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Diabetes Mellitus
The following patient types demonstrate the low, high, and very high levels of diabetes mellitus, ADGs, and associated costs.
Patient 1: Lost Cost Patient with Diabetes:
Patient Characteristics
Conditions: Diabetes mellitus and General medical exam
Resource Consumption Variable: Total Cost: $418; Pharmacy Cost: $134
Ambulatory visits: 3; Hospitalization: 0
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Input Data
Age/Sex: 57/Female
ICD9 Codes: 250.02 – diabetes mellitus, type II, w/o complications, uncontrolled IV70 – general medical exam
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ACG Output
ACG: 0900: chronic medical, stable
ADGs: ADG10 - Chronic medical: stable; ADG31- Prevention/administrative
EDCs: ADM04 - Preventive care; END06 - Type 2 diabetes, w/o complication
Cost Estimates:
Concurrent Weight – 0.334
Rub – 2(Low Morbidity)
ACG-PM Scores:
Predicted Resource Index Total Cost: 1.569
Predicted Resource Index Pharmacy Cost: 1.199
Probability High Risk Total Cost: 0.061
Probability High Risk Pharmacy Cost: 0.028
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Patient 2: High Cost Patient with Diabetes
Patient Characteristics
Conditions: Diabetes mellitus, general medical exam, congestive heart failure,
thrombophlebitis, contusions and abrasions, non-fungal infections of skin, disease of nail, chest pain, vertiginous syndromes, fibrositismyalgia, respiratory signs/symptoms, and cough
Resource Consumption Variable: Total cost: $2,122; Pharmacy cost: $1,478; Ambulatory visits: 16; Hospitalizations: 0 |
Input Data
Age/Sex: 54/Female
ICD9 Codes: V70 – general medical exam; 250.02 – diabetes mellitus, type II, w/o complications, uncontrolled; 386.2 - central origin vertigo; 428.0 - congestive heart failure; 453.9 - venous thrombosis NOS; 681.10 - cellulitis, toe NOS; 703.9 - disease of nail NOS; 729.1 - myalgia and myositis NOS; 786.1 – stridor; 786.2 – cough; 786.50 - chest pain NOS; 924.20 - contusion of foot |
ACG Output
ACG: 4930(6-9 other ADG combinations, age >34, 3 major ADGs)
ADGs: ADG0 1 - Time Limited: Minor; ADG0 4 - Time Limited: Major-Primary Infections; ADG0 9 - Likely to Recur: Progressive; ADG 10 - Chronic Medical: Stable; ADG 11 - Chronic Medical: Unstable; ADG 21 - Injuries/Adverse Effects: Minor; ADG 26 - Signs/Symptoms: Minor; ADG 27 - Signs/Symptoms: uncertain; ADG 28 - Signs/Symptoms: Major; ADG 31 - Prevention/Administrative
EDCs: ADM01 – administrative; CAR05 - Congestive heart failure; END06 - Type 2 diabetes, w/o complication; GSI02 - Chest pain; GSU09 - Nonfungal infections of skin and subcutaneous tissue; HEM03 – Thrombophlebitis; MUS01 - Musculoskeletal signs and symptoms; NUR04 - Vertiginous syndromes; RES01 - Respiratory signs and symptoms; RES05 – Cough; SKN01 - Contusions and abrasions; SKN16 - Diseases of nail
Cost Estimates:
Concurrent Weight – 14.774
Rub – 5 (Very High Morbidity)
ACG-PM Scores:
Predicted Resource Index Total Cost: 4.377
Predicted Resource Index Pharmacy Cost: 1.903
Probability High Risk Total Cost: 0.18
Probability High Risk Pharmacy Cost: 0.044
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* Major ADG, all ages
Patient 3: Very High Cost Patient with Diabetes
Patient Characteristics
Conditions: Diabetes mellitus, General medical exam, Cardiovascular symptoms,
Cardiac arrhythmia, Sinusitis, Abdominal pain, Anorectal conditions, Benign/unspecified neoplasm, Otitis medica, Cholelithiasis, Cholecystitis, Acute lower respiratory
Resource Consumption Variable: Total cost: $12,944; Pharmacy cost: $6,392; Ambulatory visits: 14; Hospitalizations: 2 |
Input Data
Age/Sex: 39/Female
ICD9 Codes: V70 – general medical exam; 220 - benign neoplasm ovary; 250.02 – diabetes mellitus, type II, w/o complications, uncontrolled; 382.01 - ac supp om w drum rupt; 427.1 - parox ventric tachycard; 427.69 - premature beats nec; 427.9 - cardiac dysrhythmia nos; 466.0 - acute bronchitis; 473.9 - chronic sinusitis nos; 493.11 - int asthma w status asth; 565.0 - anal fissure; 574.20 - cholelithiasis nos; 575.11 - chronic cholecystitis; 575.9 - dis of gallbladder nos; 785.1 – palpitations; 789.07 - abdmnal pain generalized
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ACG Output
ACG: 5060 (10+ other ADG combinations, age >17, 3 major ADGs)
ADGs: ADG01 - time limited: minor; ADG02 - time limited: minor-primary infections; ADG03 - time limited: major; ADG06 – asthma; ADG07 – likely to recur: discrete; ADG08 - likely to recur: discrete-infections; ADG09 - likely to recur: progressive; ADG10 - Chronic Medical: Stable; ADG11 - chronic medical: unstable; ADG 27 - signs/symptoms: uncertain; ADG28 - signs/symptoms: major; ADG 29 – discretionary; ADG30 - see and reassure; ADG31 - Prevention/Administrative
EDCs: ADM01 - Administrative; ALL05 - Asthma, with status asthmaticus; CAR01 - Cardiovascular signs and symptoms; CAR09 - Cardiac arrhythmia; EAR01 - Otitis media; END06 - Type 2 diabetes, w/o complication; GSU01 - Anorectal conditions; GSU03 - Benign and unspecified neoplasm; GSU04 - Cholelithiasis, cholecystitis; GSU10 - Abdominal pain; RES02 - Acute lower respiratory tract infection; RES07 – Sinusitis
Cost Estimates:
Concurrent Weight – 15.633
Rub – 5 (Very High Morbidity)
ACG-PM Scores:
Predicted Resource Index Total Cost: 3.358
Predicted Resource Index Pharmacy Cost: 1.339
Probability High Risk Total Cost: 0.205
Probability High Risk Pharmacy Cost: 0.037
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* Major ADG, all ages
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