Title: The Effect of Patient Dementia on Outpatient Clinicians’ Performance on Cost Outcomes Under Medicare Value-Based Payment
Project Summary: The Medicare program is implementing value-based payment (VBP), in which outpatient clinicians are paid based on the quality and cost of the care they deliver. However, there is increasing concern these VBP programs may not accurately measure performance among clinicians who serve high-risk patient populations, particularly those with Alzheimer’s disease and related dementias (hereafter “dementia”). This could result in systematic under-estimation of performance for clinicians that disproportionately serve patients with dementia. The objectives of this project are to: 1) validate the adequacy of claims-based measures of dementia; 2) evaluate the performance of a claims-based costs of care model that includes dementia by adding it to the standard CMS-HCC risk model; and 3) demonstrate the effects of our new model versus the standard CMS-HCC model on clinicians’ relative performance on cost measures in MIPS and the program more broadly.
Funding Organization: National Institute on Aging
Project Start Date: September 15, 2020
Project End Date: Ongoing
Principal Investigator: Kenton J. Johnston
Co-investigators: Karen E. Joynt Maddox, Travis Loux
Publications:
- Johnston KJ, Loux T, Joynt Maddox KE. Diagnosis and treatment for Alzheimer disease among Medicare beneficiaries in Shared Savings Program accountable care organizations vs standard care in Medicare Part B. Academy Health Annual Research Meeting; June 2022.
- Johnston KJ, Loux T, Joynt Maddox KE. Risk selection and care fragmentation at Medicare accountable care organizations for patients with dementia. Med Care. 2023 Aug 1;61(8):570-578. doi: 10.1097/MLR.0000000000001876. Epub 2023 Jun 13. PMID: 37411003; PMCID: PMC10328553.