The Medicare hospice payment system: a consideration of potential refinements.
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.
Nicosia
Nancy
N
RAND Corporation, Boston, MA 02116, USA. Nicosia@rand.org
Reardon
Elaine
E
Lorenz
Karl
K
Lynn
Joanne
J
Buntin
Melinda Beeuwkes
MB
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