Estimating Transition Probabilities in Mobility and Total Costs for Medicare Beneficiaries

Hoffman JM, Clot MA, Huynh M, Chan L. Estimating transition probabilities in mobility and total costs for Medicare beneficiaries. Arch Phys Med Rehabil 2010;91: 1849-55. Objective: To examine how persons move back and forth along levels of mobility disability. Design: Self-reported mobility limitations were used to create categories of annual transition states. The total cost to Medicare associated with each year was calculated for each participant. In addition, we examined cost relative to transition state, adjusting for demographic and other health status variables, Setting: National survey. Participants: Participants in the longitudinal Medicare Current Beneficiary Survey from 1992 to 2005. Interventions: Not applicable. Main Outcome Measures: Annual self-reported mobility limitations and total Medi costs. Results: Most participants remained without mobility limitations or improved over time. Reported average costs were 10 times higher for those who transitioned to severe limitations, unable to walk, or death compared with persons who reported no mobility limitation. Estimated costs were highest for those transitioning to increased states of disability and to death. Conclusions: Mobility limitations in older adults are dynamic, and improvement (as measured by annual transitions) occurred for a large number of Medicare beneficiaries. High total annual costs were observed in groups that transitioned to worsening mobility states, suggesting a link between mobility limitation transitions and cost. Prevention and treatment of mobility limitation may be an important factor to consider in health care reform.