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HCC Suspecting

Code

The HCC Suspecting data mart identifies patients who are suspected to have an HCC in the payment year but don't presently have one recorded based concepts that evaluate historical conditions and problems, comorbidities, lab test results, medications, and observations.

The 2024 CMS HCC model has 115 HCCs. Each condition category requires suspecting logic definitions. So far, we have built out the logic for the following conditions:

  • Chronic Kidney Disease
    • 326, ”Chronic Kidney Disease, Stage 5”
    • 327, "Chronic Kidney Disease, Severe (Stage 4)"
    • 328, "Chronic Kidney Disease, Moderate (Stage 3B)"
    • 329, "Chronic Kidney Disease, Moderate (Stage 3, Except 3B)"
  • Depression
    • 155, "Major Depression, Moderate or Severe, without Psychosis"
  • Diabetes
    • 37, "Diabetes with Chronic Complications"
  • Morbid Obesity
    • 48, ”Morbid Obesity”

The terminology set SNOMED-CT to ICD-10-CM Map is used to capture additional suspecting conditions coded in a system not part of the CMS HCC model. This use case follows the default mapping guidance from NLM, which specifies that the map priority rule of “TRUE” or “OTHERWISE TRUE” should be applied if nothing further is known about the patient’s condition.

Data Requirements​

This data mart uses the following tables from the Tuva Core Data Model:

  • condition
  • lab_result
  • medication
  • observation
  • patient
  • pharmacy_claim

Check out the DAG to see the list of fields used from each core table.

Note: The Tuva Project will generate these Core tables. You just need to map your data to the input layer and run the project.

Running the Data Mart​

# Runs all marts
dbt build

# Runs only the HCC Suspecting mart
dbt build --select tag:hcc_suspecting

Data Mart Structure​

Staging

The staging tables show what tables and fields are used from the Core data model.

Intermediate

The intermediate tables contain the mapping and suspecting logic.

Final

The final tables include an actionable list of all patients with suspecting HCCs and a summary.

  • List: The list of suspecting conditions per patient, data_source, hcc, and diagnosis code with the reason and contributing factors.
  • List Rollup: The list of suspecting conditions per patient and hcc with the latest contributing factor rolled up.
  • Summary: A summary of suspecting conditions per patient.

list​

This final model displays the list of suspecting conditions per patient with the reason and contributing factors.

ColumnData TypeDescriptionTerminology

list_rollup​

This final model displays the list of suspecting conditions per patient and hcc with the latest contributing factor rolled up.

ColumnData TypeDescriptionTerminology

summary​

This final model displays a rollup of suspecting conditions per patient.

ColumnData TypeDescriptionTerminology