Medicare Population End Stage Renal Disease Rate Dialysis

$179 / year

The dataset Medicare End-Stage Renal Disease (ESRD) Rate Dialysis deals with Medicare payment rates for dialysis for 2017-2019 calculated from the rates of 2016-2018.

Complexity

The Adjusted Average Per Capita Costs (AAPCCs) are five-year moving averages per beneficiary spending at the county level for fee-for-service Medicare. Medicare’s costs in paying claims for beneficiaries with ESRD were not considered in these county estimates. ESRD enrollees are handled on a state-wide 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 Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) ESRD risk adjustment 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.

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 CMS.

Date Created

2016-04-04

Last Modified

2018-03-30

Version

2018-03-30

Update Frequency

Annual

Temporal Coverage

2016-2019

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 ESRD Population, Medicare ESRD Dialysis Rates, Medicare Fee For Service, Medicare Advantage Plans, Medicare Payments, Medicare Rates, Medicare ESRD, Advantage Payment Rates

Other Titles

Medicare End Stage Renal Disease Rate Dialysis, Medicare Population End Stage Renal Disease Rate For Dialysis, Medicare ESRD Dialysis payment Rate for Dialysis

NameDescriptionTypeConstraints
YearThe year to which the risk score is calculateddate-
State_FIPS_CodeThe 2 digits state Federal Information Processing Standard (FIPS) codestring-
County_FIPS_CodeThe 5 digits county Federal Information Processing Standard (FIPS) codestring-
State_AbbreviationName of state to which ESRD dialysis rate is calculatedstring-
CountyCounty Name to which ESRD dialysis rate is calculatedstring-
Dialysis_Rate_Before_IME_DeductionRate for dialysis before indirect medical educationnumberlevel : Ratio
IME_FactorIndirect medical education factornumberlevel : Ratio
IME_Phase_Out_FactorIndirect medical education phase out payment factornumberlevel : Ratio
IME_Phase_Out_AmountIndirect medical education phase out amountnumber-
Dialysis_Rate_Before_User_Fee_DeductionDialysis Rate before $5.25 user fee deductionnumberlevel : Ratio
Dialysis_Rate_After_User_Fee_DeductionDialysis 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