2016
Rethinking Medicare Payment Adjustments for Quality
Averill RF, Fuller RL, McCullough EC, Hughes JS. Rethinking Medicare Payment Adjustments for Quality. Journal Of Ambulatory Care Management 2016, 39: 98-107. PMID: 26945288, PMCID: PMC4870963, DOI: 10.1097/jac.0000000000000137.Peer-Reviewed Original Research
2011
Paying for Outcomes, Not Performance: Lessons from the Medicare Inpatient Prospective Payment System
Averill RF, Goldfield N, Hughes J. Paying for Outcomes, Not Performance: Lessons from the Medicare Inpatient Prospective Payment System. The Joint Commission Journal On Quality And Patient Safety 2011, 37: 184-192. PMID: 21500719, DOI: 10.1016/s1553-7250(11)37023-7.Peer-Reviewed Original Research
2009
Hospital Complications: Linking Payment Reduction to Preventability
Averill R, Goldfield N, Hughes J, McCullough EC. Hospital Complications: Linking Payment Reduction to Preventability. The Joint Commission Journal On Quality And Patient Safety 2009, 35: 283-285. PMID: 19480383, DOI: 10.1016/s1553-7250(09)35040-0.Peer-Reviewed Original Research
2004
Clinical Risk Groups (CRGs)
Hughes JS, Averill RF, Eisenhandler J, Goldfield NI, Muldoon J, Neff JM, Gay JC. Clinical Risk Groups (CRGs). Medical Care 2004, 42: 81-90. PMID: 14713742, DOI: 10.1097/01.mlr.0000102367.93252.70.Peer-Reviewed Original ResearchMeSH KeywordsCapitation FeeChronic DiseaseConcurrent ReviewDiagnosis-Related GroupsForecastingHealth Services Needs and DemandHealth Services ResearchHumansInsurance Claim ReviewInsurance, HealthMedicaidMedicareProgram DevelopmentReimbursement MechanismsRisk AdjustmentSeverity of Illness IndexUnited States
1999
The Prospective Risk Adjustment System
Goldfield N, Averill R, Eisenhandler J, Hughes J, Muldoon J, Steinbeck B, Bagadia F. The Prospective Risk Adjustment System. Journal Of Ambulatory Care Management 1999, 22: 41-52. PMID: 10387584, DOI: 10.1097/00004479-199904000-00005.Peer-Reviewed Original ResearchConceptsRisk of mortalityEpisodes of illnessEpisode of careHealth care costsHealth care servicesPatient characteristicsFuture health care costsClinical episodesMedical historyDuration of serviceCare costsCare servicesClassification systemProvider profilingRisk adjustment systemSpecific diseasesEpisodesRisk adjustersIllnessMortalityDiseaseSeverityCare