RPUPReduction to a Previously Unsolved Problem
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The value of RPUPS in the base year, and hence the current performance standard, would be adjusted to reflect expected Medicare costs if the provider had seen the same case mix in the base year as occurred in the performance year.
These adjustments could be accomplished by simulating their effects on the value of RPUPS in the base year.
As with the AAPCC, we would inflate the value of RPUPS in the base year to reflect average growth rates using actual observed growth rates for comparison Medicare FFS populations.
This would be carried out for the base year and again for each performance year, using the proportion of dollars in RPUPS as the weighting factor.
For any year in which RPUPS exceeds the performance standard, the organization would accrue a penalty.
where MS is as defined previously; PCR is the Patient Capture Ratio, which is the sum of all Medicare reimbursements to organization j during the year p for Medicare beneficiaries i included in RPUPS (mrorg), divided by the sum of all Medicare reimbursements to all providers for those beneficiaries, mr:
For patients seen by GVPS groups, the base year RPUPS = $7,000.
Under GVPS, groups realize a one-time, 7 percent reduction in RPUPS that continues to manifest in each performance year.