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. 1989 Summer;10(4):17-29.

Adjusting Medicare capitation payments using prior hospitalization data

A Ash, F Porell, L Gruenberg, E Sawitz, A Beiser

Adjusting Medicare capitation payments using prior hospitalization data

A Ash et al. Health Care Financ Rev. 1989 Summer.

Abstract

The diagnostic cost group approach to a reimbursement model for health maintenance organizations is presented. Diagnostic information about previous hospitalizations is used to create empirically determined risk groups, using only diagnoses involving little or no discretion in the decision to hospitalize. Diagnostic cost group and other models (including Medicare's current formula and other prior-use models) are tested for their ability to predict future costs, using R2 values and new measures of predictive performance. The diagnostic cost group models perform relatively well with respect to a range of criteria, including administrative feasibility, resistance to provider manipulation, and statistical accuracy.

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Figures

Figure 1
Figure 1. Annual 1980 cost for Medicare enrollees, by presence of at least one 1979 hospitalization in each of 78 diagnostic subgroups: United States
See this image and copyright information in PMC

References

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