title: PACE and the Medicare+Choice risk-adjusted payment model.
abstract: This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.
authors.affiliation: Community Coalition for Long-Term Care, Inc., 10 Gibbs St., Suite 410, Rochester, NY 14604, USA.
authors.forename: H
authors.initials: H
authors.lastname: Temkin-Greener
authors.forename: M R
authors.initials: MR
authors.lastname: Meiners
authors.forename: L
authors.initials: L
authors.lastname: Gruenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002204:Capitation Fee; D014487:Centers for Medicare and Medicaid Services, U.S.; D003191:Comprehensive Health Care / Q000191:economics*; D003953:Diagnosis-Related Groups; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D016330:Frail Elderly; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics; D006299:Health Services for the Aged / Q000191:economics*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D020398:Medicare Part C / Q000191:economics*; D018803:Models, Economic; D011907:Rate Setting and Review; D020379:Risk Adjustment; D014481:United States