By James S. Kennedy, MD, CCS, CDIP
Although most physicians have heard of DRGs with inpatient admissions, only those invested in accountable care organizations and independent practice associations are likely familiar with HCCs. Based on ICD-9-CM codes submitted by physicians or hospitals in a calendar year for documented diagnoses requiring assessment, management, or treatment, HCCs will significantly change in 2014 with additions and deletions as well as relative weight changes.
One of the goals of the Patient Protection and Affordable Care Act (PPACA) is to encourage provider efficiency, defined by CMS as a ratio of observed to expected costs and outcomes for selected populations.
To this end, CMS is developing efficiency measurement metrics that will influence reimbursement and may be reported on its Physician Compare website (http://tinyurl.com/ mnq89rh).