Dartmouth: Risk Adjustment Doesn’t Work
The new study by the Dartmouth Atlas Project, published today in the health journal BMJ, faults the practice of trying to assess how sick patients are by looking at records to see patient diagnoses. The authors argue that the more times patients see doctors or get tests, the more new diagnoses they are given. “The more one looks, the more one finds,” the authors wrote….
Medicare risk-adjusts when determining how much to pay private Medicare Advantage insurance plans. It also used risk adjustments when deciding that 2,217 hospitals should be penalized for having high rates of patient readmissions. Risk adjustment is also a key component in new models of delivering care, such as the accountable care organizations….
Without these risk adjustments to level the comparisons, a hospital with more frail and very ill patients—who are more likely to die — might incorrectly appear to be doing a worse job than a hospital with healthier patients — who are more likely to survive.
Kaiser Health News. This is very important. See Linda Gorman’s previous post.
Ugh, I don’t want to live on this planet anymore..
Isn’t risk adjustment basically the same as underwriting?
“faults the practice of trying to assess how sick patients are by looking at records to see patient diagnoses.”
Obviously medical history is important, but I do like the idea of not allowing a doctor skip our on various tests and screenings to find out what is wrong.
The over-diagnosis problem is real but I think it’s a matter of empowering the patient to have more control over his/her health to avoid having to get 5 different diagnoses for perhaps the same sickness.
Risk adjustment is not like having your mechanic inspect a used car prior to a purchase. People who never see the doctor may be in poor health, while those that do may be hypochondriacs. Since doctors are paid by the task, and patients pay little for the care they receive, more exams may lead to more care without necessarily improving their health status.
I look forward to reading the article. I would note, however, that the article uses the Charlson idex as the risk adjuster. Charlson is not calibrated for this purpose, is a very crude tool and is predictive of mortality, not morbidity. There are better (and much more accurate) tools out there.
Ian has a point, but I’m fairly certain that Medicare accounts for Diagnosis-Related Groupers when looking at readmits. I feel that these may be sufficient, even if the Charlson Co-morbidity Index is not.
I could be completely wrong however.