Medicare Population End Stage Renal Disease Rate Dialysis

$79 / year

The dataset Medicare population ESRD Rate Dialysis deals with medicare payment rates for dialysis for 2017 calculated from the rates of 2010-2014.

Complexity

Average Per Capita Cost methodology (AAPCC) are five-year moving averages of per beneficiary spending at the county level for fee-for-service Medicare. Medicare’s costs in paying claims for beneficiaries with end-stage renal disease (ESRD) were not considered in these county estimates. ESRD enrollees are handled on a statewide basis. The direct link between AAPCCs and payments created perceptions of geographic inequity as plans were more likely to serve counties with high AAPCCs and typically offered more comprehensive benefits than fee-for service Medicare or counties with lower rates. The CMS-HCC ESRD model is based on the CMS-HCC model for aged/disabled beneficiaries: it uses the same HCCs and therefore retains the characteristics of the CMS-HCC model. The coefficients differ as they are estimated for the ESRD dialysis and transplant populations, which have different costs for their Part A and B benefits and different cost patterns among the various diagnoses. The following are the segments of the ESRD model: Dialysis, Transplant, and Post-Graft/Functioning Graft.

For the years after 2004, the Secretary of Health and Human Services is required to recalculate 100 percent of the fee-for-service Medicare costs at least every three years – so that at least every three years the Medicare Advantage (MA) capitation rate will be the higher of the fee-for-service rate and the minimum increase rate. CMS has implemented a number of changes in the Medicare Advantage payment methodology beginning in CY2012 as a result of payment changes enacted in the Affordable Care Act, including: a new blended benchmark as the county rate; the new methodology used to derive the new blended benchmark county rates; identify the qualifying bonus counties; how to determine transitional phase-in periods; and the applicability of the star system in the rebates. Key components of the 2017 Medicare Advantage rates include: Revision to the risk-adjustment model to better account for fully dual eligible beneficiaries, Adjustment to certain measures within the Star Ratings program for socioeconomic status, Update to the blended risk scores using 75 percent of the risk score calculated using data from the Risk Adjustment Processing System (RAPS) and 25 percent of the risk score calculated using encounter data and Incentives to Medicare Advantage organizations to offer plans with lower maximum out-of-pocket limits.

Date Created

2016-04-04

Last Modified

2016-08-01

Version

2016-08-01

Update Frequency

Annual

Temporal Coverage

2010-2014

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare Payments, Medicare rates, FFS rate, Medicare risk Score, Prescription drug plan, PACE, ESRD, Advantage payment rate

Other Titles

Medicare End Stage Renal Disease Rate Dialysis 2017, Medicare Population End Stage Renal Disease Rate for Dialysis 2017, Medicare ESRD Dialysis payment Rate for Dialysis from 2010-2014.

Name Description Type Constraints
State_CodeState code to which ESRD dialysis rate is calculatednumberlevel : Ratio
County_CodeCounty code to which ESRD dialysis rate is calculatedstringmaxLength : 5
StateName of state to which ESRD dialysis rate is calculatedstringmaxLength : 2
CountyCounty Name to which ESRD dialysis rate is calculatedstringmaxLength : 21
Dialysis_Rate_Before_IME_DeductionRate for dialysis before indirect medical education. Indirect medical education (IME) costs are additional patient care costs associated with the training of interns and residents. While the direct costs of graduate medical education (GME) are computed from the hospitals’ accounting records, the indirect costs of IME are estimated statistically. IME Phase-out represents phase-out of the incremental payments for Indirect Medical Education (IME) that resulted from including incremental amounts in both the health plans’ premium payments from CMS and the payments made directly to such hospitals by CMSnumberlevel : Ratio
IME_FactorIndirect medical education factor. Indirect medical education (IME) costs are additional patient care costs associated with the training of interns and residents. While the direct costs of graduate medical education (GME) are computed from the hospitals’ accounting records, the indirect costs of IME are estimated statistically. IME Phase-out represents phase-out of the incremental payments for Indirect Medical Education (IME) that resulted from including incremental amounts in both the health plans’ premium payments from CMS and the payments made directly to such hospitals by CMSnumberlevel : Ratio
IME_Phase_Out_FactorIndirect medical education phase out payment factor. Indirect medical education (IME) costs are additional patient care costs associated with the training of interns and residents. While the direct costs of graduate medical education (GME) are computed from the hospitals’ accounting records, the indirect costs of IME are estimated statistically. IME Phase-out represents phase-out of the incremental payments for Indirect Medical Education (IME) that resulted from including incremental amounts in both the health plans’ premium payments from CMS and the payments made directly to such hospitals by CMSnumberlevel : Ratio
IME_Phase_Out_AmountIndirect medical education phase out amount. Indirect medical education (IME) costs are additional patient care costs associated with the training of interns and residents. While the direct costs of graduate medical education (GME) are computed from the hospitals’ accounting records, the indirect costs of IME are estimated statistically. IME Phase-out represents phase-out of the incremental payments for Indirect Medical Education (IME) that resulted from including incremental amounts in both the health plans’ premium payments from CMS and the payments made directly to such hospitals by CMSnumberlevel : Ratio
Dialysis_Rate_Before_User_Fee_Deduction2017 Dialysis Rate before $5.25 user fee deductionnumberlevel : Ratio
Dialysis_Rate_After_User_Fee_Deduction2017 Dialysis Rate after $5.25 user fee deductionnumberlevel : Ratio
YearState_FIPS_CodeCounty_FIPS_CodeState_AbbreviationCountyDialysis_Rate_Before_IME_DeductionIME_FactorIME_Phase_Out_FactorIME_Phase_Out_AmountDialysis_Rate_Before_User_Fee_DeductionDialysis_Rate_After_User_Fee_Deduction
201964AS4704.520.0083139.274665.254660
201864AS5063.510.0054127.115036.45031.15
201764AS5073.320.0044122.515050.815045.56
20171010020FLBay6926.240.0086159.2468676861.75
20171010350FLLee6926.240.0086159.2468676861.75
20181616460IAIda6225.990.01731107.9961186112.75
20181616550IALee6225.990.01731107.9961186112.75
20181616800IASac6225.990.01731107.9961186112.75
20184949520VALee6810.270.01531104.026706.256701
20185353140WYPark6762.690.0099166.6966966690.75