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Medicare calibration of the clinically detailed risk information system for cost

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  • Kanika Kapur
  • Chien-Wen Tseng
  • Afshin Rastegar
  • Grace Carter
  • Emmett Keeler

Abstract

The clinically detailed risk information system for cost (CD-RISC) contains definitions for several hundred severity-adjusted conditions that can be used to predict future health care costs. We develop a prospective Medicare CD-RISC model using a 5-percent sample of Medicare beneficiaries and data that contain 1996 diagnostic information and 1997 annualized costs. The CD-RISC model has a hierarchical structure that implies that only the most expensive condition-severity variable within a body system affects payments. This minimizes incentives to game the system by entering multiple related codes for the same condition. The R² for the CD-RISC model is 11 percent.

Suggested Citation

  • Kanika Kapur & Chien-Wen Tseng & Afshin Rastegar & Grace Carter & Emmett Keeler, 2003. "Medicare calibration of the clinically detailed risk information system for cost," Open Access publications 10197/274, School of Economics, University College Dublin.
    • Handle: RePEc:ucn:oapubs:10197/274
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    File URL: http://hdl.handle.net/10197/274
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    References listed on IDEAS

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    1. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
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    Cited by:

    1. John Robst, 2009. "Development of a Medicaid Behavioral Health Case-Mix Model," Evaluation Review, , vol. 33(6), pages 519-538, December.
    2. Jing Chen & Randall P. Ellis & Katherine H. Toro & Arlene S. Ash, 2015. "Mispricing in Medicare Advantage Risk Adjustment," Boston University - Department of Economics - Working Papers Series wp2015-020, Boston University - Department of Economics.
    3. van Kleef, R.C. & van Vliet, R.C.J.A. & van Rooijen, E.M., 2014. "Diagnoses-based cost groups in the Dutch risk-equalization model: The effects of including outpatient diagnoses," Health Policy, Elsevier, vol. 115(1), pages 52-59.

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