Medicare calibration of the clinically detailed risk information system for cost

Health Care Financ Rev. Fall 2003;25(1):37-54.

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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Disease / classification
  • Female
  • Health Maintenance Organizations
  • Health Status Indicators*
  • Humans
  • Infant
  • Infant, Newborn
  • Information Systems*
  • International Classification of Diseases
  • Male
  • Medicare / economics*
  • Middle Aged
  • Models, Statistical
  • Severity of Illness Index
  • United States / epidemiology