title: The Medicare hospice payment system: a consideration of potential refinements.
abstract: The purpose of this article is to examine variation in resource utilization across and within patient stays in the context of Medicare's per diem payment system for hospice. Visit-level resource utilization data were linked to patient-level diagnosis and demographics covering more than 68,000 Medicare patients admitted in 2002 and 2003. Our findings suggest that case mix adjustment based on diagnosis and demographics does not improve our ability to explain variation in resource utilization across stays. However, we do find that there is substantial variation in resource utilization within stays that may not be captured in the current per diem payment system.
authors.affiliation: RAND Corporation, Boston, MA 02116, USA. Nicosia@rand.org
authors.forename: Nancy
authors.initials: N
authors.lastname: Nicosia
authors.forename: Elaine
authors.initials: E
authors.lastname: Reardon
authors.forename: Karl
authors.initials: K
authors.lastname: Lorenz
authors.forename: Joanne
authors.initials: J
authors.lastname: Lynn
authors.forename: Melinda Beeuwkes
authors.initials: MB
authors.lastname: Buntin
mesh_terms: D003953:Diagnosis-Related Groups / Q000145:classification / Q000191:economics*; D006295:Health Resources / Q000706:statistics & numerical data*; D006738:Hospices / Q000191:economics*; D006801:Humans; D006278:Medicare; D011907:Rate Setting and Review / Q000379:methods*; D020379:Risk Adjustment; D014481:United States