Capitation pricing: adjusting for prior utilization and physician discretion.
Anderson, Gerald F
Date of Pub
Cantor, Joel C; Holloway, James J; Steinberg, Earl P
As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting
payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost
(AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of
a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision
to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions.
The model also explains more of the variance in per capita expenditures than does the current AAPCC.
Capitation Fee : Fees and Charges : Health Expenditures : Physician's Role : Role : Costs and Cost Analysis/methods : Hospitalization/economics
: Medicare/utilization : Models, Theoretical : Rate Setting and Review/methods : Statistics : United States : United States
Health Care Financing Administration