Principal inpatient diagnostic cost group model for Medicare risk adjustment.
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.
Pope
G C
GC
Health Economics Research, Inc., Waltham, MA 02452, USA. GPope@her-cher.org
Ellis
R P
RP
Ash
A S
AS
Liu
C F
CF
Ayanian
J Z
JZ
Bates
D W
DW
Burstin
H
H
Iezzoni
L I
LI
Ingber
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002204:Capitation Fee / Q000706:statistics & numerical data*; D014487:Centers for Medicare and Medicaid Services, U.S.; D002648:Child; D002675:Child, Preschool; D003710:Demography; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000191:economics; D020398:Medicare Part C / Q000191:economics*; D008875:Middle Aged; D017059:Models, Econometric; D020379:Risk Adjustment / Q000191:economics*; D014481:United States