Fierce Healthcare September 11, 2018
Eli Richman

Functional status, such as whether a patient is able to bathe or dress themselves, makes a big difference in that patient’s estimated healthcare spending.

The Government Accountability Office flirted with the idea of requiring functional status information—such as whether patients could independently perform routine tasks such as bathing or dressing—in Medicare Advantage’s risk adjustment models.

The reason? MA’s risk adjustment models often underestimate spending for those with physical limitations while overestimating spending for those without such limitations.

But, recognizing the difficulty of collecting this information about patients in the program, the GAO ultimately stopped short in its report released Monday of actually recommending that the Centers for Medicare and Medicaid Services (CMS) do anything about taking that information into...

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Topics: CMS, GAO, Govt Agencies, Health System / Hospital, Insurance, Market Research, Medicare Advantage, Patient / Consumer, Physician, Primary care, Provider, Trends
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