Rewarding Provider Performance: Aligning Incentives in Medicare (Pathways to Quality Health Care Series)

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Rewarding Provider Performance: Aligning Incentives in Medicare (Pathways to Quality Health Care Series) (2007)
Board on Health Care Services (HCS)

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. "Appendix D: MEDPAC Data Runs." Rewarding Provider Performance: Aligning Incentives in Medicare (Pathways to Quality Health Care Series). Washington, DC: The National Academies Press, 2007.

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Rewarding Provider Performance: Aligning Incentives in Medicare

TABLE D-1 Number of Beneficiaries and Payments for Beneficiaries in Groups A–G

	(a)	(b)	(c)	(d)	(e)
Group	Number of Beneficiaries	Total Payments (Inpatient, Outpatient, and Carrier)	Total Physician Payments	Total Physician Fee Schedule Payments	Total Physician Fee Schedule Payments with Condition
A—Diabetes, Chronic Heart Failure, & Coronary Artery Disease	33,156	$930,459,017.78	$190,763,248.74	$145,289,007.75	$63,478,717.18
B—Chronic Heart Failure & Coronary Artery Disease; not Diabetes	45,669	$973,068,755.23	$204,803,139.36	$156,203,604.11	$51,811,091.99
C—Chronic Heart Failure & Diabetes; not Coronary Artery Disease	20,084	$343,667,332.55	$77,771,058.17	$57,876,926.78	$17,685,633.11
D—Diabetes & Coronary Artery Disease; not Chronic Heart Failure	52,831	$650,379,010.79	$180,745,583.66	$135,706,435.84	$49,925,585.96
E—Chronic Heart Failure; not Diabetes & Coronary Artery Disease	44,624	$571,843,797.98	$133,677,894.22	$98,210,007.62	$15,564,360.34
F—Coronary Artery Disease; not Diabetes & Chronic Heart Failure	139,998	$1,278,200,988.51	$388,080,620.15	$290,563,134.95	$73,437,377.10
G—Diabetes; not Chronic Heart Failure & Coronary Artery Disease	183,021	$1,010,989,783.78	$358,203,918.84	$254,121,712.13	$58,724,822.67
X—No Condition Category Assigned	1,108,039	$3,659,514,615.32	$1,484,938,239.88	$1,038,689,792.23
Total in Groups	519,383	$5,758,608,686.62	$1,534,045,463.14	$1,137,970,829.18	$330,627,588.35
Total in File	1,627,422	$9,418,123,301.94	$3,018,983,703.02	$2,176,660,621.41	$330,627,588.35
NOTES: Claim lines with invalid provider numbers have been removed from the physician file for all tables. (a) All beneficiaries with at least one claim line with a valid provider number. (b) Payments from the inpatient, outpatient, and carrier file. (c) Carrier file in total, regardless of provider type and fee schedule designation. (d) Carrier file, only payments associated with the fee schedule. (e) Carrier file, payments associated with the fee schedule for the condition associated with the disease group.