Risk-adjustment system for the Medicare capitated ESRD program.
Medicare is the principal payer for medical services for those in the U.S. population suffering from end-stage renal disease (ESRD). By law, beneficiaries diagnosed with ESRD may not subsequently enroll in Medicare Advantage (MA) plans, however, the potential benefits of managed care for this population have stimulated interest in changing the law and developing demonstration plans. We describe a new risk-adjustment system developed for Medicare to pay for ESRD beneficiaries in managed care plans. The model improves on current payment methodology by adjusting payments for treatment status and comorbidities.
Levy
Jesse M
JM
Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850, USA. jesse.levy@cms.hhs.gov
Robst
John
J
Ingber
Melvin J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic; D008297:Male; D006278:Medicare / Q000191:economics* / Q000458:organization & administration; D008875:Middle Aged; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D020379:Risk Adjustment / Q000379:methods*; D014481:United States