How do we address providers’ concerns about whether risk adjustment adequately captures the severity of illness of their patients?
Providers who treat a larger proportion of higher risk or less adherent patients may receive lower ratings on process and outcome measures, despite making equal efforts to practice high-quality care. Thus, providers legitimately want to make sure that a P4P program accounts fairly for patient differences. Risk adjustment models to correct patient outcome estimates (usually mortality rates) for underlying differences in patient populations have been under development for many years.19,41 Nonetheless, providers worry about the adequacy of risk adjustment.18,38,44 Furthermore, refusal to address such concerns may threaten the legitimacy and sustainability of any incentive program.10,45-47 Risk adjustment is generally less effective when administrative data are used because detailed clinical information (e.g., blood pressure) is typically unavailable. Analysts have shown, however, that in some cases the addition of a few simple clinical variables to administrative data would be sufficient
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