartDenrollmentnotavailable. BasedonFY2010President's Budget. Numbersmaynotaddtototalsbecauseofrounding. SOURCE: CMS,OfficeoftheActuary. 6