Diagnostic cost group (DCG) and hierarchical coexisting conditions (HCC) models for Medicare risk adjustment

219 Pages·1996·9.3 MB·English

by  Ellis, Randall P

he? HEALTHECONOMICSRESEARCH,INC.
300FifthAvenue,6thFloor
Waltham,MA02154
[phone]
[phone]-FAX
DIAGNOSTICCOSTGROUP(DCG)AND
HIERARCHICALCOEXISTINGCONDITIONS (HCC)
MODELS FORMEDICARERISKADJUSTMENT
Volume
II
AppendicestoFinalReport
Submittedby;
RandaUP.EUis,Ph.D.^
GregoryC.Pope,M.S.2
LisaI.lezzoni,M.D.,M.Sc.^
JohnZ.Ayanian,M.D.,M.P.P.^
DavidW.Bates,M.D.,M.Sc.5
HelenBurstin,M.D.,M.P.H.^
DebraA.Dayhoff,Ph.D7
AmyRensko,B.A.^
TimDawes,B.A.^
ArleneS.Ash,Ph.D.9
AffiliaHons: ^SBeonsitoornEUcnoinvoemrissitty,,HBeoaslttohn,EcMoAnomicsResearch,Inc.,Waltham,MAandProfessorofEconomics,
^VicePresident,HealthEconomicsResearch,Inc.,Waltham,MA
^AssociateProfessorofMedicine,HarvardMedicalSchool,DivisionofGeneralMedicineandPrimaryCare,
TDhepoamrdtimkeentLaobforMaetdoircyi,neB,osBteotnh,IMsrAaelHospital,theCharlesA.DanaResearchIr\stitute,andtheHarvard-
^ABsrsiigshtaanmtaPnrdofWeossmoerno'fsMeHdoispciitnael,,HBaorsvtoanr,dMMeAdicalSchool,andDepartmentofHealthCarePolicy,
^ABsrsiigshtaanmtaPnrdofWeossmoerno'fsMeHdoispciitnael,,HBaorsvtoanr,dMMeAdicalSchool,andDivisionofGeneralMedicine,
^IWnosmtreunc'tosrHionsMpeitdailc,inBeo,stHoanr,vMarAdMedicalSchool,andDivisionofGeneralMedicine,Brighamand
*9SAJesiimsiuooocrriaAEtnceaolRnyeosmstie,satHr,ecahHlePtraholftEehcsosEoncroo,mnHioecmasilcRtsehsRCeeaasrreceahrR,ceIhsn,ce.aI,nrcWc.a,hlWUtaihulatt,mh,BaomMs,tAMonAUniversitySchoolofMedicine,Boston,MA
April26,1996
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TABLEOFAPPENDICES
APPENDIXA: DCGProjectKeyPersonnelandConsultants
APPENDIXB: DiagnosticGroup(DXGROUP)DefinitionsandProspectiveStatistics
TABLEB-1 DXGROUPDiagnosticCategorieswithICD-9-CMCodes
TABLEB-2 1992MedicareProgramExpendituresand1991FrequencyofEnrolleesfor
PrincipalInpatientDiagnosticGroups(UpperCaseLabels)andHospitaland
Physician(All)DiagnosticGroups(LowerCaseLabels)
TABLEB-3 Regressionof1992MedicareProgramExpenditureson1991Hospitaland
Physician(AU)DiagnosisDiagnosticGroups
APPENDIXC: DiagnosticCostGroupSortingAlgorithmResults
TABLE-C-1 SortingAlgorithmOutputforPrincipalInpatientDCGModel
TABLEC-2 SortingAlgorithmOutputforHospitalandPhysician(All)DiagnosisDCG
Model
TABLEC-3 SortingAlgorithmOutputforExpandedDCGModel(PrincipalInpatient
DiagnosesareinUpperCase)
TABLEC-4 SortingAlgorithmOutputforExpandedDCGModelwithProcedures
(PrincipalInpatientDiagnosesareinUpperCase)
TABLEC-5 SortingAlgorithmOutputforConcurrentPrincipalInpatientDCGModel
TABLEC-6 SortingAlgorithmOutputforConcurrentHospitalandPhysician(AU)
DiagnosisDCGModel
APPENDIXD: Life-SustainingProcedureDefiniHons
TABLED-1 'Life-Sustaining'Procedures(5-DigitNimibersareCPT-4Codes)
APPENDIXE: DiagnosticCostGroupsbyDiagnosticCategory(DXGROUP)
TABLEE-1 DiagnosticCostGroupsbyDiagnosticCategory,forAlternativeDCG
Models
dcg\final\toc-appn.doc\nab
TABLEOFAPPENDICES
(continued)
APPENDIXF: ProspectiveHierarchicalCoexistingConditionModels
TABLEF-1 ProspectiveHierarchicalCoexistingConditions(HCCs)
TABLEF-2 HierarchicalCoexistingConditions,ProceduresandHospitalizations,
andAugmentedHierarchicalCoexistingConditions,PaymentModels
TABLEF-3 HierarchicalCoexistingConditionsClassificationModels
TABLEF-4 EstimatedProspectiveHCCPaymentModelParametersforAgedand
DisabledSubsamples
APPENDIXG: GeographicInputPriceIndex
TABLEG-1 AlternativeGeographicAdjustmentFactorsbyMetropolitanArea:
GeographicInputPriceIndex(GIPI)andComponents,andIndexed
MedicareCapitationPayment(lAAPCC)
APPENDIXH: ConcurrentDiagnosticGroup(DXGROUP)andHierarchicalCoexisting
ConditionsStatistics
TABLEH-1 1992MedicareProgramExpendituresand1992FrequencyofEnrolleesfor
ConcurrentPrincipalInpatientDiagnosticGroups(UpperCaseLabels)and
HospitalandPhysicianDiagnosticGroups(LowerCaseLabels)
TABLEH-2 Regressionof1992MedicareProgramExpenditureson1992Hospitaland
Physician(All)DiagnosisDiagnosticGroups
TABLEH-3 ConcurrentHierarchicalCoexistingConditions(HCCs)
TABLEH-4 HierarchicalCoexistingConditionsConcurrentModelParameterEstimates
APPENDIXI: SpecialtyCodesConsideredPhysicianSpecialties
TABLEI-l 1991SpecialtyCodesConsideredPhysicianSpecialties
ii
dcg\final\toc-appn.doc\nab
APPENDIX A:
DCGPROJECTKEYPERSONNEL
ANDCONSULTANTS
APPENDIXA: DCGPROJECTKEYPERSONNELANDCONSULTANTS
HEALTHECONOMICSRESEARCH,INC.SENIORSTAFF
PRINCIPALINVESTIGATOR: RANDALLP.ELLIS,PH.D.
TITLE: ProfessorofEconomics
AFFILIATION: EconomicsDepartment,BostonUniversity
MAILINGADDRESS: 270BayStateRoad
Boston,MA 02215
TELEPHONENOS.: BU: [phone];HER: [phone];
FAXNO.: [phone]
E-MAIL: [email protected]@her-cher.org
PROJECTDIRECTOR: GREGORYC.POPE,M.S.
TITLE: VicePresident
AFFILIATION: HealthEconomicsResearch,Inc.
MAILINGADDRESS: HealthEconomicsResearch,Inc.
300FifthAvenue,SixthFloor
Waltham,MA02154
TELEPHONENO. [phone],Ext.134
FAXNO.: [phone]
E-MAIL: [email protected]
H.E.R.STAFF: DEBRAA.DAYHOFF,PH.D.
TITLE: SeniorEconomist
AFHLIATION: HealthEconomicsResearch,Inc.
MAILINGADDRESS: HealthEconomicsResearch,Inc.
300FifthAvenue,SixthFloor
Waltham,MA 02154
TELEPHONENO.: [phone],Ext.142
FAXNO.: [phone]
E-MAIL: [email protected]
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HARVARDMEDICALSCHOOLFHYSICL^NCONSULTANTS
CONSULTANT: JOHNZ.AYANIAN,M.D.,M.P.P.
SPECIALTY: InternalMedicine
TITLE: AssistantProfessorofMedicine,HarvardMedicalSchool
AFHLIATION: BrighamandWomen'sHospital
MAILINGADDRESS: BrighamandWomen'sHospital
DepartmentofHealthCarePolicy
HarvardMedicalSchool
2B5osSthoant,tMucAkSt0.2,1P1a5rcelB,FirstFloor
TELEPHONENO.: [phone];
FAXNO.: [phone]
E-MAIL: [email protected]
CONSULTANT: DAVIDW.BATES,M.D.,M.Sc.
SPECIALTY: InternalMedicine
TITLE: AssistantProfessorofMedicine,HarvardMedicalSchool
AFHLIATION: BrighamandWomen'sHospital
MAILINGADDRESS: DivisionofGeneralMedicine,A-2
BrighamandWomen'sHospital
75FrancisStreet
Boston,MA02115
TELEPHONENO.: [phone]
FAXNO.: [phone]
E-MAIL: [email protected]
CONSULTANT: HELENBURSTIN,M.D.
SPECIALTY: InternalMedicine
TFILE: InstructorinMedicine,HarvardMedicalSchool
AFHLIATION: BrighamandWomen'sHospital
MAILINGADDRESS: DivisionofGeneralMedicine
BrighamandWomen'sHospital
75FrancisStreet
Boston,MA02115
TELEPHONENO. [phone]
FAXNO.: [phone]
E-MAIL: [email protected]
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HARVARDMEDICALSCHOOLPHYSICIANCONSULTANTS (continued)
CONSULTANT: LISAlEZZONI,M.D.,M.Sc.
SPECIALTY: GeneralMedicine/HealthServicesResearch
TITLE: AssociateProfessorofMedicine,HarvardMedicalSchool
AITILIATIONS: BethIsraelHospital,TheCharlesA.DanaResearchInstitute
andTheHarvard-ThomdikeLaboratory
MAILINGADDRESS: GeneralMedicine
BethIsraelHospital,LY-326
330BrooklineAvenue
Boston,MA02215
TELEPHONENO.: [phone]
FAXNO.: [phone]
E-MAIL: [email protected]
PHYSICL\NSPECIALISTCONSULTANTS
CONSULTANT: SCOTTSTROUP,M.D.,M.P.H.
SPECIALTY: Psychiatry
TITLE: ResearchFellow,J.F.KennedySchoolofGovernment;
ClinicalFellowinPsychiatry,CambridgeHospital
MAILINGADDRESS: 28CambridgeTerrace
Cambridge,MA 02140
TELEPHONENO.: [phone]
FAXNO.: [phone]
E-MAIL:
CONSULTANT: HOWARDLEIBOWITZ,M.D.
SPECIALTY: Ophthalmology
TITLE: Chairman&Professor,DepartmentofOphthalmology;
OphthalmologistinChiefatUniversityHospital
AFHLIATION: BostonUniversitySchoolofMedicine
MAILINGADDRESS: 80E.ConcordStreet
SuiteL907
Boston,MA02118
TELEPHONENO. [phone]
FAXNO.: [phone]
E-MAIL:
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PHYSICIANSPECIALISTCONSULTANTS (continued)
CONSULTANT: RENEEROSSI,M.D.
SPECIALTY: Otolaryngology
TITLE: ClinicalInstructorofOtolaryngology,HarvardMedicalSchool
AFHLIATION: DeaconessHospital
MAILINGADDRESS: HarvardMedicalSchool
DepartmentofOtolaryngology
DeaconessHospital
110FrancisStreet
Boston,MA 02215
TELEPHONENO. [phone]
FAXNO.: [phone]
E-MAIL:
PHYSICIANREVIEWERS
CONSULTANT: WILLIAMSTEPHENAARON,M.D.
SPECIALTY: GeneralSurgery
TITLE: ClinicalAssistantProfessorofSurgery
AFFILIATION: UniversityofLouisviUeSchoolofMedicine
MAILINGADDRESS: Aaron&Walker,P.S.C.
801BarretAvenue
Suite116
Louisville,KY40204
TELEPHONENO.: [phone]
FAXNO.: [phone]
E-MAIL:
CONSULTANT: DEBORAHALLEN,M.D.
SPECIALTY: FamilyPractice
TITLE: Professor&Chairman,
DepartmentofFamilyMedicine
AFHLIATION: IndianaUniversitySchoolofMedicine
MAILINGADDRESS: IndianaUruversitySchoolofMedicine
1110WestMichigan
LongHospital
Indianapolis,IN46202
TELEPHONENO. [phone]
FAXNO.: [phone]
E-MAIL:
AA
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PHYSICIANRFVIEWERS (continued)
CONSULTANT: CHARLESCLARK,M.D.
SPECIALTY: Endocrinology
TITLE: Co-Director,RegenstriefInstitute;
ProfessorofMedicine&Pharmacology
AITILIATION: IndianaUniversitySchoolofMedicine
MAILINGADDRESS: RegenstriefHealthCenter
IndianaUniversitySchoolofMedicine
1001WestTenthSta-eet
Indianapolis,IN46202
TELEPHONENO. [phone]
FAXNO.: [phone]
E-MAIL: [email protected]
CONSULTANT: MAGRUDERC.DONALDSON,M.D.
SPECIALTY: VascularSurgery
TITLE: AssociateProfessorofSurgery
AFHLIATION: BrighamandWomen'sHospital/HarvardMedicalSchool
MAILINGADDRESS: DepartmentofSurgery,DivisionofVascularSurgery
BrighamandWomen'sHospital
75FrancisStreet
Boston,MA 02115
TELEPHONENO. [phone];[phone]
FAXNO.: [phone]
E-MAIL: [email protected]
HEALTHSERVICESRESEARCHCONSULTANTS
CONSULTANT: ARLENEASH,PH.D.
TITLE: AssociateResearchProfessor,
BostonUniversityMedicalSchool&
SchoolofPublicHealth
AFFILIATION: BostonUniversitySchoolofMedicine
MAILINGADDRESS: BostonUniversitySchoolofMedicine
HealthCareResearchUnit
720HarrisonAvenue
Suite1102
Boston,MA02118
TELEPHONENO. [phone]
FAXNO.: [phone]
E-MAIL: [email protected]
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