Difference between revisions of "CMS-HCC Disease Coefficients"

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Revision as of 13:36, 10 March 2014

These are the disease coefficients component of the CMS-HCC Risk Adjustments

The relative risk scores in this table were calculated by dividing the parameter estimates by the Part C national average predicted expenditures (CMS Part C Denominator). The Part C Denominator value used is $8,034.71.

Disease Coefficients Description Label Community Factor Institutional Factor
HCC1 HIV/AIDS 0.492 1.374
HCC2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock 0.520 0.471
HCC6 Opportunistic Infections 0.557 0.541
HCC8 Metastatic Cancer and Acute Leukemia 2.425 0.928
HCC9 Lung and Other Severe Cancers 1.006 0.610
HCC10 Lymphoma and Other Cancers 0.695 0.363
HCC11 Colorectal, Bladder, and Other Cancers 0.330 0.255
HCC12 Breast, Prostate, and Other Cancers and Tumors 0.180 0.165
HCC17 Diabetes with Acute Complications 0.344 0.434
HCC18 Diabetes with Chronic Complications 0.344 0.434
HCC19 Diabetes without Complications 0.124 0.187
HCC21 Protein-Calorie Malnutrition 0.653 0.343
HCC22 Morbid Obesity 0.342 0.353
HCC23 Other Significant Endocrine and Metabolic Disorders 0.240 0.248
HCC27 End-Stage Liver Disease 1.003 0.637
HCC28 Cirrhosis of Liver 0.425 0.343
HCC29 Chronic Hepatitis 0.313 0.343
HCC33 Intestinal Obstruction/Perforation 0.337 0.302
HCC34 Chronic Pancreatitis 0.257 0.175
HCC35 Inflammatory Bowel Disease 0.279 0.250
HCC39 Bone/Joint/Muscle Infections/Necrosis 0.423 0.386
HCC40 Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 0.376 0.222
HCC46 Severe Hematological Disorders 1.078 0.638
HCC47 Disorders of Immunity 0.306 0.436
HCC48 Coagulation Defects and Other Specific Hematological Disorders 0.258 0.197
HCC51 Dementia With Complications 0.616 -
HCC52 Dementia Without Complications 0.343 -
HCC54 Drug/Alcohol Psychosis 0.358 0.051
HCC55 Drug/Alcohol Dependence 0.358 0.051
HCC57 Schizophrenia 0.471 0.274
HCC58 Major Depressive, Bipolar, and Paranoid Disorders 0.318 0.274
HCC70 Quadriplegia 1.075 0.497
HCC71 Paraplegia 0.868 0.497
HCC72 Spinal Cord Disorders/Injuries 0.441 0.191
HCC73 Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease 1.016 0.294
HCC74 Cerebral Palsy 0.036 -
HCC75 Polyneuropathy 0.281 0.256
HCC76 Muscular Dystrophy 0.460 0.247
HCC77 Multiple Sclerosis 0.482 -
HCC78 Parkinson's and Huntington's Diseases 0.555 0.110
HCC79 Seizure Disorders and Convulsions 0.252 0.173
HCC80 Coma, Brain Compression/Anoxic Damage 0.533 0.103
HCC82 Respirator Dependence/Tracheostomy Status 1.732 1.567
HCC83 Respiratory Arrest 0.769 0.611
HCC84 Cardio-Respiratory Failure and Shock 0.326 0.346
HCC85 Congestive Heart Failure 0.361 0.226
HCC86 Acute Myocardial Infarction 0.283 0.394
HCC87 Unstable Angina and Other Acute Ischemic Heart Disease 0.283 0.394
HCC88 Angina Pectoris 0.210 0.366
HCC96 Specified Heart Arrhythmias 0.276 0.227
HCC99 Cerebral Hemorrhage 0.371 0.175
HCC100 Ischemic or Unspecified Stroke 0.333 0.175
HCC103 Hemiplegia/Hemiparesis 0.481 0.063
HCC104 Monoplegia, Other Paralytic Syndromes 0.212 0.063
HCC106 Atherosclerosis of the Extremities with Ulceration or Gangrene 1.313 0.773
HCC107 Vascular Disease with Complications 0.417 0.257
HCC108 Vascular Disease 0.288 0.146
HCC110 Cystic Fibrosis 0.388 0.323
HCC111 Chronic Obstructive Pulmonary Disease 0.388 0.323
HCC112 Fibrosis of Lung and Other Chronic Lung Disorders 0.294 0.252
HCC114 Aspiration and Specified Bacterial Pneumonias 0.006 0.610
HCC115 Pneumococcal Pneumonia, Emphysema, Lung Abscess 0.212 0.194
HCC122 Proliferative Diabetic Retinopathy and Vitreous Hemorrhage 0.223 0.366
HCC124 Exudative Macular Degeneration 0.248 0.178
HCC134 Dialysis Status 0.617 0.538
HCC135 Acute Renal Failure 0.617 0.538
HCC136 Chronic Kidney Disease, Stage 5 0.227 0.304
HCC137 Chronic Kidney Disease, Severe (Stage 4) 0.227 0.304
HCC138 Chronic Kidney Disease, Moderate (Stage 3) 0.227 0.304
HCC139 Chronic Kidney Disease, Mild or Unspecified (Stage 1-2 or Unspecified) 0.227 0.304
HCC140 Unspecified Renal Failure 0.227 0.304
HCC141 Nephritis 0.075 0.235
HCC157 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone 1.071 0.284
HCC158 Pressure Ulcer of Skin with Full Thickness Skin Loss 1.071 0.284
HCC159 Pressure Ulcer of Skin with Partial Thickness Skin Loss 1.071 0.284
HCC160 Pressure Pre-Ulcer Skin Changes or Unspecified Stage 1.071` 0.610
HCC161 Chronic Ulcer of Skin, Except Pressure 0.473 0.226
HCC162 Severe Skin Burn or Condition 0.458 -
HCC166 Severe Head Injury 0.533 0.103
HCC167 Major Head Injury 0.141 -
HCC169 Vertebral Fractures without Spinal Cord Injury 0.441 0.179
HCC170 Hip Fracture/Dislocation 0.363 -
HCC173 Traumatic Amputation and Complications 0.379 0.067
HCC176 Complications of Specified Implanted Device or Graft 0.555 0.369
HCC186 Major Organ Transplant or Replacement Status 1.032 1.120
HCC188 Artificial Openings for Feeding or Elimination 0.609 0.658
HCC189 Amputation Status, Lower Limb / Amputation Complications 0.804 0.384
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