Medicare capitation model, functional status, and multiple comorbidities: Model accuracy

American Journal of Managed Care

Volumn 14, Issue 10, 2008, Pages 679-690

  Noyes, Katia ^a   Liu, Hangsheng ^a,b   Temkin Greener, Helena ^a  

^a UNIVERSITY OF ROCHESTER   (United States)

^b RAND CORPORATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCURACY; ADL DISABILITY; AGED; ARTHRITIS; ARTICLE; CHRONIC DISEASE; COMORBIDITY; CONGESTIVE HEART FAILURE; CORONARY ARTERY DISEASE; DEMENTIA; DIABETES MELLITUS; FEMALE; GERIATRIC PATIENT; HEALTH CARE COST; HEART DISEASE; HUMAN; HYPERTENSION; LUNG DISEASE; MAJOR CLINICAL STUDY; MALE; MANAGED CARE; MEDICARE; MODEL; NEOPLASM; OSTEOPOROSIS; PREDICTION; PREVALENCE; PRIORITY JOURNAL; STROKE;

ACTIVITIES OF DAILY LIVING; AGED; AGED, 80 AND OVER; CAPITATION FEE; CHRONIC DISEASE; COMORBIDITY; COSTS AND COST ANALYSIS; FEMALE; HUMANS; MALE; MANAGED CARE PROGRAMS; MEDICARE; MODELS, ECONOMIC; UNITED STATES;

EID: 53649087097     PISSN: 10880224     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (45)

1. Hoffman C, Rice D, Sung H. Persons with chronic conditions: their prevalence and costs. JAMA. 1996;276(18):1473-1479.
2. Anderson GF. Medicare and chronic conditions. N Engl J Med. 2005;353(3):305-309.
3. Anderson G, Horvath J. The growing burden of chronic disease in America. Public Health Rep. 2004;119(3):263-270.
4. Partnership for Solutions: Better Lives for People with Chronic Conditions. Chronic Conditions and Disability: Analysis of 2000 Census. June 2003. http://www.partnershipforsolutions.org/statistics/ issue_briefs.html. Accessed June 9, 2008.
5. Gijsen R, Hoeymans N, Schellevis F, et al. Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001;54(7):661-674.
6. Stuck A, Walthert J, Nikolaus T, Bula C, Hoffman C, Beck J. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999;48(4):445-469.
7. Boult C, Kane RL, Louis TA, Boult L, McCaffrey D. Chronic conditions that lead to functional limitation in the elderly. J Gerontol. 1994;49(1):M28-M36.
8. Kriegsman D, Deeg D, Stalman W. Comorbidity of somatic chronic diseases and decline in physical functioning: the Longitudinal Aging Study Amsterdam. J Clin Epidemiol. 2004;57(1):55-65.
9. Fried LP, Ettinger WH, Lind B, Newman AB, Gardin J. Physical disability in older adults: a physiologic approach. Cardiovascular Health Study Research Group. J Clin Epidemiol. 1994;47(7):747-760.
10. Fried LP, Bandeen-Roche K, Kasper J, Guralnik JM. Association of comorbidity with disability in older women: the Women's Health and Aging Study. J Clin Epidemiol. 1999;52(1):27-37.
11. Centers for Medicare & Medicaid Services (CMS). CMS-HCC payment model software and data. http://www.cms.hhs.gov/ MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp. Accessed September 26, 2008.
12. Pope GC, Kautter J, Ellis RP, et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev. 2004;25(4):119-141.
13. Kautter J, Pope GC. The CMS frailty adjustment model. Health Care Financ Rev. 2004;26(2):1-201.
14. McCall N, Khatutsky G, Smith K, Pope GC. Estimation of non-response bias in the Medicare FFS HOS. Health Care Financ Rev. 2004;25(4):27-41.
15. Riley GF. Risk adjustment for health plans disproportionately enrolling frail Medicare beneficiaries. Health Care Financ Rev. 2000;21(3):135-148.
16. Temkin-Greener H, Meiners MR, Gruenberg L. PACE and the Medicare+Choice risk-adjusted payment model. Inquiry. 2001;38(1):69-72.
17. Centers for Medicare & Medicaid Services. Special needs plans. Updated March 20, 2008. http://www.cms.hhs.gov/SpecialNeedsPlans. Accessed June 9, 2008.
18. Center for Medicare Advocacy. Medicare Advantage Special Needs Plans: A Beneficiary Perspective; October 18, 2007; Washington, DC. http://www.medicareadvocacy.org/SNP%20Conference/Home.htm. Accessed June 9, 2008.
19. Ettinger WH, Davis M, Neuhaus J, Mallon K. Long-term physical functioning in persons with knee osteoarthritis from NHANES-1: effect of comorbid medical conditions. J Clin Epidemiol. 1994;47(7):809-815.
20. Fillenbaum G, Pieper C, Cohen H, Cornoni-Huntley JC, Guralnik JM. Comorbidity of five chronic health conditions in elderly community residents: determinants and impact on mortality. J Gerontol A Biol Sci Med Sci. 2000;55(2):M84-M89.
21. Guralnik JM, LaCroix AZ, Abbott RD, et al. Maintaining mobility in late life, I: demographic characteristics and chronic conditions. Am J Epidemiol. 1993;137(8):845-857.
22. Newschaffer CJ, Bush TL, Penberthy LT. Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data. J Clin Epidemiol. 1997;50(6):725-733.
23. van den Bos GAM. The burden of chronic illness in terms of disability, use of health care and health life expectancies. Eur J Public Health. 1995;5:29-34.
24. Berenson RA, Bodenheimer T, Pham HH. Specialty-service lines: salvos in the new medical arms race. Health Aff (Millwood). 2006;25(5):w337-w343.
25. Freeman JL, Zhang D, Freeman DH, Goodwin JS. An approach to identifying incident breast cancer cases using Medicare claims data. J Clin Epidemiol. 2000;53(6):605-614.
26. Verbrugge LM, Lepkowski JM, Imanka Y. Comorbidity and its impact on disability. Milbank Q. 1989;67(3-4):450-484.
27. Centers for Medicare & Medicaid Services. Advance Notice of Methodological Changes for Calendar Year 2008 for Medicare Advantage (MA) Capitation Rates. February 16, 2007. http://www.cms.hhs.gov/ MedicareAdvtgSpecRateStats/Downloads/Advance2008.pdf. Accessed June 10, 2008.
28. Adler GS. A profile of the Medicare Current Beneficiary Survey. Health Care Financ Rev. 1994;15(4):153-163.
29. Eppig F, Chulis GS. Matching MCBS and Medicare data: the best of the both worlds. Health Care Financ Rev. 1997;18(3):211-229.
30. Centers for Medicare & Medicaid Services. Medicare Managed Care Manual. 2004. Publication 100-16. http://www.cms.hhs.gov/Manuals/IOM/ itemdetail.asp? Accessed June 10, 2008.
31. Barker WH, Mullooly JP, Getchell W. Changing incidence and survival for heart failure in a well-defined older population, 1970-1974 and 1990-1994. Circulation. 2006;113(6):799-805.
32. Pippenger M, Holloway RG, Vickrey BG. Neurologists' use of ICD-9CM codes for dementia. Neurology. 2001;56(9):1206-1209.
33. Centers for Medicare & Medicaid Services. Drug coverage claims data. Part D payment and risk adjustment. 2008. http://www.cms.hhs.gov/ DrugCoverageClaimsData/02_RxClaims_PaymentRiskAdjustment.asp. Accessed June 10, 2008.
34. Mark TL, Ozminkowski RJ, Kirk A, Ettner SL, Drabek J. Risk adjustment for people with chronic conditions in private sector health plans. Med Decis Making. 2003;23(5):397-405.
35. Center for Medicare Advocacy. Medicare Advantage Private Fee-for-Service (PFFS) Plans: A Primer for Advocates. 2008. http://www.medicareadvocacy.org/MA_PFFSPrimerForAdvocates.pdf. Accessed June 10, 2008.
36. Marder K, Levy G, Louis ED, et al. Accuracy of family history data on Parkinson's disease. Neurology. 2003;61(1):18-23.
37. Strickland D, Bertoni JM. Parkinson's prevalence estimated by a state registry. Mov Disord. 2004;19(3):318-323.
38. Noyes K, Liu H, Holloway RG, Dick AW. Accuracy of Medicare claims data in identifying Parkinsonism cases. Mov Disord. 2006;9(6):339-348.
39. Swarztrauber K, Anau J, Peters D. Identifying and distinguishing cases of Parkinsonism and Parkinson's disease using ICD-9-CM codes and pharmacy data. Mov Disord. 2005;20(8):964-970.
40. Hebert PI, Geiss LS, Tiemey EF, Engelgau MM, Yawn BP. Identifying persons with diabetes using Medicare claims data. Am J Med Qual. 1999;14(6):270-277.
41. Winkelmayer WC, Schneeweiss S, Mogun H, Patrick AR, Avom J, Soloman DH. Identification of individuals with CKD from Medicare claims data: a validation study. Am J Kidney Dis. 2005;46(2):225-232.
42. Gold HT, Do HT. Evaluation of algorithms to identify incident breast cancer in Medicare claims data. Health Serv Res. 2007;42(5):2056-2069.
43. Nattinger AB, Laud PW, Bajorunaite R, Sparapani RA, Freeman JL. An algorithm for the use of Medicare claims data to identify women with incident breast cancer. Health Serv Res. 2004;39(6, pt 1):1733-1749.
44. Warren JL, Feuer E, Potosky AL, Riley GF, Lynch CF. Use of Medicare hospital and physician data to assess breast cancer incidence. Med Care. 1999;37(5):445-456.
45. Birman-Deych E, Waterman AD, Yan Y, Nilasena DS, Radford MJ, Gage BF. Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors. Med Care. 2005;43(5):480-485.