Use Of Patient Health Survey Data For Risk Adjustment To Limit Distortionary Coding Incentives In Medicare.
A core problem with the current risk-adjustment system in Medicare Advantage and accountable care organization (ACO) programs--the Hierarchical Condition Categories (HCC) model--is that the inputs (coded diagnoses) can be influenced for gain by risk-bearing plans or providers. Using existing survey...
| Publicado en: | Health Affairs Vol. 44; no. 1; pp. 48 - 58 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Health Affairs Publishing, LLC
Jan2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=190593094&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 190593094 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02782715 HAF jtl: Health Affairs issn: 02782715 maglogo: N pubinfo: dt: Jan2025 vid: 44 iid: 1 pid: 1453 pub: Health Affairs Publishing, LLC place: Washington, District of Columbia artinfo: ui: 190593094 190593094 190593094 10.1377/hlthaff.2023.01351 190593094 ppf: 48 ppct: 10 formats: tig: atl: Use Of Patient Health Survey Data For Risk Adjustment To Limit Distortionary Coding Incentives In Medicare. aug: au: McWilliams, J. Michael Weinreb, Gabe Landrum, Mary Beth Chernew, Michael E. affil: Harvard University and Brigham and Women's Hospital, Boston, Massachusetts sug: subj: Fee for Service Plans Medicare Accountable Care Organizations International Classification of Diseases Coding Reimbursement, Incentive Health Care Costs Health Services Needs and Demand Human United States Cross Sectional Studies Concept Analysis Comparative Studies Self Report Health Status Functional Status Chronic Disease Mortality Hospitalization Drugs, Prescription Medication Management Health Expenditures Primary Health Care Activities of Daily Living Regression Descriptive Statistics Practice Patterns Prospective Payment System Health Resource Allocation Health Services Accessibility Funding Source ab: A core problem with the current risk-adjustment system in Medicare Advantage and accountable care organization (ACO) programs--the Hierarchical Condition Categories (HCC) model--is that the inputs (coded diagnoses) can be influenced for gain by risk-bearing plans or providers. Using existing survey data on health status (which provide less manipulable inputs), we found that the use of a hybrid risk score drawing from survey data and a scaled-back set of HCCs would, in addition to mitigating coding incentives, modestly lessen risk-selection incentives, strengthen payment incentives to deliver efficient care, allocate payment across ACOs more efficiently according to markers of population health that are not as affected by practice patterns or coding efforts, and redistribute payment in a manner that supports equity goals. Although sampling error and survey nonresponse present challenges, analyses suggest that these should not be prohibitive. Overall, our proof-of-concept analysis suggests that using survey data to improve riskadjustment performance is a promising strategy that merits further development. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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