照顾帕金森病患者的医疗保险受益人的成本:CMS-HCC风险调整模型的影响

Katia Noyes, Hangsheng Liu, Helena Temkin-Greener
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引用次数: 11

摘要

先前的研究表明,医疗保险风险调整的人头模型不能充分补偿主要为残疾人或体弱人群服务的项目。使用医疗保险当前受益人调查,我们证明医疗保险和医疗补助服务中心-分层条件类别(CMS-HCC)模型计算帕金森患者的医疗保险人均支付比一般人群更准确。在各种残疾水平下,帕金森患者的预测支出与实际支出之间的差异比其他受益人要小。如果CMS-HCC支付模式适用于从帕金森病社区吸引大量参与者的项目,这些项目可能会得到公平的补偿。
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Cost of caring for Medicare beneficiaries with Parkinson's disease: impact of the CMS-HCC risk-adjustment model.

Previous studies have demonstrated that Medicare risk-adjusted capitation models do not adequately compensate programs serving primarily disabled or frail populations. Using the Medicare Current Beneficiary Survey, we demonstrate that the Centers for Medicare and Medicaid Services-Hierarchical Condition Categories (CMS-HCC) model calculates Medicare capitation payments for Parkinson's patients more accurately than for the general population. The discrepancies between the predicted and actual expenditures estimated at various disability levels were smaller for Parkinson's patients than for other beneficiaries. If the CMS-HCC payment model were to apply to programs that draw a significant percentage of their participants from the Parkinson's disease community, these programs likely would be compensated fairly.

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