Principal inpatient diagnostic cost group model for Medicare risk adjustment
Pope, Gregory C. ; Ellis, Randall P. ; Ash, Arlene S. ; Liu, Chuan-Fen ; Ayanian, John Z. ; Bates, David W. ; Burstin, Helen ; Iezzoni, Lisa I. ; Ingber, Melvin J.
Citations
Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
Document Type
Publication Date
Keywords
Adult
Aged
Capitation Fee
Centers for Medicare and Medicaid Services (U.S.)
Child
Child, Preschool
Demography
Diagnosis-Related Groups
Female
Humans
Infant
Infant, Newborn
Male
Medicaid
Medicare Part C
Middle Aged
*Models, Econometric
Risk Adjustment
United States
Biostatistics
Epidemiology
Health Services Research
Subject Area
Embargo Expiration Date
Link to Full Text
Abstract
The Balanced Budget Act (BBA) of 1997 required HCFA to implement health-status-based risk adjustment for Medicare capitation payments for managed care plans by January 1, 2000. In support of this mandate, HCFA has been collecting inpatient encounter data from health plans since 1997. These data include diagnoses and other information that can be used to identify chronic medical problems that contribute to higher costs, so that health plans can be paid more when they care for sicker patients. In this article, the authors describe the risk-adjustment model HCFA is implementing in the year 2000, known as the Principal Inpatient Diagnostic Cost Group (PIPDCG) model.
Source
Health Care Financ Rev. 2000 Spring;21(3):93-118. Link to article on publisher's site