Medicare Risk Adjustment for the Frail Elderly
نویسندگان
چکیده
CMS has had a continuing interest in exploring ways to incorporate frailty adjustment into the CMS Hierarchical Condition Categories (CMS-HCC) risk adjustment methodology for Medicare Advantage and other Medicare private organizations. In this article we present research results for Medicare risk adjustment of the frail elderly since the adoption of frailty adjustment for Program of All-Inclusive Care for the Elderly (PACE) organizations in 2004. In particular, we present results on the revised frailty adjuster that is being phased in for PACE organizations between 2008 and 2012.
منابع مشابه
Risk Adjustment for Health Plans Disproportionately Enrolling Frail Medicare Beneficiaries
There is concern about the adequacy of diagnosis-based risk adjusters for paying health plans that disproportionately enroll frail Medicare beneficiaries. The Medicare Current Beneficiary Survey (MCBS) was used to examine the ability of two risk-adjustment models to predict Medicare costs for groups defined by institutional status and difficulty with activities of daily living (ADLs). Both mode...
متن کاملCMS Frailty Adjustment Model
The authors document the development of the CMS frailty adjustment model, a Medicare payment approach that adjusts payments to a Medicare managed care organization (MCO) according to the functional impairment of its community-residing enrollees. Beginning in 2004, this approach is being applied to certain organizations, such as Program of All-Inclusive Care for the Elderly (PACE), that speciali...
متن کاملPACE (Program of All-Inclusive Care for the Elderly): innovative care for the frail elderly. Comprehensive services enable most participants to remain at home.
PACE--the Program of All Inclusive Care for the Elderly--provides integrated comprehensive healthcare services to the frail elderly on a capitated basis. Begun in the early 1970s in San Francisco's Chinatown, PACE today comprises many individual programs across the nation. PACE's goal is to provide participants with the healthcare services they need for the highest possible level of functioning...
متن کاملMedicare capitation and quality of care for the frail elderly
Previous studies have shown that the quality of care provided in health maintenance organizations (HMO's) is either similar or better than that in fee-for-service settings; however, few studies have included sufficiently large numbers of older persons. Although it is reasonable to believe that healthy older patients will do as well in HMO's as younger people, the outcome for the frail elderly i...
متن کاملAdverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation.
BACKGROUND AND PURPOSE Antithrombotic therapy can prevent strokes and transient ischemic attacks (TIAs) in carefully selected patients who have chronic nonvalvular atrial fibrillation (NVAF). Our objectives were 3-fold: to document the use of warfarin and aspirin therapy in Missouri Medicare beneficiaries with chronic NVAF; to identify factors associated with warfarin and aspirin underuse; and ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره 30 شماره
صفحات -
تاریخ انتشار 2008