Enhancing Functional Impairment Assessments for Medicare Beneficiaries

Researchers from RAND Corporation are enhancing the assessment of functional impairments among Medicare beneficiaries, with a focus on those in fee-for-service (FFS) plans. Current administrative measures predominantly recognize disabilities that qualify individuals for Medicare before age 65, which overlooks impairments developing later in life or unrelated to work activities. This initiative aims to bridge that gap and improve the accuracy of data collection.

To achieve this, researchers utilized data from the 2024 Medicare FFS Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to create the FFS CAHPS functional limitations index (FCFLI). This index was a foundation for developing a claims-based predictive model, known as FCFLI-claims. By analyzing claims data from April 2023 to March 2024, the predictive model was applied to all FFS beneficiaries with Medicare Parts A and B, offering a comprehensive perspective on functional limitations.

The FCFLI relied on health self-assessments and capabilities concerning daily living activities. Nine claims-based indicators predicted the FCFLI scores, with data from 67,596 respondents highlighting significant challenges, notably in walking and managing errands. The FCFLI-claims model achieved an 80.4% positive predictive value, identifying about 12% of Medicare FFS enrollees as having potential limitations. Notably, it recognized nearly 63% who were not previously identified by existing measures. This improvement could lead to more targeted surveys and better monitoring of beneficiaries' functional status, aligning efforts with age-eligible criteria.