• On The Record (with daily recap)

    • GAO: Medicare Advantage: Changes Improved Accuracy of Risk Adjustment for Certain Beneficiaries

    Today in TIE: Don with a few suggestions on peer review, and Aaron with another Plan B outrage.

    On The Record says it will be the Crimson Tide 17-13


    • The GAO report is particularly interesting to me. It’s well known that the Hierarchical Conditions Category model, which CMS uses to risk adjust payments to MA plans, is pretty good but has some holes. It under-predicts expenses for people with severe disabilities (functional impairments, in long-term care speak) and it under-predicts expenses among the most expensive population.

      Adjusting the model for dementia is a great idea, since people with dementia do cost more than people without, and the people with dementia also tend to have other comorbidities. The problem is that the dementia adjuster is based on medical claims that are coded with the ICD-9 codes for dementia – and as Dr. Taylor has posted on this blog, dementia is currently under-coded in claims. The Alzheimer’s Association thinks that a big reason is that doctors under-diagnose it. I would guess that even the ones who do notice it don’t necessarily have an incentive to code it in – it doesn’t change much, since you don’t treat it directly, and you don’t get paid more.