High ideals & perverse consequences: risk adjustments, encounter data & Medicare+Choice.
Why should you take on the risks and complications of developing a PSO? Is it worth it? Will it mean assuming undue risk? The answer to this question gets complicated. This article will introduce more uncertainties than you had before. But, you need to have your eyes wide open. It's not just a question of your capability as a health system or a medical group. It's a question of HCFA's ability to administer the program. Even without knowing the capabilities of HCFA, most organizations would say that they don't trust the government to follow through with any program. In this article by Bruce Fried, we get a rare look at the inner thoughts and gyrations of government, as they attempt to risk-adjust Medicare payments to PSOs and HMOs. In ordinary language, that means, if you happen to have a very sick population of seniors, you will be paid more to take care of them. But, read this and weep.
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Shaw Pittman Potts and Trowbridge, Washington, DC, USA.
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D000368:Aged; D002204:Capitation Fee; D014487:Centers for Medicare and Medicaid Services, U.S.; D019058:Community Networks / Q000191:economics / Q000458:organization & administration*; D006305:Health Status Indicators; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D006278:Medicare / Q000458:organization & administration*; D016730:Program Development; D012308:Risk Management; D014481:United States