Voluntary Partial Capitation: The Community Nursing Organization Medicare Demonstration
Frakt, A. B.,
Date of Pub
Pizer, S. D., Schmitz, R. J., Soeren, M.
In a recently concluded Medicare demon-stration, Community Nursing Organizations(CNOs) received capitated payment to pro-vide
a subset of Medicare services through anursing case management delivery system.Demonstration participation was volun-tary,
both for CNOs and recruited benefi-ciaries, raising several challenging issuesassociated with selection. We investigateprovider
and beneficiary selection, as wellas Medicare costs, using multiple evalua-tion methodologies. We find that CNOenrollment
is associated with increasedpayment by Medicare for CNO-covered ser-vices. Results showing CNO enrollees to bemore costly
to Medicare for non-CNO ser-vices are consistent with cost shifting, butcould also be accounted for by biasedprovider selection
into the demonstration.