Risk Scoring and the Luck of the Draw
Many recent healthcare initiatives, including the Accountable Care Organizations that are created under health reform, utilize risk adjusters to compensate for the differences in disease status of the...
View ArticleRisk Adjustments for Individuals and Groups
A new report was recently released by CMS that measures the accuracy of the risk adjustment models that CMS utilizes for Medicare Advantage plans, the Physician Group Practice demonstration and others,...
View ArticleCMS Physician Group Practice Demonstration Results
The results of the Physician Group Practice (PGP) demonstration project have recently been released and are available from CMS here. Of interest in these results is the unevenness of the results. Of...
View ArticleCMS Modifies Risk Adjustment for ACOs
In the draft ACO regulations, CMS established a single ACO risk adjustment factor using historical data from all participants, and did not modify it throughout the participation period. This policy...
View ArticleRisk Adjustments and Bundled Payments
The CMS guidelines for the Medicare bundled payment initiative suggest that CMS will be receptive to the use of risk adjustments in establishing the episode payment budget for DRGs to be paid under...
View ArticleNEJM: ACO Success May Depend More On Rules than Results
Participants in Accountable Care Organizations expect to be rewarded based on the success or failures of their clinical initiatives. However, a recent report in the New England Journal of Medicine...
View ArticleRisk Adjustment - Overfitting the Model
Here's an interesting article that's essentially about trying too hard to develop a comprehensive model for healthcare risk adjustment. It's from the Healthcare Economist blog entitled "Risk...
View Article"The Return of Capitation - Preparing for Population-Based Health Care" in...
Our article on this topic is the cover article in the July issue of Healthcare Financial Management and can be downloaded here. This article provides an overview of capitation payment, the types of...
View ArticleRisk Adjustment: How Physician-Patient Encounters Can Justify Themselves
A recent article on risk adjustment by a group of researchers from Dartmouth attracted our attention. Entitled Observational intensity bias associated with illness adjustment: cross sectional analysis...
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