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Modified capitation and treatment incentives for end stage renal disease.
- Source :
-
Health care financing review [Health Care Financ Rev] 1996 Spring; Vol. 17 (3), pp. 129-42. - Publication Year :
- 1996
-
Abstract
- This study developed a modified capitation payment method for the Medicare end stage renal disease (ESRD) program designed to support appropriate treatment choices and protect health plans from undue financial risk. The payment method consists of risk-adjusted monthly capitated payments for individuals on dialysis or with functioning kidney grafts, lump sum event payments for expected incremental costs of kidney transplantations or graft failures, and outlier payments for expensive patients. The methodology explained 25 percent of variation in annual payments per patient. Risk adjustment captured substantial variations across patient groups. Outlier payments reduced health plan risk by up to 15 percent.
- Subjects :
- Centers for Medicare and Medicaid Services, U.S.
Disability Evaluation
Health Care Costs
Humans
Insurance Selection Bias
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic surgery
Kidney Transplantation economics
Medicare classification
Models, Economic
Risk Management
United States epidemiology
Capitation Fee
Health Maintenance Organizations economics
Kidney Failure, Chronic economics
Medicare organization & administration
Rate Setting and Review methods
Subjects
Details
- Language :
- English
- ISSN :
- 0195-8631
- Volume :
- 17
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Health care financing review
- Publication Type :
- Academic Journal
- Accession number :
- 10158726