New medicare and medicaid study findings have been reported by scientists at University of Rochester
December 1st, 2008
2008 DEC 1 -- In this recent report, researchers in the United States conducted a study "To examine financial implications of the Centers for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. The study used 1992-2000 data from the Medicare Current Beneficiary Survey and corresponding Medicare claims."
"Pairs of comorbidities were formed based,on prior evidence about possible synergy between these conditions and activities of daily living (ADLs) deficiencies, and included heart disease and cancer, lung disease and cancer, stroke and hypertension, stroke and arthritis, congestive heart failure (CHF) and osteoporosis, diabetes and coronary artery disease, and CHF and dementia. For each beneficiary, we calculated the actual Medicare cost ratio as the ratio of the individual's annualized costs to the mean annual Medicare cost for all people in the study. The actual Medicare cost ratios, by ADLs, were compared with HCC ratios under the CMS-HCC payment model. Using multivariate regression models, we tested whether having the identified pairs of comorbidities affected the accuracy of CMS-HCC model predictions. The CMS-HCC model underpredicted Medicare capitation payments for patients with hypertension, lung disease, CHF, and dementia. The difference between the actual costs and predicted payments was partially explained by beneficiary functional status and less-than-optimal adjustment for these chronic conditions. Information about beneficiary functional status should be incorporated in reimbursement models," wrote K. Noyes and colleagues, University of Rochester.
The researchers concluded: "Underpaying providers who care for populations with multiple comorbidities may provide severe disincentives for managed care plans to enroll such individuals and to appropriately manage their complex and costly conditions. (Am J Manag Care. 2008;14(10):679-690)'."
Noyes and colleagues published their study in American Journal of Managed Care (Medicare Capitation Model, Functional Status, and Multiple Comorbidities: Model Accuracy. American Journal of Managed Care, 2008;14(10):679-690).
For additional information, contact K. Noyes, University of Rochester, Dept. of Community & Prevention Medical, 601 Elmwood Avenue, Box 644, Rochester, NY 14620, USA.
Publisher contact information for the American Journal of Managed Care is: Managed Care & Healthcare Communications LLC, 666 Plainsboro Rd., Ste. 300, Plainsboro, NJ 08536, USA.
Keywords: United States, Box, Medicare and Medicaid, Angiology, Arthritis, Cancer, Cardiology, Central Nervous System Disease, Congestive Heart Failure, Coronary Artery Disease, Dementia, Diabetes, Health Policy, Heart Disease, Hypertension, Lung Disease, Managed Care, Medicaid, Medicare, Oncology, Osteoporosis, University of Rochester.
This article was prepared by Pain & Central Nervous System Week editors from staff and other reports. Copyright 2008, Pain & Central Nervous System Week via NewsRx.com.
