Featured White Papers
- 5 Strategies for Making Sales the Engine for Growth (AchieveGlobal)
- Enterprise PBX buyer's guide (VoIP-News)
- Hosted CRM comparison guide (Inside CRM)
Content provided in partnership with
Health Care Industry
Industry: Email Alert RSS FeedRisk adjustment of Medicare capitation payments using the CMS-HCC model
Health Care Financing Review, Summer, 2004 by Gregory C. Pope, John Kautter, Randall P. Ellis, Arlene S. Ash, John Z. Ayanian, Lisa I. Iezzoni, Melvin J. Ingber, Jesse M. Levy, John Robst
Table 1
Predictive Ratios (1) for Alternative Risk-Adjustment Models
Category Model
Quintiles of Expenditures Age/Sex PIP-DCG DCG/HCC
First (Lowest) 2.66 2.09 1.23
Second 1.93 1.54 1.23
Third 1.37 1.10 1.14
Fourth 0.95 0.84 1.02
Fifth (Highest) 0.44 0.75 0.86
Top 5 Percent 0.28 0.61 0.77
Top 1 Percent 0.17 0.47 0.69
Hospitalizations
None 1.33 1.07 1.03
1 0.63 1.02 1.02
2 0.44 0.91 0.98
3 or More 0.26 0.69 0.82
Diagnoses (2)
Heart Failure 0.47 0.74 0.97
Heart Attack 0.45 0.78 0.98
COPD 0.59 0.79 0.99
Hip Fracture 0.56 0.83 0.99
Depression 0.54 0.77 0.92
Colorectal Cancer 0.60 0.78 0.98
Cerebral Hemorrhage 0.44 0.73 1.04
(1) Mean predicted cost divided by mean actual cost.
(2) From either inpatient or ambulatory setting.
NOTES: Expenditures, hospitalizations, and diagnoses are measured in
the base year. COPD is chronic obstructive pulmonary disease.
SOURCE: (Pope et al., 2000b.)
Table 2 Centers for Medicare & Medicaid Services-Hierarchical Condition
Categories (CMS-HCC) Combined, Community, and Institutional Models
Models
Combined Community Institutional
Number of Observations 1,337,887 1,291,308 65,593
[R.sup.2] 0.0977 0.0976 0.0596
Adjusted [R.sup.2] 0.0977 0.0976 0.0589
Dependent Variable Mean 5,352 5,213 8,937
Root Mean Square Error 13,407 13,337 15,954
Model Parameters 105 105 50
Variable Parameter
Estimate t-ratio
Female
0-34 Years 678 3.81
35-44 Years 1,110 8.82
45-54 Years 1,177 11.20
55-59 Years 1,463 11.87
60-64 Years 1,996 17.26
65-69 Years 1,648 42.11
70-74 Years 2,061 60.25
75-79 Years 2,562 71.59
80-84 Years 2,998 71.39
85-89 Years 3,360 63.45
90-94 Years 3,683 46.81
95 Years or Over 3,128 23.27
Male
0-34 Years 405 2.72
35-44 Years 701 6.63
45-54 Years 1,059 12.15
55-59 Years 1,460 13.42
60-64 Years 1,824 17.90
65-69 Years 1,827 41.47
70-74 Years 2,380 59.66
75-79 Years 3,031 69.04
80-84 Years 3,454 62.03
85-89 Years 4,129 52.24
90-94 Years 4,505 32.20
95 Years or Over 4,753 15.83
Medicaid and Originally Disabled
Interactions with Age and Sex
Medicaid-Female-Disabled 1,141 11.31
Medicaid-Female-Aged 616 12.91
Medicaid-Male-Disabled 632 6.80
Medicaid-Male-Aged 788 10.33
Originally Disabled-Female 1,231 17.34
Originally Disabled-Male 809 11.66
Disease Coefficients Label
HCC1 HIV/AIDS 3,587 13.16
HCC2 Septicemia/Shock 4,365 34.74
HCC5 Opportunistic Infections 3,643 10.43
HCC7 Metastatic Cancer and
Acute Leukemia 7,438 81.16
HCC8 Lung, Upper Digestive Tract,
and Other Severe Cancers 7,438 81.16
HCC9 Lymphatic, Head and Neck,
Brain, and Other
Major Cancers 3,540 35.91
HCC10 Breast, Prostate, Colorectal
and Other Cancers
and Tumors 1,209 26.35
HCC15 Diabetes with Renal or
Peripheral Circulatory
Manifestation 3,827 37.71
HCC16 Diabetes with Neurologic or
Other Specified
Manifestation 2,931 30.09
HCC17 Diabetes with Acute
Complications 2,056 7.84
HCC18 Diabetes with
Ophthalmologic or
Unspecified Manifestation 1,839 18.35
HCC19 Diabetes without Complication 1,055 26.10
HCC21 Protein-Calorie Malnutrition 3,818 27.52
HCC25 End-Stage Liver Disease 4,496 14.91
HCC26 Cirrhosis of Liver 2,727 11.93
HCC27 Chronic Hepatitis 1,839 6.73
HCC31 Intestinal Obstruction/
Perforation 1,997 21.69
HCC32 Pancreatic Disease 2,336 17.30
HCC33 Inflammatory Bowel Disease 1,574 10.25
HCC37 Bone/Joint/Muscle Infections/
Necrosis 2,629 19.68
HCC38 Rheumatoid Arthritis and
Inflammatory Connective
Tissue Disease 1,683 27.72
HCC44 Severe Hematological
Disorders 5,055 30.80
HCC45 Disorders of Immunity 4,224 26.77
HCC51 Drug/Alcohol Psychosis 1,571 6.57
HCC52 Drug/Alcohol Dependence 1,477 6.15
HCC54 Schizophrenia 2,592 26.75
HCC55 Major Depressive, Bipolar,
and Paranoid Disorders 2,024 30.00
HCC67 Quadriplegia, Other
Extensive Paralysis 5,665 27.45
HCC68 Paraplegia 5,665 27.45
HCC69 Spinal Cord Disorders/
Injuries 2,484 17.77
HCC70 Muscular Dystrophy 2,239 3.82
HCC71 Polyneuropathy 1,480 19.74
HCC72 Multiple Sclerosis 2,329 11.44
HCC73 Parkinson's and Huntington's
Diseases 1,954 19.69
HCC74 Seizure Disorders and
Convulsions 1,334 17.25
HCC75 Coma, Brain Compression/
Anoxic Damage 2,396 7.88 C1
HCC77 Respirator Dependence/
Tracheostomy Status 10,417 29.54
HCC78 Respiratory Arrest 7,543 20.23
HCC79 Cardio-Respiratory Failure
and Shock 3,451 42.70
HCC80 Congestive Heart Failure 2,055 38.48
HCC81 Acute Myocardial Infarction 1,885 31.23
HCC82 Unstable Angina and Other
Acute Ischemic Heart
Disease 1,885 31.23
HCC83 Angina Pectoris/Old
Myocardial 1,246 22.82
Infarction
HCC92 Specified Heart Arrhythmias 1,362 31.73
HCC95 Cerebral Hemorrhage 1,901 10.05
HCC96 Ischemic or Unspecified
Stroke 1,498 20.90
HCC100 Hemiplegia/Hemiparesis 1,678 13.96
HCC101 Cerebral Palsy and Other
Paralytic Syndromes 767 3.34
HCC104 Vascular Disease with
Complications 3,432 36.22
HCC105 Vascular Disease 1,662 39.94
HCC107 Cystic Fibrosis 1,936 45.73
HCC108 Chronic Obstructive Pulmonary
Disease 1,936 45.73
HCC111 Aspiration and Specified
Bacterial Pneumonias 3,010 20.47
HCC112 Pneumococcal Pneumonia,
Empyema, Lung Abscess 1,151 6.55
HCC119 Proliferative Diabetic
Retinopathy and
Vitreous Hemorrhage 1,975 13.36
HCC130 Dialysis Status 15,926 26.97
HCC131 Renal Failure 2,908 23.20
HCC132 Nephritis 1,541 6.95
HCC148 Decubitus Ulcer of Skin 3,888 32.32
HCC149 Chronic Ulcer of Skin, Except
Decubitus 2,381 26.76
HCC150 Extensive Third-Degree
Burns 4,427 2.36
HCC154 Severe Head Injury 2,396 7.88 C1
HCC155 Major Head Injury 1,211 8.43
HCC157 Vertebral Fractures w/o
Spinal Cord Injury 2,462 20.64
HCC158 Hip Fracture/Dislocation 1,301 13.37
HCC161 Traumatic Amputation 3,965 17.86 C2
HCC164 Major Complications of
Medical Care and Trauma 1,438 18.25
HCC174 Major Organ Transplant Status 3,790 8.55
HCC176 Artificial Openings for
Feeding or Elimination 3,810 23.84
HCC177 Amputation Status, Lower
Limb/Amputation Complications 3,965 17.86 C2
Disabled/Disease Interactions
D-HCC5 Disabled Opportunistic
Infections 3,965 5.49
D-HCC44 Disabled Severe
Hematological Disorders 4,649 9.98
D-HCC51 Disabled Drug/Alcohol
Psychosis 2,830 7.12
D-HCC52 Disabled Drug/Alcohol
Dependence 2,160 6.90
D-HCC107 Disabled Cystic Fibrosis 9,691 6.70
Disease Interactions
INT1 DM-CHF1 1,265 14.62
INT2 DM-CVD 490 4.05
INT3 CHF-COPD 1,261 14.82
INT4 COPD-CVD-CAD 316 1.49
INT5 RF-CHF1 857 3.94
INT6 RF-CHF-DM1 4,185 18.48
Variable Parameter
Estimate t-ratio
Female
0-34 Years 598 3.36
35-44 Years 1,012 8.03
45-54 Years 1,096 10.40
55-59 Years 1,360 11.00
60-64 Years 1,924 16.56
65-69 Years 1,572 40.15
70-74 Years 1,970 57.42
75-79 Years 2,475 68.56
80-84 Years 2,936 68.34
85-89 Years 3,408 61.01
90-94 Years 4,077 46.25
95 Years or Over 4,130 25.32
Male
0-34 Years 346 2.32
35-44 Years 617 5.81
45-54 Years 973 11.14
55-59 Years 1,386 12.68
60-64 Years 1,755 17.13
65-69 Years 1,774 40.28
70-74 Years 2,323 58.17
75-79 Years 2,960 67.13
80-84 Years 3,372 59.83
85-89 Years 4,050 49.80
90-94 Years 4,620 31.08
95 Years or Over 5,307 15.89
Medicaid and Originally Disabled
Interactions with Age and Sex
Medicaid-Female-Disabled 1,133 11.18
Medicaid-Female-Aged 940 18.18
Medicaid-Male-Disabled 592 6.31
Medicaid-Male-Aged 944 11.62
Originally Disabled-Female 1,213 16.44
Originally Disabled-Male 757 10.73
Disease Coefficients Label
HCC1 HIV/AIDS 3,514 12.88
HCC2 Septicemia/Shock 4,563 32.92
HCC5 Opportunistic Infections 3,346 9.29
HCC7 Metastatic Cancer and
Acute Leukemia 7,510 81.00
HCC8 Lung, Upper Digestive Tract,
and Other Severe Cancers 7,510 81.00
HCC9 Lymphatic, Head and Neck,
Brain, and Other
Major Cancers 3,539 35.51
HCC10 Breast, Prostate, Colorectal
and Other Cancers
and Tumors 1,194 25.79
HCC15 Diabetes with Renal or
Peripheral Circulatory
Manifestation 3,921 36.90
HCC16 Diabetes with Neurologic or
Other Specified
Manifestation 2,833 28.43
HCC17 Diabetes with Acute
Complications 2,008 7.41
HCC18 Diabetes with
Ophthalmologic or
Unspecified Manifestation 1,760 17.32
HCC19 Diabetes without Complication 1,024 25.02
HCC21 Protein-Calorie Malnutrition 4,727 29.77
HCC25 End-Stage Liver Disease 4,616 14.92
HCC26 Cirrhosis of Liver 2,645 11.37
HCC27 Chronic Hepatitis 1,841 6.71
HCC31 Intestinal Obstruction/
Perforation 2,094 21.62
HCC32 Pancreatic Disease 2,281 16.61
HCC33 Inflammatory Bowel Disease 1,575 10.16
HCC37 Bone/Joint/Muscle Infections/
Necrosis 2,546 18.41
HCC38 Rheumatoid Arthritis and
Inflammatory Connective
Tissue Disease 1,653 26.93
HCC44 Severe Hematological
Disorders 5,188 30.69
HCC45 Disorders of Immunity 4,260 26.64
HCC51 Drug/Alcohol Psychosis 1,810 6.99
HCC52 Drug/Alcohol Dependence 1,361 5.44
HCC54 Schizophrenia 2,786 27.04
HCC55 Major Depressive, Bipolar,
and Paranoid Disorders 2,209 30.85
HCC67 Quadriplegia, Other
Extensive Paralysis 6,059 27.20
HCC68 Paraplegia 6,059 27.20
HCC69 Spinal Cord Disorders/
Injuries 2,526 17.45
HCC70 Muscular Dystrophy 1,981 3.27
HCC71 Polyneuropathy 1,377 18.06
HCC72 Multiple Sclerosis 2,654 12.19
HCC73 Parkinson's and Huntington's
Diseases 2,436 22.04
HCC74 Seizure Disorders and
Convulsions 1,381 16.68
HCC75 Coma, Brain Compression/
Anoxic Damage 2,912 8.62 C1
HCC77 Respirator Dependence/
Tracheostomy Status 10,783 28.46
HCC78 Respiratory Arrest 7,327 18.79
HCC79 Cardio-Respiratory Failure
and Shock 3,550 42.39
HCC80 Congestive Heart Failure 2,141 38.54
HCC81 Acute Myocardial Infarction 1,785 29.13
HCC82 Unstable Angina and Other
Acute Ischemic Heart
Disease 1,785 29.13
HCC83 Angina Pectoris/Old
Myocardial 1,205 21.76
Infarction
HCC92 Specified Heart Arrhythmias 1,363 30.95
HCC95 Cerebral Hemorrhage 2,011 9.88
HCC96 Ischemic or Unspecified
Stroke 1,569 20.34
HCC100 Hemiplegia/Hemiparesis 2,241 16.61
HCC101 Cerebral Palsy and Other
Paralytic Syndromes 840 3.42
HCC104 Vascular Disease with
Complications 3,473 35.49
HCC105 Vascular Disease 1,832 41.72
HCC107 Cystic Fibrosis 1,929 44.87
HCC108 Chronic Obstructive Pulmonary
Disease 1,929 44.87
HCC111 Aspiration and Specified
Bacterial Pneumonias 3,556 21.53
HCC112 Pneumococcal Pneumonia,
Empyema, Lung Abscess 1,034 5.68
HCC119 Proliferative Diabetic
Retinopathy and
Vitreous Hemorrhage 1,791 11.96
HCC130 Dialysis Status 15,778 25.96
HCC131 Renal Failure 2,954 22.73
HCC132 Nephritis 1,401 6.23
HCC148 Decubitus Ulcer of Skin 5,285 37.28
HCC149 Chronic Ulcer of Skin, Except
Decubitus 2,485 26.65
HCC150 Extensive Third-Degree
Burns 4,935 2.54
HCC154 Severe Head Injury 2,912 8.62 C1
HCC155 Major Head Injury 1,239 8.08
HCC157 Vertebral Fractures w/o
Spinal Cord Injury 2,514 20.23
HCC158 Hip Fracture/Dislocation 2,010 18.51
HCC161 Traumatic Amputation 4,322 17.92 C2
HCC164 Major Complications of
Medical Care and Trauma 1,346 16.60
HCC174 Major Organ Transplant Status 3,702 8.37
HCC176 Artificial Openings for
Feeding or Elimination 4,054 22.39
HCC177 Amputation Status, Lower
Limb/AmputationComplications 4,322 17.92 C2
Disabled/Disease Interactions
D-HCC5 Disabled Opportunistic
Infections 4,047 5.52
D-HCC44 Disabled Severe
Hematological Disorders 4,580 9.72
D-HCC51 Disabled Drug/Alcohol
Psychosis 2,608 6.32
D-HCC52 Disabled Drug/Alcohol
Dependence 2,122 6.61
D-HCC107 Disabled Cystic Fibrosis 9,547 6.63
Disease interactions
INT1 DM-CHF1 1,296 14.46
INT2 DM-CVD 639 4.89
INT3 CHF-COPD 1,238 14.06
INT4 COPD-CVD-CAD 406 1.82
INT5 RF-CHF1 1,202 5.24
INT6 RF-CHF-DM1 4,433 18.71
Variable Parameter
Estimate t-ratio
Female
0-34 Years 5,457 11.72
35-44 Years 5,457 11.72
45-54 Years 5,457 11.72
55-59 Years 5,457 11.72
60-64 Years 5,457 11.72
65-69 Years 5,970 11.73
70-74 Years 6,049 17.09
75-79 Years 5,089 19.63
80-84 Years 4,813 22.51
85-89 Years 4,515 23.28
90-94 Years 4,048 19.08
95 Years or Over 2,980 10.34
Male
0-34 Years 5,664 13.77
35-44 Years 5,664 13.77
45-54 Years 5,664 13.77
55-59 Years 5,664 13.77
60-64 Years 5,664 13.77
65-69 Years 7,435 13.24
70-74 Years 6,350 14.34
75-79 Years 6,210 16.45
80-84 Years 6,201 17.67
85-89 Years 6,366 17.40
90-94 Years 5,378 11.29
95 Years or Over 4,287 5.34
Medicaid and Originally Disabled
Interactions with Age and Sex
Medicaid-Female-Disabled -- --
Medicaid-Female-Aged -- --
Medicaid-Male-Disabled -- --
Medicaid-Male-Aged -- --
Originally Disabled-Female -- --
Originally Disabled-Male -- --
Disease Coefficients Label
HCC1 HIV/AIDS 6,893 5.42 C1
HCC2 Septicemia/Shock 4,854 13.89
HCC5 Opportunistic Infections 6,893 5.42 C1
HCC7 Metastatic Cancer and
Acute Leukemia 2,771 4.54
HCC8 Lung, Upper Digestive Tract,
and Other Severe Cancers 2,771 4.54
HCC9 Lymphatic, Head and Neck,
Brain, and Other
Major Cancers 2,319 3.50
HCC10 Breast, Prostate, Colorectal
and Other Cancers
and Tumors 1,330 4.01
HCC15 Diabetes with Renal or
Peripheral Circulatory
Manifestation 3,137 10.49
HCC16 Diabetes with Neurologic or
Other Specified
Manifestation 3,137 10.49
HCC17 Diabetes with Acute
Complications 3,137 10.49
HCC18 Diabetes with
Ophthalmologic or
Unspecified Manifestation 3,137 10.49
HCC19 Diabetes without Complication 1,308 5.32
HCC21 Protein-Calorie Malnutrition 2,193 6.49
HCC25 End-Stage Liver Disease 1,375 5.09
HCC26 Cirrhosis of Liver 1,375 5.09
HCC27 Chronic Hepatitis 1,375 5.09
HCC31 Intestinal Obstruction/
Perforation 1,375 5.09
HCC32 Pancreatic Disease 1,375 5.09
HCC33 Inflammatory Bowel Disease 1,375 5.09
HCC37 Bone/Joint/Muscle Infections/
Necrosis 2,539 4.42
HCC38 Rheumatoid Arthritis and
Inflammatory Connective
Tissue Disease 1,463 3.61
HCC44 Severe Hematological
Disorders 2,299 4.08
HCC45 Disorders of Immunity 2,299 4.08
HCC51 Drug/Alcohol Psychosis 1,131 6.06
HCC52 Drug/Alcohol Dependence 1,131 6.06
HCC54 Schizophrenia 1,131 6.06
HCC55 Major Depressive, Bipolar,
and Paranoid Disorders 1,131 6.06
HCC67 Quadriplegia, Other
Extensive Paralysis 504 3.94
HCC68 Paraplegia 504 3.94
HCC69 Spinal Cord Disorders/
Injuries 504 3.94
HCC70 Muscular Dystrophy 504 3.94
HCC71 Polyneuropathy 504 3.94
HCC72 Multiple Sclerosis 504 3.94
HCC73 Parkinson's and Huntington's
Diseases 504 3.94
HCC74 Seizure Disorders and
Convulsions 504 3.94
HCC75 Coma, Brain Compression/
Anoxic Damage 504 3.94 C2
HCC77 Respirator Dependence/
Tracheostomy Status 7,259 8.19
HCC78 Respiratory Arrest 7,259 8.19
HCC79 Cardio-Respiratory Failure
and Shock 1,481 4.31
HCC80 Congestive Heart Failure 903 4.16
HCC81 Acute Myocardial Infarction 1,476 5.75
HCC82 Unstable Angina and Other
Acute Ischemic Heart
Disease 1,476 5.75
HCC83 Angina Pectoris/Old
Myocardial 1,476 5.75
Infarction
HCC92 Specified Heart Arrhythmias 961 4.62
HCC95 Cerebral Hemorrhage 774 4.01
HCC96 Ischemic or Unspecified
Stroke 774 4.01
HCC100 Hemiplegia/Hemiparesis 504 3.94
HCC101 Cerebral Palsy and Other
Paralytic Syndromes 504 3.94 C2
HCC104 Vascular Disease with
Complications 2,612 6.30
HCC105 Vascular Disease 583 3.72
HCC107 Cystic Fibrosis 1,180 4.69
HCC108 Chronic Obstructive Pulmonary
Disease 1,180 4.69
HCC111 Aspiration and Specified
Bacterial Pneumonias 2,377 6.82
HCC112 Pneumococcal Pneumonia,
Empyema, Lung Abscess 2,377 6.82
HCC119 Proliferative Diabetic
Retinopathy and
Vitreous Hemorrhage 5,102 5.46
HCC130 Dialysis Status 15,959 5.82
HCC131 Renal Failure 2,152 6.26
HCC132 Nephritis 2,152 6.26
HCC148 Decubitus Ulcer of Skin 1,628 5.98
HCC149 Chronic Ulcer of Skin, Except
Decubitus 1,346 3.98
HCC150 Extensive Third-Degree
Burns 1,274 3.37
HCC154 Severe Head Injury 1,274 3.37
HCC155 Major Head Injury 1,274 3.37 C3
HCC157 Vertebral Fractures w/o
Spinal Cord Injury 504 3.94 C2
HCC158 Hip Fracture/Dislocation 0 --
HCC161 Traumatic Amputation 1,274 3.37 C3
HCC164 Major Complications of
Medical Care and Trauma 1,347 3.66
HCC174 Major Organ Transplant Status 4,523 11.13
HCC176 Artificial Openings for
Feeding or Elimination 4,523 11.13
HCC177 Amputation Status, Lower
Limb/AmputationComplications 1,274 3.37 C3
Disabled/Disease Interactions
D-HCC5 Disabled Opportunistic
Infections -- --
D-HCC44 Disabled Severe
Hematological Disorders -- --
D-HCC51 Disabled Drug/Alcohol
Psychosis -- --
D-HCC52 Disabled Drug/Alcohol
Dependence -- --
D-HCC107 Disabled Cystic Fibrosis -- --
Disease interactions
INT1 DM-CHF1 1,064 2.91
INT2 DM-CVD -- --
INT3 CHF-COPD 1,906 4.95
INT4 COPD-CVD-CAD -- --
INT5 RF-CHF1 -- --
INT6 RF-CHF-DM1 -- --
NOTES: Beneficiaries with the three-way interaction RF-CHF-DM are
excluded from the two-way interactions DM-CHF and RF-CHF. DM is
diabetes mellitus (HCCs 15-19). CHF is congestive heart failure
(HCC 80). COPD is chronic obstructive pulmonary disease (HCC 108). CVD
is cerebrovascular disease (HCCs 95-96, 100-101). CAD is coronary
artery disease (HCCs 81-83). RF is renal failure (HCC 131). "I" means
coefficients of HCCs are constrained to be equal. C1, C2, and C3 denote
non-contiguous constraints.
SOURCE: Pope, G.C. and Kautter, J., RTI International, Ellis, R.P. and
Ash, A.S., Boston University, Ayanian, J.Z., Harvard Medical School and
Brigham and Women's Hospital, lezzoni, L.I., Harvard Medical School and
Beth Israel Deaconess Medical Center, Ingber, MA., Levy, J.M., and
Robst, J., Centers for Medicare 8 Medicaid Services, Analysis of
1999-2000 Medicare 5% Standard Analytic File (SAF).
Table 3
Descriptive Statistics for Community and Institutionalized
Residents
Community
Mean
Annualized Predictive
Variable Observations Expenditures Ratio (1)
Overall 1,291,308 5,213 0.99
Demographics
Female
0-34 Years 7,007 3,623 1.00
35-44 Years 15,566 4,332 1.00
45-54 Years 22,077 4,692 1.00
55-59 Years 14,023 5,254 1.00
60-64 Years 15,793 5,993 1.00
65-69 Years 129,970 3,714 1.00
70-74 Years 171,775 4,372 1.00
75-79 Years 157,586 5,260 1.00
80-84 Years 111,303 6,101 0.99
85-89 Years 66,301 6,882 0.97
90-94 Years 26,852 7,606 0.92
95 Years or Over 8,074 7,338 0.83
Male
0-34 Years 10,272 2,868 1.00
35-44 Years 22,913 3,666 1.00
45-54 Years 29,377 3,968 1.00
55-59 Years 16,391 4,651 1.00
60-64 Years 18,581 5,214 1.00
65-69 Years 105,856 4,018 1.00
70-74 Years 128,874 5,014 1.00
75-79 Years 106,402 6,207 1.00
80-84 Years 64,263 7,083 1.00
85-89 Years 30,765 8,144 0.99
90-94 Years 9,343 8,731 0.97
95 Years or Over 1,944 9,062 0.92
Medicaid 196,604 6,523 0.97
Originally-Disabled 81,894 7,614 0.99
Institutional
Mean
Annualized Predictive
Variable Observations Expenditures Ratio (1)
Overall 65,593 8,937 1.12
Demographics
Female
0-34 Years 49 9,251 0.99
35-44 Years 199 9,395 0.94
45-54 Years 473 8,869 1.07
55-59 Years 343 10,168 0.91
60-64 Years 501 9,906 1.04
65-69 Years 1,380 10,961 0.99
70-74 Years 3,098 10,901 0.97
75-79 Years 6,260 9,458 1.08
80-84 Years 9,801 8,797 1.13
85-89 Years 12,294 8,054 1.19
90-94 Years 9,535 7,146 1.29
95 Years or Over 4,729 5,734 1.42
Male
0-34 Years 106 10,622 0.95
35-44 Years 384 9,596 0.92
45-54 Years 606 10,186 0.91
55-59 Years 438 10,340 0.96
60-64 Years 588 10,486 1.00
65-69 Years 1,132 12,432 0.88
70-74 Years 1,921 11,501 0.99
75-79 Years 2,842 11,411 1.04
80-84 Years 3,404 11,049 1.06
85-89 Years 3,116 10,754 1.08
90-94 Years 1,783 9,489 1.20
95 Years or Over 611 8,096 1.37
Medicaid 33,074 8,895 1.17
Originally-Disabled 7,415 10,606 1.11
(1) Ratio of mean expenditures predicted by the Centers for Medicare
& Medicaid Services--Hierarchical Condition Categories (CMS-HCC) model
for combined community/institutional samples to mean actual
expenditures.
SOURCE: Pope, G.C. and Kautter, J., RTI International, Ellis, R.P
and Ash, A.S., Boston University, Ayanian, J.Z., Harvard Medical
School and Brigham and Women's Hospital, lezzoni, L.I., Harvard
Medical School and Beth Israel Deaconess Medical Center, Ingber,
M.J., Levy, J.M., and Robst, J., Centers for Medicare & Medicaid
Services, Analysis of 1999-2000 Medicare 5% Standard Analytic
File (SAF).
Table 4
Descriptive Statistics for New and Continuing Medicare Enrollees (1)
New Enrollees (2) Continuing Enrollees (3)
Mean Mean
Age/Sex Annualized Annualized
Category Observations Expenditures Observations Expenditures
Female
0-34 Years 2,540 3,532 7,037 3,653
35-44 Years 3,685 4,341 15,717 4,385
45-54 Years 5,891 4,814 22,431 4,767
55-59 Years 4,029 4,903 14,277 5,354
60-64 Years 3,310 5,705 16,159 6,094
65 Years 58,946 2,729 3,336 6,952
66 Years 1,448 3,319 29,534 3,401
67 Years 845 3,349 31,560 3,684
68 Years 531 3,116 32,578 3,740
69 Years 504 3,608 33,893 3,905
70-74 Years 1,311 4,672 173,829 4,461
75-79 Years 471 5,063 161,843 5,387
80-84 Years 200 6,043 118,144 6,276
85-89 Years 95 8,111 75,186 7,035
90-94 Years 46 5,931 34,135 7,500
95 Years or
Over 15 6,457 11,886 6,795
Male
0-34 Years 3,434 3,089 10,342 2,934
35-44 Years 4,281 3,690 23,172 3,746
45-54 Years 5,820 4,099 29,814 4,074
55-59 Years 4,120 4,603 16,677 4,772
60-64 Years 4,196 4,775 18,986 5,346
65 Years 46,262 2,900 3,940 6,055
66 Years 1,546 3,205 24,472 3,644
67 Years 872 2,976 25,279 3,933
68 Years 570 3,501 25,915 4,145
69 Years 490 3,638 27,009 4,295
70-74 Years 1,223 5,700 130,148 5,087
75-79 Years 429 6,476 108,214 6,307
80-84 Years 144 5,916 66,505 7,231
85-89 Years 63 8,028 32,848 8,326
90-94 Years 19 13,027 10,601 8,827
95 Years or
Over 2 3,221 2,420 8,867
(1) Aged and disabled beneficiaries. Excludes working aged and
ESRD beneficiaries.
(2) Enrollees with less than 12 months of base year eligibility.
(3) Enrollees with 12 months of base year eligibility.
SOURCE: Pope, G.C. and Kautter, J., RTI International, Ellis, R.P.
and Ash, A.S., Boston University, Ayanian, J.Z., Harvard Medical School
and Brigham and Women's Hospital, lezzoni, L.I., Harvard Medical School
and Beth Israel Deaconess Medical Center, Ingber, M.J., Levy, J.M., and
Robst, J., Centers for Medicare & Medicaid Services, Analysis of
1999-2000 Medicare 5% Standard Analytic File (SAF).
Find Research Guides for:
Find Featured Titles for: Home & Garden
Most Popular Articles in Health
- Fuel your workout: exercisers who eat before they work out have more energy ...
- Soothe a dry, itchy scalp: 5 easy expert solutions
- Cocktails and calories: Beer, wine and liquor calories can really add up. ...
- The sour truth about apple cider vinegar - evaluation of therapeutic use
- The, six best supplements you've never heard of: these secret weapons can ...
- More »