Dear Readers,
It has been my pleasure over the last 4 years to blog on HCC-related topics and exchange ideas with many of you. I have learned a ton from everyone.
This is my last post and I anticipate retiring the blog by the end of the month. Please grab any content that might be useful and feel free to use it as needed.
Happy and Successful 2012 to all!
Regards,
Matt
For anyone wanting to do a deeper dive into the history of the methodology of the CMS HCC risk model, here is Greg Pope’s recent evaluation of the model.
Mr. Pope is the Director of Health Care Financing and Payment Program at RTI International. He was one of the principal architects of the original DCG/HCC model which used 189 condition categories (and you thought 70 HCCs was alot), from which CMS created a simplified model with 70 HCCs.
A key point in the paper that many forget is that the CMS HCC model is not intended to predict individual costs, rather has been calibrated to predict costs at a group level.
Here is the pdf: Evaluation_Risk_Adj_Model_2011
Any confusion surrounding ICD-9 code 412 for Old Myocardial Infarction is likely related to CMS’ decision to delay the revision of the HCC model until 2012. CMS had given guidance that the model revision would start in 2011, but the 2011 CY Announcement stated that this would be postponed until 2012. So, therefore, ICD-9 412 still maps to HCC 83 for now.
Here is the proposed new model for 2012, new HCCs on the right are bolded, substantially revised HCCs are italicized. In the document, you will see that HCC 83 gets changed to Respiratory Arrest.
