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 As PDPM Approaches, Assessing Frailty Can Help Predict Outcomes, Costs

Frailty is common among older people, and a new study, “Global Incidence of Frailty and Prefrailty among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis,” suggests the value of assessing and addressing frailty to prevent surprises and minimize its negative consequences.
Characterized by sudden declines and diminished recovery from illness or trauma, frailty is a result of the natural aging process. In the study, published on JAMA Network Open, the authors found approximately one in six community-dwelling older people may have frailty, with a higher incidence in women.
The incidence varied according to the measurement methods used, the authors said, and by the income level in the region/country. As frailty is associated with negative outcomes such as falls, disability, and even death, as well as increased costs, emergency department visits, and hospital admissions, the authors stressed the importance of reducing the burden of frailty.
Preventing, predicting, and addressing frailty calls for an understanding of its risk factors, the JAMA author suggested. Steven Buslovich, MD, MSHCPM, chief executive officer of Patient Pattern and a New York-based geriatrician, agrees and further suggests that assessing frailty is key to capturing revenue and accurately predicting costs of care in the world of the Patient-Driven Payment Model (PDPM), as the components affecting reimbursement—cognitive, psychosocial, and functional domains—all involve frailty.
“Understanding frailty can help us identify the risks associated with patients’ costs, as these are higher for frail patients with similar diagnoses than for their non-frail counterparts,” he says. In other words, the trajectory of care for two patients with similar diagnoses but different levels of frailty are drastically different.
“Providers need this information to understand the impact of frailty on lengths of stay, staffing requirements, readmissions, and so on,” he says. Understanding this can help them manage patients better and successfully predict costs and resource needs, he observes.
Fortunately, barriers to assessing frailty are disappearing. For instance, these assessments previously called for the skills of a geriatrician or geriatric nurse practitioner. New technology is bridging the gap and allowing quicker assessments—integrated into the workflow—by registered nurses, licensed practical nurses, or other team members.
The ability to assess and share a patient’s frailty score is an important communication tool for the care team, suggests Eugene Gonsiorek, PhD, vice president of long term care at Kaldeida Health in Buffalo, N.Y. “All disciplines have different backgrounds, perspectives, and viewpoints.” The frailty score is like a consumer’s FICO credit score in that it enables a leveler so that everyone can speak the same language, Buslovich says.
“When they share a common understanding of the patient’s frailty, the team can better work together to address care and resource needs, care plan, and communicate with family members,” Gonsiorek says. Under PDPM, managing outcomes becomes critical to remaining a successful provider.
The authors of the JAMA article stressed that with about two-thirds (66 percent) of older people having at least two chronic medical conditions, it is more important than ever to assess, prevent, and manage frailty. To date, they noted, “several interventions” involving exercise, nutrition, cognitive training, geriatric assessment, hormone therapy, and rehabilitation have been used to prevent and management frailty—with generally positive but varying results. “It is imperative to improve understanding of the factors that confer increased risk of frailty,” they said. “This will help inform the design of interventions to prevent frailty or minimize its negative consequences on health.”
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