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Related Concept Videos

Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Issues And Trends In Healthcare Delivery System01:29

Issues And Trends In Healthcare Delivery System

The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
Health Information Technology and Healthcare Information System01:30

Health Information Technology and Healthcare Information System

Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Standards of Care II01:19

Standards of Care II

Nurses bear specific legal responsibilities under several federal statutes, including:
Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions01:15

Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions

PK–PD modeling has significantly influenced FDA regulatory decisions, particularly drug approval, dosage optimization, and labeling. These models integrate pharmacokinetics (PK) and pharmacodynamics (PD) to predict drug behavior and effects, aiding in optimizing dosing regimens and enhancing the probability of clinical trial success.One notable example is Nesiritide (Natrecor®), a recombinant human brain natriuretic peptide for treating acute decompensated congestive heart failure (CHF).

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Related Experiment Video

Updated: Jul 12, 2026

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
06:55

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index

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.

Inquiry : a Journal of Medical Care Organization, Provision and Financing
|May 31, 2001
PubMed
Summary

The Medicare principal inpatient diagnostic cost group (PIP-DCG) model would decrease payments to the Program of All-Inclusive Care for the Elderly (PACE) by 38%. This model inadequately captures the risks associated with functionally impaired seniors in PACE.

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Area of Science:

  • Health Economics
  • Geriatric Care
  • Healthcare Policy

Background:

  • The Program of All-Inclusive Care for the Elderly (PACE) serves over 6,000 Medicare beneficiaries needing nursing home care.
  • PACE is positioned for expansion under the Balanced Budget Act of 1997.
  • Current Medicare payment models may not accurately reflect the costs of PACE's comprehensive care for functionally impaired seniors.

Purpose of the Study:

  • To evaluate the financial impact of applying the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model to the PACE program.
  • To assess the adequacy of the PIP-DCG model's risk adjustment for the PACE population.

Main Methods:

  • Analysis of the application of the PIP-DCG payment model to PACE program data.
  • Risk adjustment evaluation based on inpatient diagnoses versus functional impairments.

Main Results:

  • The PIP-DCG model is projected to reduce Medicare payments to PACE by an average of 38%.
  • The PIP-DCG model's reliance on inpatient diagnoses does not sufficiently account for the complex health needs and functional impairments of PACE participants.

Conclusions:

  • Implementing the PIP-DCG model for PACE could lead to significant underfunding.
  • A payment model tailored to the unique needs of PACE participants, including functional status, is necessary for accurate risk adjustment and financial sustainability.