Clinical Conditions Factors

Clinical Conditions are elements of the clinical factors in patient recovery. Medicare has developed a model to categorize the clinical conditions factors in order to risk risk adjust health insurers that are covering patients. The CMS-HCC Risk Adjustments model adjust for patient demographics (i.e., age, disabled) and disease (i.e., diabetes, congested heart failure).

Behavioral Health

• Addictions
• Behavioral Disorders (depression, anxiety disorders, schizophrenia, bipolar etc.)
• Substance Abuse

Comorbidities

Comorbidities are chronic disorders (or diseases) that need to be managed. Most comorbidities do not get cured. Comorbidities include behavioral or mental disorders.

• Alzheimer's disease
• Arthritis
• Asthma
• Cancer
• COPD
• Diabetes
• Congestive Heart Failure
• High Blood Pressure
• High Cholesterol
• Obesity
• Osteoporosis
• Stroke

Demographics

• Age
• Sex
• Disabled
• Long Term Institutional Status (LTI Designated Status)

Immunizations

• Flu
• Tetanus

Impairments

• Cognitive Impairments (Delirium "confused state", Dementia)
• Developmental Challenges (Autism)
• Physical Impairments (Use of limbs, arthritis, amputation, birth defects, Epilepsy)
• Sensory Impairments (Blind or Visually Impaired, Deaf or Hard of Hearing, loss of taste and smell)

Medical History

• Adverse events
• Family Medical History
• Medical Conditions
• Surgeries

Physiological Metrics

• Blood glucose level
• Blood pressure
• Cholesterol level (HDL, LDL, etc)
• Heart rate

Problem lists

• Abdominal pain
• Acute asthma
• Chest Pain
• Fever
• Fractures
• Headache
• Pain (Chest Pain)
• Rash or skin infection
• Shortness of Breath
• Sprains
• Upper respiratory tract infection
• Wounds