Diagnosis-based risk adjustment for Medicare capitation payments.
Part of a special section on advances in financing managed care. A study was conducted to develop, estimate, and assess risk-adjustment models that employ diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Data from a 5 per...
| Publicado en: | Health Care Financing Review Vol. 17; pp. 101 - 129 |
|---|---|
| Autores principales: | , , |
| Formato: | Artículo |
| Publicado: |
HCFA ORDS Publications
Spring 1996
|
| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| Sumario: | Part of a special section on advances in financing managed care. A study was conducted to develop, estimate, and assess risk-adjustment models that employ diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Data from a 5 percent sample of aged and disabled beneficiaries eligible for Medicare in 1991 or 1992 were used. The findings reveal that hierarchical coexisting conditions models achieve greater explanatory power than diagnostic cost group models by including consideration of multiple coexisting medical conditions. It is found that prospective models forecast average costs of individuals with chronic conditions almost as well as concurrent models. It is concluded that all models are more accurate than the current health maintenance organization payment formula at predicting medical costs. |
|---|