RPUPReduction to a Previously Unsolved Problem
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* Adjust the base-year RPUPS to reflect the geographic distribution and health status distribution of Medicare patients seen in the relevant performance year p.
* Inflate the adjusted base-year RPUPS (i.e., BASE) to the performance year p using a population-wide Standard Growth Rate (SGR.sub.j,p]) in Medicare spending per beneficiary, based on beneficiaries' residence locations.
The following sections describe the adjustments to RPUPS, and the standard growth rates.
The observed RPUPS for each year would be compared with the performance standard.
There should be adjustments for differences in the health status distributions of patients seen in the base year and performance year because patient mix is an important determinant of RPUPS. One factor is any change in the relative proportions of aged, disabled, and end stage renal disease (ESRD) patients, which is readily observable.
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.
The organization's target would be 1.05 times its own adjusted base-year RPUPS (i.e., the BASE).
* 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.