Evaluating the Role of Past Clinical Information on Risk Adjustment.

Objective: The objective of this study was to evaluate whether incorporating historical clinical information beyond 1 year improves risk adjustment.

Data Sources: Administrative data from the Department of Veterans Affairs and Medicare (for veterans concurrently enrolled in Medicare) for fiscal years (FYs) 2011-2015.

Study Design: We regressed total annual costs on Medicare hierarchical condition category indicators and risk scores for FY 2015 in both a concurrent and a prospective model using 5-fold cross-validation.

Assessment of the Medicare Advantage Risk Adjustment Model for Measuring Veterans Affairs Hospital Performance.

Importance: Policymakers and consumers are eager to compare hospitals on performance metrics, such as surgical complications or unplanned readmissions, measured from administrative data. Fair comparisons depend on risk adjustment algorithms that control for differences in case mix.

Objective: To examine whether the Medicare Advantage risk adjustment system version 21 (V21) adequately risk adjusts performance metrics for Veterans Affairs (VA) hospitals.

Persistence of High Health Care Costs among VA Patients.

Objectives: To examine high-cost patients in VA and factors associated with persistence in high costs over time.

Data Sources: Secondary data for FY2008-2012.

Data Extraction: We obtained VA and Medicare utilization and cost records for VA enrollees and drew a 20 percent random sample (N = 1,028,568).

Case-Mix for Performance Management: A Risk Algorithm Based on ICD-10-CM.

Background: Accurate risk adjustment is the key to a reliable comparison of cost and quality performance among providers and hospitals. However, the existing case-mix algorithms based on age, sex, and diagnoses can only explain up to 50% of the cost variation. More accurate risk adjustment is desired for provider performance assessment and improvement.

PA and NP productivity in the Veterans Health Administration.

This study assessed the 2014 clinical productivity of 5,959 physician assistants (PAs) and nurse practitioners (NPs) in the US Department of Veterans Affairs' Veterans Health Administration (VHA). Total work relative value units divided by the direct clinical full-time equivalent measured annual productivity, and correlated factors were examined using weighted analysis of variance. PAs and NPs in adult primary care roles were more productive than those in other specialties.