Diagnosis-based risk adjustment for Medicare capitation payments.
Files
Date
1996
DOI
Authors
Ellis, Randall P.
Pope, Gregory C.
Iezzoni, Lisa I.
Ayanian, John Z.
Bates, David W.
Burstin, Helen
Ash, Arlene S.
Version
OA Version
Citation
RP Ellis, GC Pope, L Iezzoni, JZ Ayanian, DW Bates, H Burstin, AS Ash. 1996. "Diagnosis-based risk adjustment for Medicare capitation payments.." Health Care Financ Rev, Volume 17, Issue 3, pp. 101 - 128.
Abstract
Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula.
Description
License
This article is in the public domain and may be reproduced or copied without permission; however, citation to source is appreciated.