在家的健康风险评估和图表审查有助于编码强度在医疗保险优势
1Paul D. Jacobs (paul.jacobs@ahrq.hhs.gov), Agency for Healthcare Research and Quality, Rockville, Maryland.
Health affairs (Project Hope)
|July 1, 2024
概括
医疗保险优势计划通过鼓励更多的诊断来增加纳税人的成本. 家庭评估和图表审查显著提高了风险得分,影响了支付.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保险政策 医疗保险政策
- 医疗保健管理的管理
背景情况:
- 与传统医疗保险相比,医疗保险优势 (MA) 计划的纳税人成本更高.
- MA计划根据提交的诊断获得支付,为全面的诊断报告创造了激励.
- MA计划利用家庭健康风险评估和图表审查来确定额外的诊断.
研究的目的:
- 量化家庭健康风险评估和图表审查对MA支付相关风险评分的影响.
- 分析这些诊断工具对MA计划支付总体的影响.
主要方法:
- 使用的医疗保险优势遭遇数据从2015年到2020年.
- 隔离了家庭评估和图表审查对风险得分的影响.
- 2016-2021年付款年计算的风险评分变化.
主要成果:
- 对于MA入学者的基于遭遇的风险分数增加了0.091分.
- 这意味着这些评估工具所产生的风险得分增加了7.4%.
- 包括家庭健康风险评估和图表审查在内的风险得分明显膨胀.
结论:
- 在家进行的健康风险评估和图表审查显著增加了Medicare Advantage风险得分.
- 这些MA计划实践有助于提高总体支付和纳税人的成本.
- 需要进一步研究这些诊断方法的成本效益和公平性.
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