frequently, a complex and comprehensive array of medical and other services is required to manage the multidimensional sequelae of populations with serious or complex medical conditions. chapter 2 outlines the challenges of ensuring timely access to high-quality health care services and resources for patients with serious and complex medical conditions. the remainder of this chapter outlines conceptual categories of conditions that might be considered serious and complex, examines possible alternative operational definitions to screen for the presence of serious and complex conditions, and discusses the implications of these definitions for use in the regulatory or legislative process. it is important to recognize that these conditions may be serious and complex for some patients at some points during the course of their disease or disability. in practice, then, an individual with one or more icd-9 codes in the “included” list in a defined period would be considered to have a serious and complex medical condition. in the present context, individuals having specific impairments would be considered to have serious and complex medical conditions. in the context of describing serious and complex medical conditions, a threshold (or possibly multiple thresholds for different ages or classes of patients) would need to be established. it is possible, then, to select specific dimensions rather than an overall score, or perhaps to identify a specific profile of scores that would be consistent with the concept of a serious and complex medical condition. the scores may not be stable over long periods of time for specific individuals with serious and complex conditions.
the dcgs would be useful only to the extent that annual expense is associated with the concept of serious and complex medical conditions. the acgs might conceivably be a better conceptual fit than dcgs to the concept of serious and complex medical conditions. the measure of cost or expense itself could be used to identify a group or groups of persons who are likely to have serious and complex medical conditions. at best, this is a partial solution to the problem of defining serious and complex conditions. there are some widely used clinical measures that may be markers for the presence of serious and complex medical conditions. virtually all patients meeting the nho guidelines would be considered to have a serious and complex condition. no single criterion or definition in the above lists will completely meet the needs of hcfa to define patient populations with serious and complex medical conditions. furthermore, use of retrospective data to predict future events has the potential for misclassification of patients as having or not having a serious and complex medical condition. definition of serious and complex medical conditions.
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