Why do my patients cost so much? I showed you the numbers in my MIPS “cost” category which concluded that I spend $58,000 per episode rather than $16,000, which is the average for a family practice doctor. Remember that these costs are being triggered by hospitalizations that probably have nothing to do with the patient’s wound and about which I may even be unaware.
Now look at the Medicare data regarding my Hierarchical Classification Code (HCC).  More than half my patients have chronic kidney disease, half have ischemic heart disease, nearly half have diabetes, 38% have heart failure and more than a quarter have COPD. I have just listed the most expensive conditions for a Medicare beneficiary, and my patients always have at least one of them; most of my patients have two of them.

As a side note, practitioners tell me they see HCC scores > 6 internally computed by their hospital EHR. This is  NOT your actual HCC score – you must get that from CMS.
My HCC score is 3.24, which is about the same as a nephrologist. HCC data are publicly available. Nephrology has one of the highest scores at 4.2 + 1.3.  It’s interesting to note that practitioners who are board certified in Undersea and Hyperbaric Medicine have higher HCC scores than the aggregate data of every doctor in the country who billed the code for chamber supervision (2.63 vs. 2.44). An HCC score of  2.63 is about the same as hematology. Remember that the higher a practitioner’s HCC score, the more CMS “understands” why the practitioner spends so much money to care for a patient – their patients are sicker.

KEY POINT: Practitioners need to understand how to optimize HCC through their documentation, within the applicable rules for doing so.