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  1. FHIR Specification Feedback
  2. FHIR-34773

" Hierarchical Condition Categories (HCCs) with less severe HCCs superseded (ignored) if evidence of higher severity HCCs is present" statement is not accurate description.

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Highest Highest
    • US Da Vinci Risk Adjustment (FHIR)
    • 0.1.0 [deprecated]
    • Clinical Quality Information
    • Da Vinci Risk Adjustment Implementation Guide Home Page
    • 1.3.2 Moddel Hierarchies
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      When a disease hierarchy is applied it assigns Condition Categories (CCs) into Hierarchical Condition Categories (HCCs) with less severe HCCs superseded (dropped) if evidence of higher severity HCCs is present. Since different HCCs have impact upon total risk assessment, they should be maintained. For example, the combination of a new diagnosis of major depression to an existing diagnosis of non-insulin dependent diabetes may increase total risk by more than the sum of the individual category risk assignments."

      In addition, we will update the IG, where CC or CCs are used, we will udpate it to use Condition Category (CC) or Condition Categories (CCs), so this would not be confused with Chief Complaints (CCs).

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      When a disease hierarchy is applied it assigns Condition Categories (CCs) into Hierarchical Condition Categories (HCCs) with less severe HCCs superseded (dropped) if evidence of higher severity HCCs is present. Since different HCCs have impact upon total risk assessment, they should be maintained. For example, the combination of a new diagnosis of major depression to an existing diagnosis of non-insulin dependent diabetes may increase total risk by more than the sum of the individual category risk assignments." In addition, we will update the IG, where CC or CCs are used, we will udpate it to use Condition Category (CC) or Condition Categories (CCs), so this would not be confused with Chief Complaints (CCs).
    • Yan Heras/Floyd Eisenberg: 17-0-1
    • Clarification
    • Non-substantive

    Description

      "When a disease hierarchy is applied it changes CCs into Hierarchical Condition Categories (HCCs) with less severe HCCs superseded (ignored) if evidence of higher severity HCCs is present."  This is not quite accurate since risk assessment and risk prediction would supercede conditions in the same category set but not ignore other categories.  For example insulin dependent diabetes would supercede non-insulin dependent diabetes (NIDDM); however, the addition of non-insulin dependent diabetes would not ignore the condition of depression.  In fact, as I recall, a HCC example from some years ago was that NIDDM plus depression HCC categories had approximately four times the annual coverage cost compared to the same NIDDM classification without depression.  Recommend clarification for those entering this aspect of healthcare.

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            lmichaelsen Linda Michaelsen
            peter.muir Peter Muir
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