Sample Selection for Medicare Risk Adjustment Due to Systematically Missing Data
Sample Selection for Medicare Risk Adjustment Due to Systematically Missing Data
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DOI：
10.1111/1475-6773.13046
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发表时间：
2018-12-01
影响因子：
3.4
通讯作者：
Rose, Sherri
中科院分区：
文献类型：
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作者：
Bergquist, Savannah L.;McGuire, Thomas G.;Rose, Sherri
目的数据来源评估医疗保险优势（MA）风险调整中的非代表性抽样问题。2008年至2011年的医疗保险注册和索赔数据。数据提取研究设计风险调整预测变量是从2008年至2010年的A部分和B部分索赔以及Medicare受益人摘要文件创建的。支出是基于2009-2011年A和B部分，耐用医疗设备和家庭健康机构索赔文件。创建了一个与MA注册者相似的传统医疗保险（TM）受益人的倾向评分匹配样本。风险调整公式估计使用多种技术，和性能进行评估的基础上R-2，预测比率，并在匹配的样本和TM受益人的随机样本的公式系数。主要调查结果结论匹配改善了可观察的平衡，但性能指标相似，比较风险调整公式的结果，适合在匹配的样本与随机样本，并在匹配的样本进行评估。在随机样本与匹配样本上拟合MA风险调整公式，在MA计划付款方面几乎没有差异。这并不排除通过匹配方法的潜在改进，如果可靠的MA遭遇数据和额外的变量可用于风险调整。
Objective Data Sources To assess the issue of nonrepresentative sampling in Medicare Advantage (MA) risk adjustment. Medicare enrollment and claims data from 2008 to 2011. Data Extraction Study Design Risk adjustment predictor variables were created from 2008 to 2010 Part A and B claims and the Medicare Beneficiary Summary File. Spending is based on 2009-2011 Part A and B, Durable Medical Equipment, and Home Health Agency claims files. A propensity-score matched sample of Traditional Medicare (TM) beneficiaries who resembled MA enrollees was created. Risk adjustment formulas were estimated using multiple techniques, and performance was evaluated based on R-2, predictive ratios, and formula coefficients in the matched sample and a random sample of TM beneficiaries. Principal Findings Conclusions Matching improved balance on observables, but performance metrics were similar when comparing risk adjustment formula results fit on and evaluated in the matched sample versus fit on the random sample and evaluated in the matched sample. Fitting MA risk adjustment formulas on a random sample versus a matched sample yields little difference in MA plan payments. This does not rule out potential improvements via the matching method should reliable MA encounter data and additional variables become available for risk adjustment.