Medicare calibration of the clinically detailed risk information system for cost.
The clinically detailed risk information system for cost (CD-RISC) contains definitions for several hundred severity-adjusted conditions that can be used to predict future health care costs. We develop a prospective Medicare CD-RISC model using a 5-percent sample of Medicare beneficiaries and data that contain 1996 diagnostic information and 1997 annualized costs. The CD-RISC model has a hierarchical structure that implies that only the most expensive condition-severity variable within a body system affects payments. This minimizes incentives to game the system by entering multiple related codes for the same condition. The R2 for the CD-RISC model is 11 percent.
University of Hawaii, USA. kapur@rand.org
Kanika
K
Kapur
Chien-Wen
CW
Tseng
Afshin
A
Rastegar
Grace M
GM
Carter
Emmett
E
Keeler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004194:Disease / Q000145:classification; D005260:Female; D006279:Health Maintenance Organizations; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007256:Information Systems; D038801:International Classification of Diseases; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D015233:Models, Statistical; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology