Medicare Risk Adjustment for the Frail Elderly

Overview

Journal Health Care Financ Rev

Specialty Health Services

Date 2009 Apr 14

PMID 19361118

Citations 7

Authors

John Kautter

Melvin Ingber

Gregory C Pope

Affiliations

Soon will be listed here.

Abstract

CMS has had a continuing interest in exploring ways to incorporate frailty adjustment into the CMS Hierarchical Condition Categories (CMS-HCC) risk adjustment methodology for Medicare Advantage and other Medicare private organizations. In this article we present research results for Medicare risk adjustment of the frail elderly since the adoption of frailty adjustment for Program of All-Inclusive Care for the Elderly (PACE) organizations in 2004. In particular, we present results on the revised frailty adjuster that is being phased in for PACE organizations between 2008 and 2012.

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PMID: 36098417 PMC: 9826123. DOI: 10.1002/nau.25040.

The combined effects of physical frailty and cognitive impairment on emergency department- versus direct-admission hospitalizations.

Buta B, Friedman A, Chung S, Sheehan O, Blinka M, Gearhart S BMC Geriatr. 2022; 22(1):718.

PMID: 36042414 PMC: 9429704. DOI: 10.1186/s12877-022-03397-6.

Evaluating the Impact of Medication Risk Mitigation Services in Medically Complex Older Adults.

Jin H, Yang S, Bankes D, Finnel S, Turgeon J, Stein A Healthcare (Basel). 2022; 10(3).

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Validation of the JEN frailty index in the National Long-Term Care Survey community population: identifying functionally impaired older adults from claims data.

Kinosian B, Wieland D, Gu X, Stallard E, Phibbs C, Intrator O BMC Health Serv Res. 2018; 18(1):908.

PMID: 30497450 PMC: 6267903. DOI: 10.1186/s12913-018-3689-2.

Effect of frailty on resource use and cost for Medicare patients.

Simpson K, Seamon B, Hand B, Roldan C, Taber D, Moran W J Comp Eff Res. 2018; 7(8):817-825.

PMID: 29808714 PMC: 7136980. DOI: 10.2217/cer-2018-0029.

References

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Pope G, Adamache K, Walsh E, Khandker R . Evaluating Alternative Risk Adjusters for Medicare. Health Care Financ Rev. 2014; 20(2):109-129. PMC: 4194526. View

Kautter J, Pope G . CMS Frailty Adjustment Model. Health Care Financ Rev. 2014; 26(2):1-19. PMC: 4194868. View

Pope G, Ellis R, Ash A, Liu C, Ayanian J, Bates D . Principal inpatient diagnostic cost group model for Medicare risk adjustment. Health Care Financ Rev. 2001; 21(3):93-118. PMC: 4194677. View

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