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Published on: January 8, 2020
PACE and the Medicare+Choice risk-adjusted payment model
H Temkin-Greener1, M R Meiners, L Gruenberg
1Community Coalition for Long-Term Care, Inc., 10 Gibbs St., Suite 410, Rochester, NY 14604, USA.
Abstract:
This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.
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