Principal Inpatient Diagnostic Cost Group Model for Medicare Risk Adjustment
Principal Inpatient Diagnostic Cost Group Model for Medicare Risk Adjustment
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医疗保险风险调整的主要住院诊断成本组模型
作者：
G. Pope;R. Ellis;A. Ash;Chuan;J. Ayanian;D. Bates;H. Burstin;L. Iezzoni;M. Ingber
1997年的《平衡预算法案》（BBA）要求HCFA在2000年1月1日之前对管理式医疗计划的医疗保险资金支付实施基于健康状况的风险调整。为了支持这一任务，卫生保健中心自1997年以来一直在从健康计划中收集住院病人就诊数据。这些数据包括诊断和其他信息，可用于识别导致更高成本的慢性医疗问题，以便医疗计划在照顾病情较重的患者时可以支付更多费用。在这篇文章中，作者描述了HCFA在2000年实施的风险调整模型，即主要住院患者诊断成本组（PIPDCG）模型。
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.