In the Part 1 edition of the 4-part series, we discussed the changes in demographic rates and the first 7 groupings of the V28 hierarchies. In this Part 2 edition of the 4-part series, we will examine the changes in the disease + disease interaction modifiers and cover the next 7 groupings.
Taking care of a patient with multiple conditions is more expensive and difficult than taking care of patients with fewer conditions. Medicare recognizes this and includes an additional RAF value addition for patients that have certain combinations of HCCs. For example: if a patient is coded with diabetes and CHF, an additional modifier is added to the RAF score. Although HCCs were rearranged into new categories, all of the interaction categories from V24 are still present in V28, with one exception: immune disorders + cancer. The interaction of immune disorders and cancer has been eliminated, which traditionally added an additional RAF of 0.6-0.8 to each patient. Looking at the values of the interaction categories, the value of most groups decreased by 12% – 70%. Notably, two particular groupings had substantial increases and deviated from the other trends. These are the interaction of CHF and diabetes and the interaction between CHF and arrhythmias in the ‘partially dual-eligible aged’ population, with an increase of 31% and 25%, respectively.
In the Part-1 of the 4 Part Series, we covered the HCCs in the groupings for Infections Diseases, Neoplasms, Diabetes, Metabolic Diseases, Liver Diseases, Gastrointestinal Diseases, and Musculoskeletal diseases. In this part-2 of the series, we will cover the next 7 groupings, Blood Diseases to Arrest Diseases.