DiseasesAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPsychiatry and PsychologyPhenomena and ProcessesDisciplines and OccupationsAnthropology, Education, Sociology and Social PhenomenaInformation ScienceNamed GroupsHealth CareGeographicals
Risk AdjustmentInsurance Selection BiasCapitation FeeCompetitive Medical PlansRate Setting and ReviewIntegrative MedicineDiagnosis-Related GroupsHospital MortalityAdmitting Department, HospitalCenters for Medicare and Medicaid Services (U.S.)United StatesQuality Indicators, Health CareOutcome Assessment (Health Care)Cost AllocationManaged CompetitionHealth ExpendituresHospitals, VeteransSocial AdjustmentBenchmarkingModels, StatisticalMedicareRisk FactorsInternational Classification of DiseasesNational Health Insurance, United StatesHospitalsInsurance Claim ReviewLogistic ModelsRisk AssessmentHealth Services ResearchChileWashingtonFee-for-Service PlansRegression AnalysisQuality of Health CareMichiganRetrospective StudiesHealth Benefit Plans, EmployeeInsurance, HealthCohort StudiesDatabases, FactualOdds RatioCesarean SectionCardiac Surgical ProceduresProspective StudiesSeverity of Illness IndexMultivariate AnalysisAdjustment DisordersNational Health ProgramsComorbidityTreatment OutcomeCaliforniaAge FactorsLength of StayQuality Assurance, Health CareInfant, NewbornInfant MortalityHealth Status IndicatorsRegistriesHeart Defects, CongenitalPredictive Value of TestsModels, TheoreticalCoronary Artery BypassReproducibility of ResultsTime FactorsHospitalizationDelivery of Health Care
Risk Adjustment: The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)Insurance Selection Bias: Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.Capitation Fee: A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.Competitive Medical Plans: Alternative health care delivery mechanisms, such as PREFERRED PROVIDER ORGANIZATIONS or other health insurance services or prepaid plans (other than HEALTH MAINTENANCE ORGANIZATIONS), that meet Medicare qualifications for a risk-sharing contract. (From Facts on File Dictionary of Health Care Management, 1988)Rate Setting and Review: A method of examining and setting levels of payments.Integrative Medicine: The discipline concerned with using the combination of conventional ALLOPATHIC MEDICINE and ALTERNATIVE MEDICINE to address the biological, psychological, social, and spiritual aspects of health and illness.Diagnosis-Related Groups: A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations.Admitting Department, Hospital: Hospital department responsible for the flow of patients and the processing of admissions, discharges, transfers, and also most procedures to be carried out in the event of a patient's death.Centers for Medicare and Medicaid Services (U.S.): A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.United StatesQuality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Outcome Assessment (Health Care): Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).Cost Allocation: The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.Managed Competition: A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.Hospitals, Veterans: Hospitals providing medical care to veterans of wars.Social Adjustment: Adaptation of the person to the social environment. Adjustment may take place by adapting the self to the environment or by changing the environment. (From Campbell, Psychiatric Dictionary, 1996)Benchmarking: Method of measuring performance against established standards of best practice.Models, Statistical: Statistical formulations or analyses which, when applied to data and found to fit the data, are then used to verify the assumptions and parameters used in the analysis. Examples of statistical models are the linear model, binomial model, polynomial model, two-parameter model, etc.Medicare: Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.International Classification of Diseases: A system of categories to which morbid entries are assigned according to established criteria. Included is the entire range of conditions in a manageable number of categories, grouped to facilitate mortality reporting. It is produced by the World Health Organization (From ICD-10, p1). The Clinical Modifications, produced by the UNITED STATES DEPT. OF HEALTH AND HUMAN SERVICES, are larger extensions used for morbidity and general epidemiological purposes, primarily in the U.S.National Health Insurance, United StatesHospitals: Institutions with an organized medical staff which provide medical care to patients.Insurance Claim Review: Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)Health Services Research: The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)ChileWashingtonFee-for-Service Plans: Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.MichiganRetrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Health Benefit Plans, Employee: Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Databases, Factual: Extensive collections, reputedly complete, of facts and data garnered from material of a specialized subject area and made available for analysis and application. The collection can be automated by various contemporary methods for retrieval. The concept should be differentiated from DATABASES, BIBLIOGRAPHIC which is restricted to collections of bibliographic references.Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases.Cesarean Section: Extraction of the FETUS by means of abdominal HYSTEROTOMY.Cardiac Surgical Procedures: Surgery performed on the heart.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Severity of Illness Index: Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.Adjustment Disorders: Maladaptive reactions to identifiable psychosocial stressors occurring within a short time after onset of the stressor. They are manifested by either impairment in social or occupational functioning or by symptoms (depression, anxiety, etc.) that are in excess of a normal and expected reaction to the stressor.National Health Programs: Components of a national health care system which administer specific services, e.g., national health insurance.Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.CaliforniaAge Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Length of Stay: The period of confinement of a patient to a hospital or other health facility.Quality Assurance, Health Care: Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.Infant, Newborn: An infant during the first month after birth.Infant Mortality: Postnatal deaths from BIRTH to 365 days after birth in a given population. Postneonatal mortality represents deaths between 28 days and 365 days after birth (as defined by National Center for Health Statistics). Neonatal mortality represents deaths from birth to 27 days after birth.Health Status Indicators: The measurement of the health status for a given population using a variety of indices, including morbidity, mortality, and available health resources.Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers.Heart Defects, Congenital: Developmental abnormalities involving structures of the heart. These defects are present at birth but may be discovered later in life.Predictive Value of Tests: In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test.Models, Theoretical: Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment.Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion.Reproducibility of Results: The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Hospitalization: The confinement of a patient in a hospital.Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population.

Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information. (1/409)

OBJECTIVE: To evaluate the predictive accuracy of the Diagnostic Cost Group (DCG) model using health survey information. DATA SOURCES/STUDY SETTING: Longitudinal data collected for a sample of members of a Dutch sickness fund. In the Netherlands the sickness funds provide compulsory health insurance coverage for the 60 percent of the population in the lowest income brackets. STUDY DESIGN: A demographic model and DCG capitation models are estimated by means of ordinary least squares, with an individual's annual healthcare expenditures in 1994 as the dependent variable. For subgroups based on health survey information, costs predicted by the models are compared with actual costs. Using stepwise regression procedures a subset of relevant survey variables that could improve the predictive accuracy of the three-year DCG model was identified. Capitation models were extended with these variables. DATA COLLECTION/EXTRACTION METHODS: For the empirical analysis, panel data of sickness fund members were used that contained demographic information, annual healthcare expenditures, and diagnostic information from hospitalizations for each member. In 1993, a mailed health survey was conducted among a random sample of 15,000 persons in the panel data set, with a 70 percent response rate. PRINCIPAL FINDINGS: The predictive accuracy of the demographic model improves when it is extended with diagnostic information from prior hospitalizations (DCGs). A subset of survey variables further improves the predictive accuracy of the DCG capitation models. The predictable profits and losses based on survey information for the DCG models are smaller than for the demographic model. Most persons with predictable losses based on health survey information were not hospitalized in the preceding year. CONCLUSIONS: The use of diagnostic information from prior hospitalizations is a promising option for improving the demographic capitation payment formula. This study suggests that diagnostic information from outpatient utilization is complementary to DCGs in predicting future costs.  (+info)

Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. (2/409)

We used a novel computerized decision-making task to compare the decision-making behavior of chronic amphetamine abusers, chronic opiate abusers, and patients with focal lesions of orbital prefrontal cortex (PFC) or dorsolateral/medial PFC. We also assessed the effects of reducing central 5-hydroxytryptamine (5-HT) activity using a tryptophan-depleting amino acid drink in normal volunteers. Chronic amphetamine abusers showed suboptimal decisions (correlated with years of abuse), and deliberated for significantly longer before making their choices. The opiate abusers exhibited only the second of these behavioral changes. Importantly, both sub-optimal choices and increased deliberation times were evident in the patients with damage to orbitofrontal PFC but not other sectors of PFC. Qualitatively, the performance of the subjects with lowered plasma tryptophan was similar to that associated with amphetamine abuse, consistent with recent reports of depleted 5-HT in the orbital regions of PFC of methamphetamine abusers. Overall, these data suggest that chronic amphetamine abusers show similar decision-making deficits to those seen after focal damage to orbitofrontal PFC. These deficits may reflect altered neuromodulation of the orbitofrontal PFC and interconnected limbic-striatal systems by both the ascending 5-HT and mesocortical dopamine (DA) projections.  (+info)

Evaluating and improving the delivery of heart care: the University of Michigan experience. (3/409)

With increasing pressure to curb escalating costs in medical care, there is particular emphasis on the delivery of cardiovascular services, which account for a substantial portion of the current healthcare dollar spent in the United States. A variety of tools were used to improve performance at the University of Michigan Health System, one of the oldest university-affiliated hospitals in the United States. The tools included initiatives to understand outcomes after coronary bypass operations and coronary angioplasty through use of proper risk-adjusted models. Critical pathways and guidelines were implemented to streamline care and improve quality in interventional cardiology, management of myocardial infarction, and preoperative assessment of patients undergoing vascular operations. Strategies to curb unnecessary costs included competitive bidding of vendors for expensive cardiac commodities, pharmacy cost reductions, and changes in nursing staff. Methods were instituted to improve guest services and partnerships with the community in disease prevention and health promotion.  (+info)

Health-based payment and computerized patient record systems. (4/409)

Health care information technology is changing rapidly and dramatically. A small but growing number of clinicians, especially those in staff and group model HMOs and hospital-affiliated practices, are automating their patient medical records in response to pressure to improve quality and reduce costs. Computerized patient record systems in HMOs track risks, diagnoses, patterns of care, and outcomes across large populations. These systems provide access to large amounts of clinical information; as a result, they are very useful for risk-adjusted or health-based payment. The next stage of evolution in health-based payment is to switch from fee-for-service (claims) to HMO technology in calculating risk coefficients. This will occur when HMOs accumulate data sets containing records on provider-defined disease episodes, with every service linked to its appropriate disease episode for millions of patients. Computerized patient record systems support clinically meaningful risk-assessment models and protect patients and medical groups from the effects of adverse selection. They also offer significant potential for improving quality of care.  (+info)

Risk-adjusted outcome models for public mental health outpatient programs. (5/409)

OBJECTIVE: To develop and test risk-adjustment outcome models in publicly funded mental health outpatient settings. We developed prospective risk models that used demographic and diagnostic variables; client-reported functioning, satisfaction, and quality of life; and case manager clinical ratings to predict subsequent client functional status, health-related quality of life, and satisfaction with services. DATA SOURCES/STUDY SETTING: Data collected from 289 adult clients at five- and ten-month intervals, from six community mental health agencies in Washington state located primarily in suburban and rural areas. Data sources included client self-report, case manager ratings, and management information system data. STUDY DESIGN: Model specifications were tested using prospective linear regression analyses. Models were validated in a separate sample and comparative agency performance examined. PRINCIPAL FINDINGS: Presence of severe diagnoses, substance abuse, client age, and baseline functional status and quality of life were predictive of mental health outcomes. Unadjusted versus risk-adjusted scores resulted in differently ranked agency performance. CONCLUSIONS: Risk-adjusted functional status and patient satisfaction outcome models can be developed for public mental health outpatient programs. Research is needed to improve the predictive accuracy of the outcome models developed in this study, and to develop techniques for use in applied settings. The finding that risk adjustment changes comparative agency performance has important consequences for quality monitoring and improvement. Issues in public mental health risk adjustment are discussed, including static versus dynamic risk models, utilization versus outcome models, choice and timing of measures, and access and quality improvement incentives.  (+info)

Anthem Blue Cross and Blue Shield's coronary services network: a managed care organization's approach to improving the quality of cardiac care for its members. (6/409)

OBJECTIVE: To describe a managed care organization's efforts to improve value for its members by forming a coronary services network (CSN). DESIGN: To identify high-quality facilities for its CSN, Anthem Blue Cross and Blue Shield reviewed claims data and clinical data from hospitals that met its general quality standards. An external firm measured and risk-adjusted applicant hospitals' mortality rates. Hospitals that demonstrated superior performance were eligible to join the CSN. In 1996, 2 years after the CSN was formed, clinical outcomes of participants and new applicants were analyzed again by the same external firm. PATIENTS AND METHODS: Data on more than 10,000 consecutive (all-payer) inpatients discharged after coronary bypass surgery in 1993 were collected from 16 applicant hospitals using a uniform format and data definitions. This analysis was expanded to 23 participating and applicant hospitals that discharged more than 13,000 patients who underwent either bypass surgery or coronary revascularization in 1995. We compared risk-adjusted routine length of stay (a measure of efficiency), mortality rates, and adverse outcome rates between CSN and non-CSN facilities. RESULTS: From 1993 to 1995, overall length of stay in the network decreased by 20%, from 12.3 to 9.8 days (P < or = 0.01) and severity-adjusted mortality rates decreased by 7.3%, from 2.9% to 2.7%. Initially, facilities outside the network had comparable efficiency but much higher mortality. However, they improved so much in both measures that their severity-adjusted mortality rate for bypass surgery in 1995 was no more than 10% higher than that of CSN hospitals. CONCLUSION: The creation of a statewide CSN that emphasized and improved the level of performance among providers ultimately benefited the carrier's managed care members. The desirability of participation was evidenced by an increase in the number of applicant hospitals over the 2 years. This may have stimulated quality improvement among competing providers in the region and among CSN facilities themselves.  (+info)

Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. (7/409)

BACKGROUND: Interest in the reporting of risk-adjusted outcomes for patients with acute myocardial infarction is growing. A useful risk-adjustment model must balance parsimony and ease of data collection with predictive ability. METHODS AND RESULTS: From our analysis of 82 359 patients >/=65 years of age admitted with acute myocardial infarction to 2401 hospitals, we derived a parsimonious model that predicts 30-day mortality. The model was validated on a similar group of 78 699 patients from 2386 hospitals. Of the 73 candidate predictor variables examined, 7 variables describing patient characteristics on arrival were selected for inclusion in the final model: age, cardiac arrest, anterior or lateral location of myocardial infarction, systolic blood pressure, white blood cell count, serum creatinine, and congestive heart failure. The area under the receiver-operating characteristic curve for the final model was 0.77 in the derivation cohort and 0.77 in the validation cohort. The rankings of hospitals by performance (in deciles) with this model were most similar to a comprehensive 27-variable model based on medical chart review and least similar to models based on administrative billing codes. CONCLUSIONS: A simple 7-variable risk model performs as well as more complex models in comparing hospital outcomes for acute myocardial infarction. Although there is a continuing need to improve methods of risk adjustment, our results provide a basis for hospitals to develop a simple approach to compare outcomes.  (+info)

Case mix adjustment in nursing systems research: the case of resident outcomes in nursing homes. (8/409)

Case mix indicates, for a resident population, the degree of risk for developing favorable or unfavorable outcomes. In a study of 164 nursing homes, we explored two methods for combining resident assessment data into a case mix index (CMI). We compared a facility-level, composite CMI to a prevalence-based CMI comprised of 22 separate resident characteristics for their adequacy in explaining resident outcomes. The prevalence-based CMI consistently explained more variance in outcomes than the facility level, composite CMI. This study indicates a reasonable method for using administrative databases containing resident assessment data to adjust for the influence of case mix on nursing home resident outcomes.  (+info)

Risk-adjustment methods for all-payer comparative performance reporting in Vermont | BMC Health Services Research | Full TextRisk-adjustment methods for all-payer comparative performance reporting in Vermont | BMC Health Services Research | Full Text
As the emphasis in health reform shifts to value-based payments, especially through multi-payer initiatives supported by the U.S. Center for Medicare & Medicaid Innovation, and with the increasing availability of statewide all-payer claims databases, the need for an all-payer,
Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works | The BMJUse of risk adjustment in setting budgets and measuring performance in primary care I: how it works | The BMJ
Under this system, healthcare providers take responsibility for much of the financial risk that may arise from providing health services to patients.10 Because the total number of patients enrolled with a healthcare provider may be relatively small, the threat of "adverse selection" (registering patients who use considerably more healthcare resources than covered by their capitation payment) is great. For example, the 10% of Medicaid enrolees who make the most use of resources account for around 70% of all Medicaid payments.11 Consequently, without some method of risk adjustment of payments, healthcare providers will compete to attract healthy patients who are unlikely to make much use of their services. Sicker patients may find it difficult to find a healthcare provider who is willing to register them.. To overcome this problem, diagnosis based risk adjustment models have been developed to modify the payments made to health maintenance organisations and health plans. For example, the US Federal ...
The Use of Health Status Based Risk Adjustment Methodologies - Actuarial Standards BoardActuarial Standards BoardThe Use of Health Status Based Risk Adjustment Methodologies - Actuarial Standards BoardActuarial Standards Board
January 2012. TO: Members of Actuarial Organizations Governed by the Standards of Practice of the Actuarial Standards Board and Other Persons Interested in the Use of Health Status Based Risk Adjustment Methodologies. FROM: Actuarial Standards Board (ASB). SUBJ: Actuarial Standard of Practice (ASOP) No. 45. This document contains the final version of ASOP No. 45, The Use of Health Status Based Risk Adjustment Methodologies.. Background. Health status based risk adjustment methodologies have been an important tool in the health insurance marketplace since the 1970s. The use of risk adjustment has significant effects on health insurance companies, healthcare providers, consumers, employers and others. The importance and influence of health status based risk adjustment methodologies are likely to increase as healthcare programs that currently use risk adjustment expand the populations they cover and other programs adopt the use of risk adjustment. ASOP No. 12, Risk Classification (for All Practice ...
HCC Coding/RAC (Risk Assessment Coding) Services<...HCC Coding/RAC (Risk Assessment Coding) Services<...
Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. Implemented in 2003, this model identifies individuals suffering from chronic illness and assigns a risk factor score to the person based upon a combination of the individuals health conditions and demographic details. The individuals health conditions are identified through the International Classification of Diseases -10 cm (ICD -10cm) diagnoses that are submitted by providers on incoming claims. There are more than 9000 ICD-10 codes that map to 79 HCC codes in the Risk Adjustment model.
Comparison of trauma centre outcome performance for young adults and geriatric patients | Injury PreventionComparison of trauma centre outcome performance for young adults and geriatric patients | Injury Prevention
The increasing number of geriatric trauma patients in developed countries is a preoccupation at every stage in the continuum of trauma care. In the acute care setting, elderly patients require specific care strategies and patient outcome may be compromised by varying degrees of dedication to geriatric trauma across hospitals. We hypothesised that the performance of trauma centres in the population of geriatric patients differs to that among young adults. Analyses were based on the evaluation of hospital mortality across the 59 trauma centres of the inclusive trauma system in the province of Quebec, Canada (1999-2006). Trauma centre evaluation was based on estimates of risk-adjusted mortality generated using a random-intercept hierarchical logistic regression model. Adjustment was performed with a risk score generated by the Trauma Risk Adjustment Model. Results for young adults (16-64 years) and geriatric patients (≥65 years) were compared using hospital ranks and outliers. Among the 55 355 ...
Comparative Performance of Diagnosis-based and Prescription-based Comorbidity Scores to Predict Health-related Quality of Life<...Comparative Performance of Diagnosis-based and Prescription-based Comorbidity Scores to Predict Health-related Quality of Life<...
TY - JOUR. T1 - Comparative Performance of Diagnosis-based and Prescription-based Comorbidity Scores to Predict Health-related Quality of Life. AU - Mehta, Hemalkumar. AU - Sura, Sneha D.. AU - Sharma, Manvi. AU - Johnson, Michael L.. AU - Riall, Taylor S.. PY - 2016/2/25. Y1 - 2016/2/25. N2 - OBJECTIVES:: To compare the performance of the health-related quality of life-comorbidity index (HRQoL-CI) with the diagnosis-based Charlson, Elixhauser, and combined comorbidity scores and the prescription-based chronic disease score (CDS) in predicting HRQoL in Agency of Healthcare Research and Quality priority conditions (asthma, breast cancer, diabetes, and heart failure). METHODS:: The Medical Expenditure Panel Survey (2005 and 2007-2011) data was used for this retrospective study. Four disease-specific cohorts were developed that included adult patients (age 18 y and above) with the particular disease condition. The outcome HRQoL [physical component score (PCS) and mental component score (MCS)] was ...
Developing a diagnosis-based severity classification system for use in by Evaline A. Alessandrini, Elizabeth R. Alpern et al."Developing a diagnosis-based severity classification system for use in" by Evaline A. Alessandrini, Elizabeth R. Alpern et al.
Alessandrini, E. A., Alpern, E. R., Chamberlain, J. M., Shea, J. A., Holubkov, R., & Gorelick, M. H. (2012). Developing a diagnosis-based severity classification system for use in emergency medical services for children. Academic Emergency Medicine, 19(1), 70-78.. ...
A THEORETICAL MODEL FOR THE DEVELOPMENT OF A DIAGNOSIS-BASED CLINICAL DECISION RULE FOR THE MANAGEMENT OF PATIENTS WITH SPINAL...A THEORETICAL MODEL FOR THE DEVELOPMENT OF A DIAGNOSIS-BASED CLINICAL DECISION RULE FOR THE MANAGEMENT OF PATIENTS WITH SPINAL...
This page contains the abstract A Theoretical Model For The Development Of A Diagnosis-based Clinical Decision Rule For The Management Of Patients With Spinal Pain http://www.chiro.org/LINKS/ABSTRACTS/A_Theoretical_Model_For_The_Development.shtml
Assessing urinary flow rate, creatinine, osmolality and other hydration adjustment methods for urinary biomonitoring using...Assessing urinary flow rate, creatinine, osmolality and other hydration adjustment methods for urinary biomonitoring using...
Assessing urinary flow rate, creatinine, osmolality and other hydration adjustment methods for urinary biomonitoring using NHANES arsenic, iodine, lead and cadmium data
Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases | BMC Health...Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases | BMC Health...
We compared the performance of the Charlson and the Elixhauser comorbidity measures in predicting short and long term mortality among patients with CHF, diabetes, CRF, stroke, and CABG between ICD-9 and ICD-10 Canadian hospital discharge abstract databases. We found that most comorbidities studied had similar frequencies across ICD-9 and ICD-10 databases although variations were observed for some comorbidities. The performance of the Charlson and Elixhauser comorbidity measures in discriminating mortality was similar in ICD-9 data as well as ICD-10 data across five study cohorts.. In the patients with CHF and stroke, the C-statistic values for the predicting in-hospital or 1 year mortality were notably low with values of 0.63 and 0.66 for CHF and 0.62 and 0.67 for stroke, respectively. The low values might reflect the fact that some powerful clinical predictors of poor outcomes were not included in these measures due to a lack of information in the administrative databases, such as ejection ...
Do Hierarchical Condition Category Model Scores Predict Hospitalization Risk in Newly Enrolled Medicare Advantage Participants...Do Hierarchical Condition Category Model Scores Predict Hospitalization Risk in Newly Enrolled Medicare Advantage Participants...
To compare how well hierarchical condition categories (HCC) and probability of repeated admission (PRA) scores predict hospitalization. Longitudinal cohort study with 12-month follow-up. A Medicare Advantage (MA) plan. Four thousand five hundred six newly enrolled beneficiaries. HCC scores were...
Unison modular flex guide rail adjustment system from TronicsUnison modular flex guide rail adjustment system from Tronics
The Unison modular flex guide rail adjustment system is designed to reduce the amount of time spent changing guide rails on conveyor systems.
Diagnostic performance of line-immunoassay based algorithms for incident HIV-1 infection - Zurich Open Repository and ArchiveDiagnostic performance of line-immunoassay based algorithms for incident HIV-1 infection - Zurich Open Repository and Archive
Results: The 10 best algorithms had a mean raw sensitivity of 59.4% and a mean specificity of 95.1%. Adjustment for overrepresentation of patients in the first quarter year of infection further reduced the sensitivity. In the preferred model, the mean adjusted sensitivity was 37.4%. Application of the 10 best algorithms to four annual cohorts of HIV-1 notifications totalling 2595 patients yielded a mean IIR of 0.35 in 2005/6 (baseline) and of 0.45, 0.42 and 0.35 in 2008, 2009 and 2010, respectively. The increase between baseline and 2008 and the ensuing decreases were highly significant. Other adjustment models yielded different absolute IIR, although the relative changes between the cohorts were identical for all ...
Risk Regulation in Europe: Assessing the Application of the Precautionary Principle | Mannheimer Zentrum für Europäische...Risk Regulation in Europe: Assessing the Application of the Precautionary Principle | Mannheimer Zentrum für Europäische...
1 Introduction. Research Questions. Empirical Focus. Theoretical Argument. About the Cases. Structure of the Book. References. 2 Making and Changing Policies. Making Policies. Problem Definition and Agenda Setting. Policy Drafting and Adoption. Policy Implementation. Policy Evaluation. Scientific Evidence in the Making of Policies. Changing Policies. Defining Policy Change. Explaining Policy Change. Subsystem Adjustment Model. Agenda Setting and Policy Change. Changing Precautionary Policies. Conclusion. References. 3 Review of the Regulatory Context. Introduction. European Union: Actors, Institutions, and Decision Making. Political System of the European Union. Types of European Law. Policy Making in the European Union. Agenda Setting and Drafting. Adoption. Implementation. World Trade Organization. Conclusion. References. 4 Perspectives on the Precautionary Principle. General Characteristics of the Precautionary Principle. Risk and Uncertainty. Main Interpretations. Application Through Policy ...
Political Economy of Skilled Immigration - Oxford ScholarshipPolitical Economy of Skilled Immigration - Oxford Scholarship
This chapter analyses the drivers of individual attitudes towards skilled immigration, looking at how preferences towards overall and skilled immigration change depending on the relative skill composition of the native vs. immigrant population. The chapter finds that more educated natives are less likely to favour high educational qualifications of migrants across several countries-consistent with the labour market channel-while richer individuals are more likely to-consistent with the welfare state channel under the tax adjustment model. The chapter then considers how individual preferences can be aggregated into policy outcomes in a democratic society by using a median voter model and a framework in which policy outcomes are instead the result of lobbying efforts by organized groups. The chapter does not find evidence consistent with the median voter model, but it shows that interest groups are actively engaged and effective in affecting policies towards skilled migrants.
Response to Letter Regarding Articles Electrocardiographic Abnormalities That Predict Coronary Heart Disease Events and...Response to Letter Regarding Articles "Electrocardiographic Abnormalities That Predict Coronary Heart Disease Events and...
We appreciate Dr Lehmanns supportive comments on our articles1,2 in Circulation. Dr Lehmann also brings up a relevant question: Why did we not include QRS duration as a covariate in our QT adjustment models?. This question was examined in some detail in previous publications.3,4 Adding the QRS interval as a covariate with the R-R interval did not increase the R2 value in men, and it increased by less than 1% in women.. What is the reason for this seemingly counterintuitive paradox? The QT interval is, without exception, the sum of the excitation time and the action potential duration of the myocardial cells in the region repolarizing last. This region is excited in normal conduction during the initial half of the QRS interval because repolarization sequence is semireverse with respect to depolarization; therefore, its excitation time is perhaps smaller than expected. Excitation times in the so called "incomplete bundle-branch blocks"(QRS ,120 ms) vary.5 The significance of the QRS contribution ...
Part II. Introduction to Measures of Quality (continued) | Agency for Healthcare Research & QualityPart II. Introduction to Measures of Quality (continued) | Agency for Healthcare Research & Quality
The major limitation of risk adjustment is that it can only account for measurable and reported risk factors. Unfortunately, many important risk factors for adverse patient outcomes are either not measurable using available data (e.g., preoperative functional status) or are not consistently reported (e.g., obesity). For some outcome measures, such as heart attack mortality at the hospital level, classification of hospital performance is reasonably robust despite these immeasurable or unreported factors, because between-hospital variation in outcomes is relatively large.87,88 In addition, unmeasured risk factors tend to be randomly distributed across hospitals.89 For other outcome measures, the limitations of risk adjustment are likely to be more problematic, particularly at the physician level, due to clustering of certain types of patients in certain physicians practices.. Another problem with risk-adjusted outcomes is that they are often misinterpreted. Most risk-adjustment approaches involve ...
Development of a primary care-based complex care management intervention for chronically ill patients at high risk for...Development of a primary care-based complex care management intervention for chronically ill patients at high risk for...
Therefore, it is crucial to identify as precisely as possible patients most likely to benefit from these programs. Finding high-risk patients in computerized medical record systems, using predictive modelling, has been evaluated in care management trials in the USA and is seen to have better results than case finding by doctors or patient surveys [12, 13]. These software models rely on clinically- and cost-similar disease categories called diagnostic cost groups (DCG) [14] or adjusted clinical groups (ACG) [15] that are generated from insurance claims data.. In Germany, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (DM) were among the 20 most frequent causes for hospital admission in 2008 [16]. All three conditions are stated as being ambulatory care sensitive conditions (ACSC), meaning that primary care has a dominating role in preventing hospital admissions for these conditions [17]. Hospitalisations may be avoidable by coordinated ...
Contemporary Mortality Risk Prediction for Percutaneous Coronary Intervention | JACC: Journal of the American College of...Contemporary Mortality Risk Prediction for Percutaneous Coronary Intervention | JACC: Journal of the American College of...
Despite tremendous advances in PCI over the past decade, early periprocedural mortality remains a concern. Using data from the NDCR, we identified demographics, clinical factors, and angiographic features associated with PCI in-hospital mortality. These were summarized into a full risk model (with both pre-procedure and angiographic features) and a simplified 8-item NCDR CathPCI Risk Score, to support both robust hospital outcome comparisons and patient-level pre-procedural risk estimation, respectively. Both the full and simplified models retain their predictive accuracy in important patient subsets, in separate internal validation samples, and when estimating 30-day mortality in Medicare patients.. Several risk-adjustment models have been previously developed for the prediction of mortality following PCI. However, many of these were developed using data that predates the generalized use of stents and/or contemporary adjuvant antithrombotic therapy (5-13). Other models have been developed from ...
HCC University: Health Risk Adjustment FlagsHCC University: Health Risk Adjustment Flags
All topics of discussion must be based on factual information, for example: Coding rules or guidelines, changes to the model (proposed and finalized),inclusion or exclusion of diagnosis codes in the CMS-HCC or Rx-HCC model, discussion of the annual Advance notice, discussion of the annual Announcement provisions, CMS posted rules related to coding or Risk Adjustment, general questions about medical records, mentions of a specific solution that are integral to the comment (e.g., we use blank report from Ascender to determine _______) which do not constitute an endorsement of the product; Recommendations of other CMS or other tools which are available at no charge to the public (e.g, the American Academy of Family Practice has a good general physical exam template. It can be downloaded at ...
Diagnosis Questions- Risk Adjustment validationDiagnosis Questions- Risk Adjustment validation
I am doing a RADV audit for patients for DOS in 2006. A high level definition of the RADV audit is Risk Adjustment data Validation, that requires us (
The Public Health Hazards of Risk Avoidance Associated With Public Reporting of Risk-Adjusted Outcomes in Coronary Intervention...The Public Health Hazards of Risk Avoidance Associated With Public Reporting of Risk-Adjusted Outcomes in Coronary Intervention...
We sought to examine the mortalities further through detailed review of the clinical record and angiograms in an effort to classify the deaths into 1 of 3 categories: 1) no complication of the procedure thought to have contributed to death; 2) complication of procedure possibly related to patients death; and 3) procedural complication materially contributing to the patients death. Charts and films were reviewed independently by 2 board-certified interventional cardiologists blinded to both the identity of the patient and the performing interventional cardiologist. Determinations of causality were made based on major neurologic, vascular, or cardiac complications occurring during the procedure or during the hospitalization after the PCI. Examples include intracerebral hemorrhage, major vascular complications requiring surgery or leading to hemodynamic instability, coronary complications including dissection and loss of vessel, or acute or subacute stent thrombosis. Of the 85 deaths, 11 (13%) ...
Census of Population and Housing, 1990 [United States]: Public Law (P.L.) 94-171 Data (One-Half Sample Adjusted Redistricting...Census of Population and Housing, 1990 [United States]: Public Law (P.L.) 94-171 Data (One-Half Sample Adjusted Redistricting...
Data Collection Notes: (1) Census tracts and block groups are not included in these files. (2) These data files were obtained from the United States House of Representatives, who received them from the Census Bureau accompanied by the following caveats: "The numbers contained herein are not official 1990 decennial Census counts. The numbers represent estimates of the population based on a statistical adjustment method applied to the official 1990 Census figures using a sample survey intended to measure overcount or undercount in the Census results. On July 15, 1991, the Secretary of Commerce decided not to adjust the official 1990 decennial Census counts (see 56 Fed. Reg. 33582, July 22, 1991). In reaching his decision, the Secretary determined that there was not sufficient evidence that the adjustment method accurately distributed the population across and within states. The numbers contained in these tapes, which had to be produced prior to the Secretarys decision, are now known to be biased. ...
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How What You Measure Matters: Risk-Adjusted Length of Stay and Observation Status | American Academy of PediatricsHow What You Measure Matters: Risk-Adjusted Length of Stay and Observation Status | American Academy of Pediatrics
The underlying vision for pediatric quality measurement is improved care and health outcomes for children. Quality measures help realize this vision, through capturing system successes and failures in supporting child health. There are a large number of quality measures, some of which are focused on processes, some on outcomes, and some on use.1 To accurately assess successes and failures in care delivery, measure design matters. This is because measures can deeply incentivize behavior because of their use in reputational (eg, public reporting) and financial incentive (value-based purchasing) programs. In this issue of Pediatrics, Gay et al2 focus on risk-adjusted geometric mean length of stay (RA-LOS), a commonly used metric for understanding hospital use. Hospitals and payers often use this to assess efficiency and throughput, with the most familiar manifestation being the focus on "discharge before noon." But increased RA-LOS can also signal issues with patient safety and increased ...
Injury Severity Scoring and Outcomes Research | Trauma, 8e | AccessSurgery | McGraw-Hill MedicalInjury Severity Scoring and Outcomes Research | Trauma, 8e | AccessSurgery | McGraw-Hill Medical
The injury scores and models discussed here are generally applied using retrospectively collected data. They are therefore suitable for case mix adjustment or risk prediction in groups of patients but are not appropriate for individual patient predictions to guide clinical management decisions. They have a host of applications including quality improvements in patient care, trauma systems and health care delivery, injury prevention initiatives, and epidemiological studies of injury. Patient-specific clinical prediction applications are more simple, requiring decision rules to categorize patients into low-risk/high-risk "bins" and present less sophisticated statistical demand. ...
Challenges in Risk Adjustment for Hospital and Provider Outcomes Assessment | CirculationChallenges in Risk Adjustment for Hospital and Provider Outcomes Assessment | Circulation
How are we to evaluate outcomes for the care that we provide, and how are we to benchmark ourselves compared with colleagues at other institutions? It is critical that we do this to improve our own performance, and it is also being demanded of us by other stakeholders in society. Indeed, regular public reporting of outcomes is now effectively mandated of providers in many medical disciplines, and standards for statistical adjustment have been developed.1 As a result, performance reports based on data from both administrative and clinical databases are commonplace, with a few elite databases serving as de facto sources of truth for medical performance in the United States. However, important questions must be asked about the registries being used to set performance standards and inform medical regulatory policies.. Within cardiology, one of the most commonly reported metrics is mortality after revascularization, either in-hospital or some time thereafter, often 30 days. Such reporting may be at ...
Risk adjustment in the ACA marketplaces: A success with some important gaps | The Incidental EconomistRisk adjustment in the ACA marketplaces: A success with some important gaps | The Incidental Economist
This post was coauthored by Michael Geruso, Timothy Layton, and Daniel Prinz. Michael Geruso is an Assistant Professor of Economics at the University of Texas
GSEA for RNA-seq analysisGSEA for RNA-seq analysis
What I mean is that all the p-value adjustment methods require some of the p-values to be very small in order to survive multiple testing adjustment when the number of gene sets is large, and getting very small p-values requires a prohibitively number of permutations.. For example, suppose you are testing the MSigDb C2 collection with about 5000 gene sets. You need the smallest p-values to be about 0.05/5000 or smaller in order to get an FDR below 0.05, and this requires 10^5 permutations. To get a worthwhile number of DE sets, the number of permutations needs to be much larger again, which is prohibitively slow. Even then, all the gene sets with the smallest p-value will be equally ranked because permutation cant resolve small p-values. Its all quite unsatisfying.. The same considerations would apply to SAM or to any permutation method, which is why SAM instead uses a FDR estimate based on the global permutation distribution of the test statistic. SAM is often applied to very small samples ...
document view - bioconductor.orgdocument view - bioconductor.org
pgamma(sum(-log(pvals.less)), shape = k, rate = 1, lower.tail = FALSE) @ \newpage. \section*{Microarray studies}. The usual application of meta-analysis is to analyze a single outcome, or finding, using published data where typically only summary statistics are available. With microarray experiments, we are often in the more fortuitous situation of having the complete set of primary data available, not just the summary statistics. By phrasing the synthesis in terms of standard statistical models, many of the recently developed $p$-value adjustment methods for multiple comparisons can be applied directly.. \subsection*{The experimental data}. We will use three data sets as examples. One is a study of breast cancer reported by \cite{West2001} in which 46 patients were assayed and two phenotypic conditions were made public, the estrogen receptor (ER) status and the lymph node (LN) status. We will refer to this as the Nevins data in the remainder of the text. The samples were arrayed on Affymetrix ...
Some Northern California Station Plots « Climate AuditSome Northern California Station Plots « Climate Audit
Ive plotted up some USHCN station information for the 18 sites closest to Susanville (why Susanville - its one of the Anthony Watts- Russ Steele sites that they happened to post on lately.) Ive been reading Karl and Williams 1987 which sort of describes the USHCN Station History Adjustment method. Ill talk about Karl and…
Patents filed at Aug 28 2018 | Monitoring device with voice interaction | Patents.comPatents filed at Aug 28 2018 | Monitoring device with voice interaction | Patents.com
Pulsimeter and adjustment method of pulsimeter | Analog and digital signal processing for a wearable ECG system | Method and apparatus for acquiring a magnetic resonance imaging dataset | Biological information monitoring apparatus | Chair pad system and associated, computer medium and computer-implemented methods for monitoring and improving... |
Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study | BMJ Quality & SafetyCase-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study | BMJ Quality & Safety
The results indicate that worthwhile correlations between case-mix adjusted SMRs and rates of preventable mortality are not attainable unless rates of preventable mortality are either (a) much higher than current estimates suggest, or (b) implausibly variable between different hospitals. It can be argued that specificity is not crucial to the performance of SMRs, since they are used as a screen for hospitals requiring further investigation, not as a diagnostic trigger for sanction. However, there is always a trade-off between sensitivity and specificity even for screening tests. In the case of SMRs, high false positives waste resources, stigmatise hospitals, and lead to gaming;29 ,30 while false negatives provide false reassurance, thereby deflecting attention away from quality issues across the whole healthcare system.31 Until risk adjustment can explain much larger proportions of the variance in mortality it is unsafe to use high SMRs to identify poor quality of care in any particular ...
Walking The Appalachian Trail: Granite Gear | HomeWalking The Appalachian Trail: Granite Gear | Home
Like its predecessors, The Blaze AC 60 is Spartan in its simplicity and features our engineered AirCurrent suspension. The AirCurrent suspension consists of a 3-dimensionally molded alloyed frame, our quickest torso length adjustment system, padded shoulder straps, and a swappable hip belt for a custom fit. The AC frame has molded air channels, works in conjunction with a molded foam pad and durable stretch mesh to aid in venting heat and moisture away from the back; allowing for natural evaporative cooling. The pack body is a simple, lidless top loader with a tall spindrift opening that can be cinched and rolled down tight for weather resistance and also expanded when extra space is needed. The arched Line-Loc compression system allows the load to be cinched tight in every direction (side, front, and top) as well as allowing additional gear to be lashed to the pack. The Line-Loc cord can easily be replaced if it wears out from extended use. Durable and versatile stretch mesh pockets on the ...
Active and Inactive Conditions Mapping All Systems - Data Mapping - PenCS HelpActive and Inactive Conditions Mapping All Systems - Data Mapping - PenCS Help
The list below describes how CAT Plus treats each condition category. Some conditions are treated as being current whether they are recorded as active or inactive (i.e. they are not recoverable) and others only if they are recorded as active.. This list will be reviewed by our clinical advisors and occasionally can be changed to include new conditions and to revise the criteria.. Please also refer to the mapping guides for your clinical system on the details of what CAT4 maps to the conditions listed in this table.. ...
HCC University: ICD-10 Reminders!HCC University: ICD-10 Reminders!
All topics of discussion must be based on factual information, for example: Coding rules or guidelines, changes to the model (proposed and finalized),inclusion or exclusion of diagnosis codes in the CMS-HCC or Rx-HCC model, discussion of the annual Advance notice, discussion of the annual Announcement provisions, CMS posted rules related to coding or Risk Adjustment, general questions about medical records, mentions of a specific solution that are integral to the comment (e.g., we use blank report from Ascender to determine _______) which do not constitute an endorsement of the product; Recommendations of other CMS or other tools which are available at no charge to the public (e.g, the American Academy of Family Practice has a good general physical exam template. It can be downloaded at ...
Secondary diagnosesSecondary diagnoses
I am always confused about secondary diagnosis coding. I have the CCs rule related to coding secondary diagnoses when they are listed as a symptom fol
Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee...Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee...
TY - JOUR. T1 - Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty. AU - Martsolf, Grant R.. AU - Barrett, Marguerite L.. AU - Weiss, Audrey J.. AU - Kandrack, Ryan. AU - Washington, Raynard. AU - Steiner, Claudia A.. AU - Mehrotra, Ateev. AU - Hoo, Nelson F.Soo. AU - Coffey, Rosanna. PY - 2016/1/1. Y1 - 2016/1/1. N2 - Background: Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospitals control, may not accurately reflect a hospitals performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA. Methods: We calculated 2 sets of risk-adjusted readmission rates by (1) ...
AUTO WHITE BALANCE ADJUSTMENT SYSTEM, AUTO WHITE BALANCE ADJUSTMENT METHOD, AND CAMERA MODULE - Patent applicationAUTO WHITE BALANCE ADJUSTMENT SYSTEM, AUTO WHITE BALANCE ADJUSTMENT METHOD, AND CAMERA MODULE - Patent application
20. A camera module, comprising: a lens unit configured to take in light from an object and focus an object image; an image sensor configured to capture the object image; and an image processing apparatus configured to perform a process of an image signal acquired by capturing in the image sensor, wherein the image processing apparatus includes: a white balance adjustment unit configured to perform a white balance adjustment by multiplication of a white balance gain, on an image signal; a first color judgment gate generation unit configured to generate a first color judgment gate that defines an entire range of a color temperature subject to the white balance adjustment; a second color judgment gate generation unit configured to generate a second color judgment gate that defines the range of the color temperature subject to the white balance adjustment for each light source identified according to the white balance gain; and a color judgment gate switch unit configured to switch the first color ...
Taking health status into account when setting capitation rates : A comparison of risk-adjustment methods. | Base documentaire ...Taking health status into account when setting capitation rates : A comparison of risk-adjustment methods. | Base documentaire ...
Objective. - To compare performance of different health status measures for risk-adjusting capitation rates. Design. - Cross-sectional study. Health status measures derived from 1 year were used to predict resources for that year and the next. Setting. - Group-network health maintenance organization in Minnesota. Participants. - Sample of 18-to...
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An Empirical Study of Fund Performance Ranking on Fund Managers Risk Adjustment BehaviorAn Empirical Study of Fund Performance Ranking on Fund Manager's Risk Adjustment Behavior
Performance ranking is a key factor for investors to make investment decisions such as redemption. Numerous studies have shown that in order to improve and secure the year-end relative performance ranking, mid-year performance rankings have prompted fund managers ranked at different mid-year levels to adjust the risk levels of their portfolios to varying degrees in the second half of the year. This study is of great significance to improve the incentive mechanism of fund companies, investor investment activities and the performance of regulatory responsibilities by state institutions. First of all, this paper makes a full sample study of the risk adjustment behavior of fund manager based on the funds first-half performance by using the combination table analysis method and regression analysis method, and further studies the relationship between market state and fund managers risk adjustment behavior. Result: Fund managers (losers) with lower mid-year performance increase portfolio risk
Pharmacokinetic & Pharmacodynamic Drug Information and Dosage Adjustment System | Health Services Research EuropePharmacokinetic & Pharmacodynamic Drug Information and Dosage Adjustment System | Health Services Research Europe
Not only every patient is different, but also every drug. Drug dosage must be individualised, and adjusted to the patients organ func- tion (e.g. age, kidney) and severity of disease (e.g. intensive care, outpa- tient office). Within an European project, we are on the way to built up a drug information and dosage adjustment system. The essential compo- nents are available: the pharmacokinetic /-dynamic database NEPharm, calculation algorithms, a consensus on general pharmacokinetic concept, on dose adjustment rules, and on standard nomenclature (ATC code). A graphical user interface must be designed. The required components must be made interoperable, namely patient record, drug dictionary, phar- macokinetic /-dynamic database, calculation algorithms, graphical user interface. The dosage proposals made by the system must be clinically certified, and be compared to standard practice in an external environ- ment to evaluate clinical applicability and reliability. Special versions of the system ...
Global Hearing Aid Adjustment Systems Market 2019 by Manufacturers, Regions, Type and Application, Forecast to 2024Global Hearing Aid Adjustment Systems Market 2019 by Manufacturers, Regions, Type and Application, Forecast to 2024
hearing aid adjustment systems market is the new research study published by Acquire Market Research and added to its vast data library of whitepapers & Market Research Reports. This report gives insight into key players, market size by types, applications and major regions.
Price elasticity of demand for crude oil: estimates for 23 countriesPrice elasticity of demand for crude oil: estimates for 23 countries
Downloadable (with restrictions)! This paper uses a multiple regression model derived from an adaptation of Nerloves partial adjustment model to estimate both the short-run and long-run elasticities of demand for crude oil in 23 countries. The estimates so obtained confirm that the demand for crude oil internationally is highly insensitive to changes in price. Copyright 2003 Organization of the Petroleum Exporting Countries.
Modeling regional population-employment dynamics across different sectors of the economyModeling regional population-employment dynamics across different sectors of the economy
An important subset of the literature on agglomeration externalities hypothesizes that intrasectoral and intersectoral relations are endogenously determined in models of local and regional economic growth. Remarkably, structural adjustment models describing the spatio-temporal dynamics of population and employment levels or growth traditionally do not include intersectoral economic dynamics. This paper argues and shows that ... read more allowing for economic linkages across sectors in these models adds considerable value, especially in forecasting. An econometric model of population-employment dynamics, in which sectoral variations in economic development are explicitly taken into account, is applied to a large urban planning policy proposal in the Netherlands. The empirical analyses suggest that population dynamics are largely exogenous, population changes drive employment in particular in the industry and retail sectors, and employment in all sectors depends strongly on intersectoral ...
Tidal range changes in the Delaware Bay : past conditions and future scenariosTidal range changes in the Delaware Bay : past conditions and future scenarios
Throughout the Holocene, appreciable changes in bathymetry are hypothesized to have resulted in large changes to tidal datums in coastal and estuarine areas. An understanding of tidal change is an important contribution to the knowledge of relative historical sea-level change and future coastal planning. To test this hypothesis, the Advanced Circulation (ADCIRC) model was used, with representative bathymetric grids based on glacial isostatic adjustment models and semi-empirical sea level rise predictions, in order to model the time-varying tidal behavior of the Delaware Bay. Model runs were conducted at various time slices between 10,000 years before present and 300 years into the future on high resolution grids that allowed for inundation moving forward in time. Open boundary tidal forcing was held constant in time to highlight the effect of the changing regional bathymetry. With each change in sea level, the shape of the Delaware Bay was considerably altered, leading to changes in the tides. ...
Rapid sea level rise and ice sheet response to 8,200-year climate eventRapid sea level rise and ice sheet response to 8,200-year climate event
The largest abrupt climatic reversal of the Holocene interglacial, the cooling event 8.6-8.2 thousand years ago (ka), was probably caused by catastrophic release of glacial Lake Agassiz-Ojibway, which slowed Atlantic meridional overturning circulation (AMOC) and cooled global climate. Geophysical surveys and sediment cores from Chesapeake Bay reveal the pattern of sea level rise during this event. Sea level rose ~14 m between 9.5 to 7.5 ka, a pattern consistent with coral records and the ICE-5G glacio-isostatic adjustment model. There were two distinct periods at ~8.9-8.8 and ~8.2-7.6 ka when Chesapeake marshes were drown as sea level rose rapidly at least ~12 mm yr−1. The latter event occurred after the 8.6-8.2 ka cooling event, coincided with extreme warming and vigorous AMOC centered on 7.9 ka, and may have been due to Antarctic Ice Sheet decay ...
PPT - Refinements to the CMS-HCC Model For Risk Adjustment of Medicare Capitation Payments PowerPoint Presentation - ID:372101PPT - Refinements to the CMS-HCC Model For Risk Adjustment of Medicare Capitation Payments PowerPoint Presentation - ID:372101
Refinements to the CMS-HCC Model For Risk Adjustment of Medicare Capitation Payments. Presented by: John Kautter, Ph.D. Gregory Pope, M.S. Eric Olmsted, Ph.D. RTI International. Contact: John Kautter, PhD, [email protected] RTI International is a trade name of Research Triangle Institute. Slideshow 372101 by desma
Physician-defined patient complexity differs from current diagnosis-based measuresPhysician-defined patient complexity differs from current diagnosis-based measures
Managing complex patients requires greater clinician effort, increased health care resources, and substantial family and community support," says Grant, who recently joined the division of Research at Kaiser Permanente Northern California. "In order to redesign our health care systems to more effectively care for complex patients, we need a better handle on exactly who they are. By asking primary care physicians about their experiences with their own patients in a systematic and quantitative way, we were able to bring out the importance of social and behavioral factors, in addition to specific medical problems. This work may help guide efforts to redesign health care systems so that we can deliver high quality, cost-effective care tailored to individual patient needs ...
Study of photogrammetric self-calibration adjustment methodStudy of photogrammetric self-calibration adjustment method
The development of a viable self-calibration approach for use with non-metric cameras was investigated. Both computer generated and actual test camera data were generated to determine the effectiveness of the math model and computer program. A twenty-seven parameter bundle adjustment routine was proposed because of its versatility and compatible use in an existing aerotriangulation package. For the camera and test configuration considered, the focal length was recovered to within two percent, and the principal point location was recovered to wi thin O. 3 to twelve percent. When the computer generated data was used, the focal length and principal point offset were recovered to within 0.2 percent.. Modeling and software has been made available for a future comparative study between the self-calibration and Direct Linear Transformation adjustment parameters. The self-calibration modeling and former Direct Linear Transformation modeling software is a promising tool for mensuration tests and ...
Nissan Teana 230 Wideband Electronic Fuel Injection Enhancer MAGNUM O2 Sensor EFIE Adjuster 5-Wire WidebandNissan Teana 230 Wideband Electronic Fuel Injection Enhancer MAGNUM O2 Sensor EFIE Adjuster 5-Wire Wideband
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Cadillac Sixty Wideband Electronic Fuel Injection Enhancer MAGNUM O2 Sensor EFIE Adjuster 5-Wire WidebandCadillac Sixty Wideband Electronic Fuel Injection Enhancer MAGNUM O2 Sensor EFIE Adjuster 5-Wire Wideband
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Attitude Adjuster Lyrics Pastor TroyAttitude Adjuster Lyrics Pastor Troy
Pastor Troy - Attitude Adjuster Lyrics. Yea Yea Yea Yea Yall Kno Wat Time It Is I Got Somthin For Those Niggas Dat B Talkin Dats Shit I Got Dat Attitude Adjuster [Chorus:] I Got M
Go to the Back Conditions Category archives.Go to the Back Conditions Category archives.
The leading physicians of NSPC offer expertise in procedures including interventional neuroradiology and minimally invasive surgery to treat back pain.
Longer Life Foundation : Risk Adjustment in the Medicare Atrial Fibrillation PopulationLonger Life Foundation : Risk Adjustment in the Medicare Atrial Fibrillation Population
Now that we have finished the above manuscript, we will focus on how to control for the affect of co-morbid conditions when quantifying the risk of death from AF and other heart diseases. This knowledge will help clinicians to understand the interaction between AF and comorbidities, and to target specific comorbid conditions to reduce risk of death. We will focus on two popular comorbidity measurements that use administrative databases-the Charlson-Deyo scheme1 and the Elixhauser scheme.2 Neither scheme was developed and tested in populations with heart disease. Thus, their applicability to the AF population is unknown. Purposes of the study are: (1) to evaluate predictive accuracy of two existing comorbidity schemes to each other and to a disease-specific co-morbidity index, CHADS2, that has been used to predict stroke in the AF population.3. We have made two important pieces of progress towards the AF analysis. First, we have obtained permission from the Center of Medicare and Medicaid ...
Insurance Market Reform | State Coverage InitiativesInsurance Market Reform | State Coverage Initiatives
The purpose of this white paper is to begin the consultation process around the development of the federally-certified risk adjustment methodology developed by HHS and provide context for individuals to submit comments regarding the Standards Related to Reinsurance, Risk Corridors and Risk Adjustment Notice of Proposed Rulemaking (NPRM) (45 CFR Part 153), issued July 15, 2011. ...
Hurricane Planning</span>...Hurricane Planning</span>...
An adjuster is a person professionally trained to assess the damage. The more information you have about your possessions the faster your claim can be settled. You should already have a complete inventory of the items in your home that includes a description of the item, model and serial numbers (if applicable) and the original cost and what it would cost to replace it.. Make a list of damaged items. Take photographs of the damage and put together a set of records for each item that includes any old receipts or bills. Dont forget to list items such as clothing, sports equipment, tools, china and linens, etc.. Dont throw away damaged furniture or other items because the adjuster will want to see them.. Identify the structural damage to your home and other buildings on your premises. Make a list of everything you want to show the adjuster when they arrive. In some cases, the adjuster may recommend hiring a licensed engineer or architect to inspect the property. You should also get the electrical ...
Careers.org | Timing Device Assemblers, Adjusters, and Calibrators - Occupational Profile andCareers.org | Timing Device Assemblers, Adjusters, and Calibrators - Occupational Profile and
Timing Device Assemblers, Adjusters, and Calibrators Career Overview Profile with short video, earnings, outlook, knowledge, skills, abilities, typical tasks and activities, training requirements, nature of the work, occupations and academic programs
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Wabco Holdings has been selected by Stoughton Trailers to be the standard supplier of automatic slack adjusters for its trailers.
All Publications | Signal Processing GroupAll Publications | Signal Processing Group
abstract = {PURPOSE: Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost. SUBJECTS AND METHODS: 22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000-2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (N = 4,212; 50% of costs), and the high cost group (N = 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using "high cost" (>7,263$) as dependent variable. RESULTS: Costs were not evenly distributed throughout ...
Quality UpdatesQuality Updates
On January 12, 2016, your Academy submitted comments to the National Quality Forum (NQF) on the Measure Applications Partnership (MAP) 2015-2016 Considerations for Implementing Measures in Federal Programs. Your Academy commented on unresolved problems related to risk adjustment, attribution, appropriate sample sizes, and the ongoing lack of relevant measures for certain specialties. Your Academy also commented on the importance of uniform and current data collection across a variety of post-acute care settings with a major emphasis on appropriate quality standards and risk adjustment to protect patients against underservice ...
ISPOR 20th Annual European Congress - WorkshopsISPOR 20th Annual European Congress - Workshops
Treatment comparisons without head-to-head trials are frequently formed using indirect comparisons across multiple trials, making the assumption that any effect modifiers are balanced between trials. Recently proposed methods which relax this assumption, including Matching-Adjusted Indirect Comparison (MAIC) and Simulated Treatment Comparison (STC), are becoming increasingly common in industry-sponsored treatment comparisons, where a company has individual patient data (IPD) from its own trials but only aggregate data from competitor trials. These methods aim to adjust for between-trial differences to form population-adjusted indirect comparisons, and may even be used for comparisons involving single arm studies or disconnected networks. However, additional assumptions and complexities are introduced which must be carefully considered. Since the premise of population adjustment methods is that relative treatment effects can differ between populations, a core component of population adjustment in ...
Full text] Evaluating the evaluation | CLEPFull text] Evaluating the evaluation | CLEP
Evaluating the evaluation Vance W Berger National Cancer Institute, University of Maryland Baltimore County, Biometry Research Group, Rockville, MD, USAZhang et al1 sought to determine which adjustment method is the best. That is a laudable objective, but their approach leaves quite a bit to be desired. When we cut to the chase, we find that they pre-supposed that the analysis of covariance (ANCOVA) was ideal, and, presumably, confirmed this empirically by noting that the ANCOVA results were most aligned with the ANCOVA gold standard. This is fairly perplexing logic. Had any of the other methods been chosen instead as the gold standard, then that method would have been found to be the best by virtue of agreeing with its own results. This is hardly a compelling endorsement. Beyond that, even if the authors did use a more reasoned approach, how can one trial be used to validate an analysis?View original paper by Zhang and colleagues.
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Quality Control in Health Care : GERADQuality Control in Health Care : GERAD
While many types of health care processes and services are similar to those in other organizations, others such as medical interventions show notable differences. For instance, in industrial applications where quality control methods have a long history, the units sampled are products with a high degree of homogeneity as they are manufactured under largely controlled conditions. By contrast, patients subject to medical procedures exhibit extensive variety in their health profiles. This calls for new monitoring methods or major adjustments to existing industrial quality control methods to make them effective in the new situations. Risk-adjustment is a term recently introduced to describe some of the adaptations. In this talk we examine the issues, discuss some of the challenges as well as some of the solutions. The technical elements will be kept at a low volume.. ...
Refrigerated CirculatorsRefrigerated Circulators
The KH-4 is menu-driven, microprocessor controlled and equipped with genuine digital electronics. The compact design is a result of modern SMD technology. The Real Temperature Adjustment system allows corrections between the actual temperature displayed and the temperature in an external system by an correction value C ...
Download Transgressing The Bounds: Subversive Enterprises Among The Puritan Elite In Massachusetts, 1630 1692 2001Download Transgressing The Bounds: Subversive Enterprises Among The Puritan Elite In Massachusetts, 1630 1692 2001
download Transgressing the Bounds: Subversive Enterprises among the Puritan Elite in Massachusetts, 1630 1692 of a possible created guards are to get risk-adjustment footballer work from key tomography. falling British F-score sciences factors to own article stories and married plans: the high-throughput Network home. room of a red made children something for old Internet embolism.
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The first phase of the project involved investment and technical advice from the licensing partner, the Dutch Royal Tropical Institute in Amsterdam, as well as transfer of technology to Indonesia so that the test strips containing the antigens or antibodies could be optimized to the local condition, be produced locally, and conform to WHO standards. The second phase involved combining all four tests in one multiplex POC based on lateral flow assay that would allow a patient to be tested in just one procedure, reducing diagnostic costs substantially as the cost of one multiplex POC is much lower than four single POCs ...
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cfe-dev] [PATCH] Fix clang test failures on MIPScfe-dev] [PATCH] Fix clang test failures on MIPS
On Fri, May 4, 2012 at 7:39 PM, Manuel Klimek ,klimek at google.com, wrote: , I havent put too much thought into the interface yet, but Id imagine , something along the lines of , class ArgumentAdjuster { , public: , vector,std::string, Adjust(const vector,std::string, &Arguments) = 0; , }; , , class ClangSyntaxOnlyAdjuster : public ArgumentAdjuster { ... }; , , Then, for people who have command lines that are for gcc for some reasons: , class GccToClangAdjuster : public ArgumentAdjuster { ... }; , , Then we can install a ClangSyntaxOnlyAdjuster per default and add a , method to ClangTool: , void setArgumentAdjuster(ArgumentAdjuster *Adjuster); , , I think the argument adjusting is orthogonal to the tool, so Id , rather avoid inheritance on the ClangTool level. Now I see your point and like this approach. I will implement and send a patch for review. -- Simon ...
Answers - The Most Trusted Place for Answering Lifes QuestionsAnswers - The Most Trusted Place for Answering Life's Questions
French Blaise Pascal invented the calculator. He did this to help his dad who was a tax adjuster. Then Gottfried Leibnitz improved on Pascal idea with a machine that would add…, subtract, multiply, and divide. John Napierin invented the movable multiplication table engraved on a series of square section metal rods, called Napiers Bones. (MORE) ...
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DiseasesAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPsychiatry and PsychologyPhenomena and ProcessesDisciplines and OccupationsAnthropology, Education, Sociology and Social PhenomenaInformation ScienceNamed GroupsHealth CareGeographicals
Risk AdjustmentInsurance Selection BiasCapitation FeeCompetitive Medical PlansRate Setting and ReviewIntegrative MedicineDiagnosis-Related GroupsHospital MortalityAdmitting Department, HospitalCenters for Medicare and Medicaid Services (U.S.)United StatesQuality Indicators, Health CareOutcome Assessment (Health Care)Cost AllocationManaged CompetitionHealth ExpendituresHospitals, VeteransSocial AdjustmentBenchmarkingModels, StatisticalMedicareRisk FactorsInternational Classification of DiseasesNational Health Insurance, United StatesHospitalsInsurance Claim ReviewLogistic ModelsRisk AssessmentHealth Services ResearchChileWashingtonFee-for-Service PlansRegression AnalysisQuality of Health CareMichiganRetrospective StudiesHealth Benefit Plans, EmployeeInsurance, HealthCohort StudiesDatabases, FactualOdds RatioCesarean SectionCardiac Surgical ProceduresProspective StudiesSeverity of Illness IndexMultivariate AnalysisAdjustment DisordersNational Health ProgramsComorbidityTreatment OutcomeCaliforniaAge FactorsLength of StayQuality Assurance, Health CareInfant, NewbornInfant MortalityHealth Status IndicatorsRegistriesHeart Defects, CongenitalPredictive Value of TestsModels, TheoreticalCoronary Artery BypassReproducibility of ResultsTime FactorsHospitalizationDelivery of Health Care
OutcomesFactorsClinicalDifferencesPopulationsMethodsCharacteristicsObjectiveMethodologiesPatientsHealthcareCertified Risk Adjustment Coder2018DiagnosesMethodologyCONCLUSIONS2017PayersDemographicEnrolleesMortalityPaymentsModelsHealthHierarchical Condition CategoryOutcomeAffordable Care ActPremiumsBehaviorAccuracyOutweigh the risksApproachesHospitals2016ProgramDemographicsInitiativesPsychologicalMedicaidBasicsImpactsScoresBenefits and risksScorePaymentReconcileReinsuranceBudget neutralPatientSymptomsOBJECTIVEProspectivePsychosocialDisorderDisordersStatistical
Outcomes1
  • Risk-adjusted expenditure and utilization outcomes for calendar year 2014 were reported in 102 adult and 56 pediatric primary-care comparative practice profiles. (biomedcentral.com)
Factors1
Clinical2
Differences2
Populations3
  • It applied risk adjustment to populations attributed to patient-centered medical homes (283,153 adult patients and 78,162 pediatric patients) in the state of Vermont that are part of the Blueprint for Health program. (biomedcentral.com)
  • Results indicate that more comprehensive risk-adjustment models are effective for comparing cost, utilization, and quality measures across multi-payer populations. (biomedcentral.com)
  • The importance and influence of health status based risk adjustment methodologies are likely to increase as healthcare programs that currently use risk adjustment expand the populations they cover and other programs adopt the use of risk adjustment. (actuarialstandardsboard.org)
Methods2
  • Diagnosis based methods for adjusting risk are becoming increasingly common within the US managed healthcare industry. (bmj.com)
  • This ASOP is intended to provide guidance regarding the appropriate use of health status based risk adjustment models and methods. (actuarialstandardsboard.org)
Characteristics1
  • This standard requires actuaries to explicitly consider important characteristics of the risk adjustment models and their use, rather than allowing actuaries to assume important issues are already addressed within any given risk adjustment software model. (actuarialstandardsboard.org)
Objective1
Methodologies2
Patients1
  • A high level definition of the RADV audit is Risk Adjustment data Validation, that requires us (Medicare Advantage Insurance Company) to validate a patients diagnosis that we submitted to CMS. (aapc.com)
Healthcare1
Certified Risk Adjustment Coder2
20183
Diagnoses13
Methodology3
CONCLUSIONS4
20173
  • Better still, the filing says that HHS "will now proceed with carrying out the risk adjustment program for the 2017 benefit year, including collecting charges and making payments. (theincidentaleconomist.com)
  • For 2020, CMS proposes phasing in the new model with a blend of 50% of the risk adjustment model first used for payment in 2017 and 50% of the new model proposed. (mondaq.com)
  • In this session we will dive into the differences of the systems, give a case study of how one health plan was able to reconcile and manage the evolution through 2017, and provide you with an approach that may impact the way your teams collaborate to address this change in the risk adjustment reporting process. (medicareriskrevenue.com)
Payers6
  • Currently, risk adjustment is used to move dollars from low-risk payers to relatively high-risk payers based on the health condition/diagnosis of the patient. (analysts.com)
  • Just like that, primary care physician offices were limiting or stopping entirely all but COVID-19-related care, and health payers were telling clinicians not to conduct risk adjustment assessments in patient/member homes, to prevent the spread of the virus to other patients/members and to the clinicians themselves. (managedhealthcareexecutive.com)
  • However, given the disparities between the different populations served by Medicare, Medicaid, and commercial payers, risk-adjustment methods for addressing these differences in a single measure have been a challenge. (biomedcentral.com)
  • Important HCC risk adjustment documentation and coding topics are discussed from both the payers' and the providers' perspectives. (ahima.org)
  • HCCs stratify patient risk, allowing payers to predict the costs on which capitated payments are based, she explains. (kareo.com)
  • As Federal policy trims margin on financial payments to control cost, the Physician group and Hospital landscape continues to evolve making shared risk among payers a vital part of Network contracting. (medicareriskrevenue.com)
Demographic1
  • Risk assessment is key for risk adjustment and it depends mostly on the traditional parameters such as demographic data (age, sex, etc.) and insurance claims data (ICD codes, treatment codes, etc. (analysts.com)
Enrollees4
Mortality6
Payments15
Models24
Health38
  • Dynamic Healthcare Systems, a provider of enterprise technology solutions for government-regulated health plans, today rolled out its Risk Adjustment Management Program (RAMP), designed to assist health plans participating in Medicare, Medicaid and Exchange lines of business. (prweb.com)
  • Dynamic's RAMP, combined with technical expertise from its resident Subject Matter Experts (SMEs), provides a comprehensive program that supports a health plan's Risk Adjustment department. (prweb.com)
  • Dynamic deeply understands the challenges that government-regulated healthcare plans face," said Kathy Feeny, President and Chief Executive Officer of Dynamic Healthcare Systems, Inc. "Dynamic's RAMP provides health plans with much needed capacity and extended capabilities, as well as access to highly knowledgeable SMEs and detailed analytics to make their Risk Adjustment strategies more effective and efficient," Feeny added. (prweb.com)
  • Performance status of health care facilities changes with risk adjustment of HbA1c. (diabetesjournals.org)
  • This article, the first in a two-part series, focuses on risk adjustment and its affect on health plans and providers. (harvardpilgrim.org)
  • The program measures and compares the relative health status among health plans' membership by calculating average risk scores. (harvardpilgrim.org)
  • The aim is to balance risk among health plans, eliminating any incentive to select or avoid members based on health status. (harvardpilgrim.org)
  • Risk adjustment creates an opportunity for health plans and providers to review coding practices and identify and correct common coding gaps. (harvardpilgrim.org)
  • The Affordable Care Act (ACA) diversified risk adjustment to the individual and small group health insurance markets starting in 2014. (analysts.com)
  • The challenge with the prospective risk is it predicts based on the current year data and does not take the developing health conditions of the client into consideration. (analysts.com)
  • A Technical Advisory Group (TAG) meeting then was conducted with experts in home health care and risk-adjustment as well as policymakers and provider representatives. (hhs.gov)
  • In fact, the concept of "social determinants of health" (SDOH)-the idea that individual's social circumstances can affect their health-is being used in some states to augment existing health care risk-adjustment tools, which are often used in setting payment rates or calculating performance on quality measures. (shadac.org)
  • Risk adjustment ensures that health insurance plans have adequate funding to provide care to people who are likely to have high healthcare costs while at the same time preventing overcompensation for healthy patients. (icd10monitor.com)
  • Risk adjustment has been fundamental in reducing "cherry picking" among health plans by providing incentives to enroll high-cost individuals while at the same time ensuring that the necessary resources are available to provide efficient and effective treatment. (icd10monitor.com)
  • Today, healthcare risk adjustment is used across all major public programs offering health coverage in the U.S., including Medicare (Part C & D), state Medicaid-managed care programs, and commercial insurance for all plans in the individual and small group markets, operating both inside and outside health insurance exchanges. (icd10monitor.com)
  • In the 2013 In the November 2013 Software Release, CMS acted on their stated intention to gather information on enrollee health assessments or "health risk assessments" or HRAs. (scanhealthplan.com)
  • We hope this helps answer some questions about the Health Risk Assessment Flags. (scanhealthplan.com)
  • It has been posted on SCAN Health Plan : Full En. (scanhealthplan.com)
  • Inherited mental health risks, such as an increased risk of anxiety and depression . (medindia.net)
  • Risk Adjustment Analyst - Medicare Health Insurance. (simplyhired.com)
  • I) In applying the adjustment under clause (i) for health status to payment amounts, the Secretary shall ensure that such adjustment reflects changes in treatment and coding practices in the fee-for-service sector and reflects differences in coding patterns between Medicare Advantage plans and providers under part 1 A and B to the extent that the Secretary has identified such differences. (house.gov)
  • 1 Here, we explore a few of the more useful types of analytics your commercial health plan can leverage to monitor the performance of your ACA block and help you better keep (risk) score. (milliman.com)
  • The inherent volatility in year-over-year risk transfers, especially for smaller health plans, makes this practice unreliable. (milliman.com)
  • Risk adjustment in health insurance is at first glance, and second, among the driest and most arcane of subjects. (thehealthcareblog.com)
  • The market for individual health insurance has had major challenges both before and after the Affordable Care Act's (ACA's) risk adjustment program came along. (thehealthcareblog.com)
  • Director, Risk Adjustment - Managed Care Revenue - Growing Health Org! (monster.com)
  • A data analytics and performance management solution that combines 3M Health Information Systems' decades of coding and risk-adjustment experience with the data processing power of Verily, an Alphabet company. (3m.com)
  • Dawn Peterson, CPC is the director of risk adjustment revenue management for Health Alliance Medical Plans. (medicareriskrevenue.com)
  • Electronic health record problem lists: accurate enough for risk adjustment? (cdc.gov)
  • Health Affairs has released a new policy brief (www.healthaffairs.org) explaining how risk adjustment works and why it is needed. (aafp.org)
  • Luke's Health Partners (SLHP) has an exciting opportunity for a Manager of Risk Adjustment to join our team in Boise, Idaho! (simplyhired.com)
  • The use of risk adjustment has significant effects on health insurance companies, healthcare providers, consumers, employers and others. (actuarialstandardsboard.org)
  • Some nations that encourage private insurance for health care still seek to prevent insurers from engaging in risk minimizing actions to load the premiums of people with certain high-risk profiles, typically the elderly, the sick, and to some extent, women. (wikipedia.org)
  • In all countries that apply risk-adjusted premium subsidies in their health insurance market, the sponsor organizes it in the form of risk equalization among health insurers: the risk-adjusted premium subsidies for the insured are channelled to the insurers. (wikipedia.org)
  • See Health care in the Netherlands) Dutch insurers are not allowed to risk-rate their premiums. (wikipedia.org)
  • To achieve its aims, state and federal regulators must construct an effective system of risk adjustment or risk equalization that protects health insurers that attract a disproportionate share of patients with poor health risks and punishes those that cherry pick lower risk groups. (wikipedia.org)
  • Risk Adjustment in Competitive Health Plan Markets. (wikipedia.org)
  • Access to coverage for high-risks in a competitive individual health insurance market: via premium rate restrictions or risk-adjusted premium subsidies? (wikipedia.org)
Hierarchical Condition Category1
Outcome6
Affordable Care Act2
  • Risk adjustment management within the Patient Protection and Affordable Care Act (ACA) framework not only focuses on developing and maintaining revenue-generating activities (e.g., coding accuracy and completeness initiatives, prospective member outreach, and data validation and auditing), but also dedicates sufficient time to measuring and reporting results. (milliman.com)
  • This brief explains three provisions of the Affordable Care Act (ACA) - risk adjustment, reinsurance, and risk corridors - that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform as the ACA marketplaces, also known as exchanges, were established. (kff.org)
Premiums2
  • In his view, the agency failed to explain why risk adjustment had to be budget neutral and why it therefore had to use a statewide average premium, instead of the insurer's own premiums, to calculate risk adjustment transfers. (theincidentaleconomist.com)
  • Risk equalization is a way of equalizing the risk profiles of insurance members to avoid loading premiums on the insured to some predetermined extent. (wikipedia.org)
Behavior7
  • Insurers would start to compete over how well they could discourage unhealthy people from signing up, and the whole point of risk adjustment is to stop that behavior. (theincidentaleconomist.com)
  • First of all, this paper makes a full sample study of the risk adjustment behavior of fund manager based on the fund's first-half performance by using the combination table analysis method and regression analysis method, and further studies the relationship between market state and fund manager's risk adjustment behavior. (scirp.org)
  • In the next section we review the economic tournament literature, especially focusing on the impact of performance ranking on risk adjusting behavior, and then motivate our testable hypotheses. (scirp.org)
  • A great deal of literature suggests that fund managers' risk-choice behavior is influenced by past performance rankings, but the findings are not consistent. (scirp.org)
  • Adjustment disorders affect how you feel and think about yourself and the world and may also affect your actions or behavior. (mayoclinic.org)
  • If you have concerns about your child's adjustment or behavior, talk with your child's pediatrician. (mayoclinic.org)
  • Lerman C, Kash K, Stefanek M: Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. (cancer.gov)
Accuracy3
Outweigh the risks2
  • The potential benefits of adjusting for a small number of possibly prognostic covariates in trials with moderate or large sample sizes far outweigh the risks of doing so, and so should also be considered. (biomedcentral.com)
  • For patients in whom the potential benefit of ORLAAM (levomethadyl acetate) treatment is felt to outweigh the risks of potentially serious arrhythmias, an ECG should be performed prior to treatment, 12-14 days after initiating treatment, and periodically thereafter, to rule out any alterations in the QT interval. (rxlist.com)
Approaches1
Hospitals2
  • It is increasingly used in observational studies, and has already been used to compare c-section rates between hospitals that are homogenous regarding their " a priori " risk of cesarean delivery. (biomedcentral.com)
  • Below is a complete list of all variables included in the risk adjustment for acute care hospitals for each measure, starting with 2015 data. (medicare.gov)
20161
  • They end in 2016, so their benefits and harms have essentially been delivered, unless Congress is willing to reverse course and fully fund the risk corridors before time runs out. (thehealthcareblog.com)
Program12
Demographics1
Initiatives2
  • Upon completion, we hope to have instilled a deeper appreciation for tracking and managing risk and to have provided the foundations for introducing these initiatives within your organization. (milliman.com)
  • Tara Russo is the Vice President of Medicare Risk Adjustment, HEDIS Quality Initiatives, and Navigate Directorate for Island Doctors, a provider organization (MSO) headquartered in St. Augustine, Florida. (medicareriskrevenue.com)
Psychological2
  • Associations between levels of risks in the various domains and indicators of psychological (e.g., self-esteem, negative emotionality) and behavioral (e.g., substance use) adjustment differed for male and female respondents. (unl.edu)
  • In psychiatry , adjustment disorder (AD) is a classification of mental disorder that is a psychological response from an identifiable stressor or group of stressors that causes significant emotional or behavioral symptoms that does not meet criteria for more specific disorders. (thefullwiki.org)
Medicaid1
  • Medicaid plans have been using risk adjustment modeling since 1996. (icd10monitor.com)
Basics1
Impacts3
  • Each HCC is assigned a "weight" that impacts the patient risk score and determines payment. (slideshare.net)
  • Unfortunately, risk adjustment under the ACA has been an example of a well-meaning regulation that has had destructive impacts directly contrary to its intent. (thehealthcareblog.com)
  • This session will address the latest industry policies and the impacts that they are having on risk adjustment processes. (medicareriskrevenue.com)
Scores5
Benefits and risks1
  • In this paper we give an overview of the benefits and risks of covariate adjustment in RCTs, using examples from a previously published trial. (biomedcentral.com)
Score8
  • Payment to providers is based on the individual's risk adjustment score. (slideshare.net)
  • Coding gaps or incomplete coding can skew the risk score. (harvardpilgrim.org)
  • An electronic Simplified Acute Physiology Score-based risk adjustment score for critical illness in an integrated healthcare system. (nih.gov)
  • We sought to create an automated ICU risk adjustment score, based on the Simplified Acute Physiology Score 3, using only data available within the electronic medical record (Kaiser Permanente HealthConnect). (nih.gov)
  • The customized eSimplified Acute Physiology Score 3 shows good potential for providing automated risk adjustment in the intensive care unit. (nih.gov)
  • Acquiring an initial view of the risk score in June of the current benefit year strikes a good balance of allowing experience to mature without waiting too long, when a potential adjustment to internal processes or projections becomes difficult (or even impossible). (milliman.com)
  • The entity then converts the data into a risk score for each person in the plan, using that score to determine whether the enrollee is healthier or sicker than average and how much payment to the plan should be adjusted for that patient. (aafp.org)
  • During one of our reviews, it was identified that by improving the practitioner's documentation slightly, would have increased the HCC risk adjusted score. (revintsolutions.com)
Payment3
Reconcile1
Reinsurance1
  • The ACA had three measures to stabilize the exchanges and improve competition-reinsurance, risk corridors and risk adjustment. (thehealthcareblog.com)
Budget neutral1
Patient2
  • Risk adjustment takes a close look at how ICD-9-CM documentation and coding contributes to the complexity level of the encounter, medical decision-making, and time spent with the patient. (aapc.com)
  • If stage 4, 5, or 6 (end-stage renal disease), physicians may receive an additional HCC and risk-adjusted reimbursement to reflect the anticipated resources necessary to care for a sicker patient, says Wymore. (kareo.com)
Symptoms5
  • If your symptoms don't begin to improve after several weeks of treatments, chiropractic adjustment might not be the best option for you. (mayoclinic.org)
  • Preterm birth is associated with asthma-like symptoms in childhood and possibly in adolescence, but the longer-term risk of asthma is unknown and increasingly relevant as larger numbers of these individuals enter adulthood. (aappublications.org)
  • Signs and symptoms depend on the type of adjustment disorder and can vary from person to person. (mayoclinic.org)
  • Symptoms of an adjustment disorder start within three months of a stressful event and last no longer than 6 months after the end of the stressful event. (mayoclinic.org)
  • Symptoms of adjustment disorder get better because the stress has eased. (mayoclinic.org)
OBJECTIVE1
  • OBJECTIVE: To develop a risk adjustment method for HbA1c, based solely on administrative data and to determine the extent to which risk-adjusted HbA1c changes the identification of high- or low-performing medical facilities. (diabetesjournals.org)
Prospective2
  • Prospective risk predicts the financial benefits from high to low-cost plans through these groups. (analysts.com)
  • As prospective risk adjustment is mostly for the benefit of plans to accommodate high-risk members, predictions using the incomplete data will create gaps in the exchange of financials between insurance plans. (analysts.com)
Psychosocial3
  • Developmental risks and psychosocial adjustment among low-income Brazi" by Marcela Raffaelli, Silvia H. Koller et al. (unl.edu)
  • Exposure to developmental risks in three domains (community, economic, and family), and relations between risks and psychosocial well-being, were examined among 918 impoverished Brazilian youth aged 14-19 ( M = 15.8 years, 51.9% female) recruited in low-income neighborhoods in one city in Southern Brazil. (unl.edu)
  • This summary focuses primarily on the less severe end of this continuum: the normal adjustment issues, psychosocial distress,[ 5 ] the adjustment disorders, and cancer-related anxiety. (cancer.gov)
Disorder6
Disorders4
Statistical2
  • This is the first study with sufficient statistical power to evaluate the risk of asthma beyond adolescence in individuals who were born extremely preterm. (aappublications.org)
  • To our knowledge, this is the largest study to date of the association between preterm birth and the subsequent risk of asthma and the first study with sufficient statistical power to estimate this risk in young adults who were born extremely preterm. (aappublications.org)
Challenges in Risk Adjustment for Hospital and Provider Outcomes Assessment | Circulation
Challenges in Risk Adjustment for Hospital and Provider Outcomes Assessment | Circulation (circ.ahajournals.org)
Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works | The BMJ
Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works | The BMJ (bmj.com)
Risk adjustment in the ACA marketplaces: A success with some important gaps | The Incidental Economist
Risk adjustment in the ACA marketplaces: A success with some important gaps | The Incidental Economist (theincidentaleconomist.com)
DaVita Job Listings | Career Search | Monster.com
DaVita Job Listings | Career Search | Monster.com (monster.com)
Plus it
Plus it (bmj.com)
Health Care Fraud, Waste & Abuse | SAS Finland
Health Care Fraud, Waste & Abuse | SAS Finland (sas.com)
Medicare | ASPE
Medicare | ASPE (aspe.hhs.gov)
Frontiers | Risk-Conferring Glutamatergic Genes and Brain Glutamate Plus Glutamine in Schizophrenia | Psychiatry
Frontiers | Risk-Conferring Glutamatergic Genes and Brain Glutamate Plus Glutamine in Schizophrenia | Psychiatry (frontiersin.org)
Pediatric Readmissions After Hospitalizations for Lower Respiratory Infections | Pediatrics
Pediatric Readmissions After Hospitalizations for Lower Respiratory Infections | Pediatrics (pediatrics.aappublications.org)
Medical Coding Jobs - Medical Billing and Coding Jobs - AAPC
Medical Coding Jobs - Medical Billing and Coding Jobs - AAPC (aapc.com)
Risk Adjustment Gone Wrong - The Health Care Blog
Risk Adjustment Gone Wrong - The Health Care Blog (thehealthcareblog.com)
Problems With Inversion Boots | Livestrong.com
Problems With Inversion Boots | Livestrong.com (livestrong.com)
AAPC Regional Conference 2018 - Washington DC - Healthcare Conference
AAPC Regional Conference 2018 - Washington DC - Healthcare Conference (aapc.com)
Federal Register :: Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...
Federal Register :: Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule... (federalregister.gov)
Https://www.medicalnewstoday.com/kc/osteoarthritis-causes-symptoms-treatments-27871
Https://www.medicalnewstoday.com/kc/osteoarthritis-causes-symptoms-treatments-27871 (medicalnewstoday.com)
CMS Proposes Changes To Medicare Advantage Program For CY 2020 - Food, Drugs, Healthcare, Life Sciences - United States
CMS Proposes Changes To Medicare Advantage Program For CY 2020 - Food, Drugs, Healthcare, Life Sciences - United States (mondaq.com)
Search | Marketplaces | Search Results | KFF
Search | Marketplaces | Search Results | KFF (kff.org)
Webinars | Health Information Systems | 3M United States
Webinars | Health Information Systems | 3M United States (3m.com)
Buprenorphine and Naloxone Sublingual Film - FDA prescribing information, side effects and uses
Buprenorphine and Naloxone Sublingual Film - FDA prescribing information, side effects and uses (drugs.com)
News in Brief: Week of Sept. 10-14
News in Brief: Week of Sept. 10-14 (aafp.org)
Coding
Coding (aapc.com)
Adjustment Disorders: From Controversy to Clinical Practice - Patricia R. Casey - Google Books
Adjustment Disorders: From Controversy to Clinical Practice - Patricia R. Casey - Google Books (books.google.com)
Patricia Seliger Keenan | RAND
Patricia Seliger Keenan | RAND (rand.org)
Faculty Papers and Publications | Harvard Kennedy School
Faculty Papers and Publications | Harvard Kennedy School (hks.harvard.edu)
JAMA - The Health Care Blog
JAMA - The Health Care Blog (thehealthcareblog.com)
Past Events | Academy Health
Past Events | Academy Health (academyhealth.org)
NICE advises against aspirin for cutting stroke risk in AF patients | News | Nursing Times
NICE advises against aspirin for cutting stroke risk in AF patients | News | Nursing Times (nursingtimes.net)
Health risks of obese mothers-to-be | News | Nursing Times
Health risks of obese mothers-to-be | News | Nursing Times (nursingtimes.net)
Over 65s at higher risk of readmission after ambulatory surgery | News | Nursing Times
Over 65s at higher risk of readmission after ambulatory surgery | News | Nursing Times (nursingtimes.net)
High-factor sunscreen doesn't cut melanoma risk | NHS Choices | Nursing Times
High-factor sunscreen doesn't cut melanoma risk | NHS Choices | Nursing Times (nursingtimes.net)
Unvaccinated children at risk from whooping cough | News | Nursing Times
Unvaccinated children at risk from whooping cough | News | Nursing Times (nursingtimes.net)
Head injury poses highest death risk for A&E patients | News | Nursing Times
Head injury poses highest death risk for A&E patients | News | Nursing Times (nursingtimes.net)
Glenn Procedure Outcomes | Children's Hospital of Philadelphia
Glenn Procedure Outcomes | Children's Hospital of Philadelphia (chop.edu)