In the CMS-HCC model, which statement about the relative RAF values for Sepsis, Lobar Pneumonia, and COPD is true?

In the CMS-HCC model, which statement about the relative RAF values for Sepsis, Lobar Pneumonia, and COPD is true?

• A. Sepsis has a higher RAF than lobar pneumonia, which is higher than COPD.
• B. Sepsis has a higher RAF than lobar pneumonia, and lobar pneumonia has a higher RAF than COPD.
• C. COPD has a higher RAF than Sepsis.
• D. Lobar pneumonia has the highest RAF of the three.

Answer: (B)

In CMS-HCC, the RAF reflects predicted future healthcare costs, with higher weights given to more severe or costly conditions. Sepsis is a systemic, life-threatening illness that often requires intensive treatment and substantial resources, so it carries a high RAF weight. Lobar pneumonia is serious but typically costs less to manage than sepsis, placing it at a moderate weight. COPD is a chronic condition whose incremental costs are generally lower than those driven by an acute, severe infection, so it has a lower RAF among these three. Therefore, Sepsis > Lobar Pneumonia > COPD is the correct ordering.

In CMS-HCC, the RAF reflects predicted future healthcare costs, with higher weights given to more severe or costly conditions. Sepsis is a systemic, life-threatening illness that often requires intensive treatment and substantial resources, so it carries a high RAF weight. Lobar pneumonia is serious but typically costs less to manage than sepsis, placing it at a moderate weight. COPD is a chronic condition whose incremental costs are generally lower than those driven by an acute, severe infection, so it has a lower RAF among these three. Therefore, Sepsis > Lobar Pneumonia > COPD is the correct ordering.