Modified capitation and treatment incentives for end stage renal disease.
Farley, Donna O
Date of Pub
Carter, Grace M; Kallich, Joel D; Lucas, Thomas W; Spritzer, Karen L
This study developed a modified capitation payment method for the Medicare end stage renal disease (ESRD) program designed
to support appropriate treatment choices and protect health plans from undue financial risk. The payment method consists of
risk-adjusted monthly capitated payments for individuals on dialysis or with functioning kidney grafts, lump sum event payments
for expected incremental costs of kidney transplantations or graft failures, and outlier payments for expensive patients.
The methodology explained 25 percent of variation in annual payments per patient. Risk adjustment captured substantial variations
across patient groups. Outlier payments reduced health plan risk by up to 15 percent.
Capitation Fee : Disability Evaluation : Health Care Costs : Health Maintenance Organizations/economics : Human : Insurance
Selection Bias : Kidney Failure, Chronic/economics/epidemiology/surgery : Kidney Transplantation/economics : Medicare/classification/organization
& administration : Models, Economic : Rate Setting and Review/methods : Risk Management : Support, U.S. Gov't, Non-P.H.S.
: United States Health Care Financing Administration : United States/epidemiology