A system for paying for hospital care being tried by the Health Care Financing Administration (HCFA) for patients of Medicare HMOs. In this system, a patient’s prior hospitalization history during the preceding 15 months is used to predict future costs. Prior utilization is expected to reflect the patient’s health status and the physician’s practice patterns. Each patient is placed in one of eight DCGs, depending on costliness, with the higher number DCGs reflecting higher expected costs to treat the patient. For each DCG, there is a set of cost weights that depend on the patient’s age, sex, and welfare status. A formula results in the setting of the HMO’s capitation rate.<\/p>\n
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A system for paying for hospital care being tried by the Health Care Financing Administration (HCFA) for patients of Medicare HMOs. In this system, a patient’s prior hospitalization history during the preceding 15 months is used to predict future costs. Prior utilization is expected to reflect the patient’s health status and the physician’s practice patterns. […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-112209","post","type-post","status-publish","format-standard","hentry","category-d"],"yoast_head":"\n