Principal inpatient diagnostic cost group model for Medicare risk adjustment
Pope, Gregory C
Date of Pub
Ash, Arlene S; Ayanian, John Z; Bates, David W; Burstin, Helen; Ellis, Randall P; Iezzoni, Lisa I; Ingber, Melvin J; Liu,
The Balanced Budget Act (BBA) of 1997 required HCFA to implement health-status-based risk adjustment for Medicare capitation
payments for managed care plans by January 1, 2000. In support of this mandate, HCFA has been collecting inpatient encounter
data from health plans since 1997. These data include diagnoses and other information that can be used to identify chronic
medical problems that contribute to higher costs, so that health plans can be paid more when they care for sicker patients.
In this article, the authors describe the risk-adjustment model HCFA is implementing in the year 2000, known as the Principal
Inpatient Diagnostic Cost Group (PIPDCG) model.
Costs and Cost Analysis/methods : Health Expenditures : Insurance Selection Bias : Chronic Disease : Diagnosis-Related Groups
: Fee-for-Service Plans : Health Maintenance Organizations : Health Status : Medicare : Regression Analysis : Risk Factors
: Support, U.S. Gov't, non-P.H.S. : United States