Table 3.
Effect on apparent mortality and Medicare spending of four methods of risk adjustment in regions ranked into fifths according to mean number of physician visits in last six months of life
| Variables | Fifths of visits (95% CI), % change* | Ratio highest to lowest fifth | ||||
|---|---|---|---|---|---|---|
| 1st (lowest) | 2nd | 3rd | 4th | 5th (highest) | ||
| Visits per decedent | 18.0 | 23.6 | 26.8 | 31.2 | 43.9 | 2.43 |
| Effect on mortality: | ||||||
| ASR adjustment only | 51.0 (50.6 to 51.4) | 54.0 (53.6 to 54.4) | 53.1 (52.7 to53.6) | 53.1 (52.7 to 53.5) | 50.0 (49.5 to 50.4) | 0.98 |
| ASR HCC adjustment | 57.2 (56.8 to 57.6), 12.1 | 55.3 (54.9 to 55.6), 2.4 | 53.1 (52.7 to 53.5), −0.1 | 51.2 (50.8 to 51.6), −3.6 | 44.7 (44.3 to 45.1), −10.5 | 0.78 |
| ASR visit corrected HCC adjustment | 51.8 (51.4 to 52.2), 1.5 | 52.6 (52.2 to 53.0), −2.5 | 52.1 (51.7 to 52.5), −2.0 | 52.4 (52.0 to 52.8), −1.4 | 52.2 (51.8 to 52.6), 4.5 | 1.01 |
| ASR poverty adjustment | 50.8 (50.4 to 51.3), −0.4 | 53.7 (53.3 to 54.2), −0.5 | 53.2 (52.8 to 53.7), 0.2 | 53.3 (52.8 to 53.7), 0.2 | 50.4 (49.9 to 50.8), 0.8 | 0.99 |
| ASR population health adjustment | 52.1 (51.6 to 52.5), 2.1 | 52.1 (51.6 to 52.5), −3.5 | 51.9 (51.5 to 52.4), −2.3 | 52.6 (52.2 to 53.0), −1.0 | 52.4 (51.9 to 52.8), 4.9 | 1.01 |
| Effect on spending: | ||||||
| ASR price adjustment only | $7228 (7195 to 7262) | $8227 (8193 to 8260) | $8498 (8464 to 8531) | $8878 (8844 to 8912) | $9572 (9539 to 9605) | 1.32 |
| ASR price HCC adjustment | $8153 (8129 to 8177), 12.8 | $8419 (8395 to 8443), 2.3 | $8492 (8468 to 8516), -0.1 | $8595 (8571 to 8619), -3.2 | $8782 (8759 to 8805), -8.3 | 1.08 |
| ASR price visit corrected HCC | $7342 (7318 to 7366), 1.6 | $8027 (8003 to 8051), −2.4 | $8337 (8314 to 8361), −1.9 | $8767 (8743 to 87891), −1.3 | 9910 (9886 to 9933), 3.5 | 1.35 |
| ASR price poverty | $7172 (7138 to 7206), −0.8 | $8144 (8111 to 8178), −1.0 | $8464 (8430 to 8498), −0.4 | $8851 (8817 to 8885), −0.3 | $9565 (9532 to 9598), −0.1 | 1.33 |
| ASR price population health adjustment | $7372 (7337 to 7407), 2.0 | $8019 (7985 to 8053), −2.5 | $8341 (8307 to 8375), −1.8 | $8819 (8785-8853), −0.7 | $9837 (9802 to 9872), 2.8 | 1.33 |
$1.00 (£0.60; €0.72).
ASR=age, sex, and race; HCC=Hierarchical Condition Categories.
*Percent change from ASR adjusted mortality or spending.