Draw an Entity Relationship diagram, the Crow’s Foot notation, based on the following narrative about assigning Hierarchical Condition Category (HCC) codes to patients to compute each patient’s risk adjustment factor (RAF) score. Be sure to indicate the various attributes of each entity and relationship set; also specify the key and participation constraints for each relationship set. The HCC is a coding system developed by the Centers for Medicare & Medicaid Services (CMS) to pay Medicare Advantage insurance companies. Along with demographic factors (such as age and gender), insurance companies assign HCC codes to patients to compute each patient’s risk adjustment factor (RAF) score. Using algorithms, insurances can use a patient’s RAF score to predict costs. The following table shows the RAF score and expected annual expenditure for a 76-year-old male that was assigned three HCC codes, corresponding to his three medical conditions Risk Adjustment Factor (RAF) RAF Score Expected Annual Expenditure Male 75 to 79 years old 1.062 $9,611 HCC 86, Acute myocardial infarction 0.282 $2,552 HCC 111, Chronic obstructive pulmonary disease 0.355 $3,213 HCC 137, Renal failure stage IV 0.230 $2,082 Totals 1.929 $17,457
The following is a hypothetical short list of HCC codes: 8, 9, 10, 11, 12, 17, 18, 19, 50, and 51. There are business rules (constraints) that relate HCC codes to other HCC codes. Several examples of business rules for HCC codes are as follows:
• HCC code 8 dominates codes 9, 10, 11, and 12. HCC code 9 dominates codes 10, 11, and 12. HCC Code 10 dominates codes 11 and 12. HCC code 11 dominates code 12
• HCC code 17 dominates codes 18 and 19. HCC code 18 dominates code 19.
• HCC code 50 dominates code 51.
The above business rules can be simplified as follows: (8,9),(8,10),(8,11),(8,12),(9,10),( 9,11),(9,12),(10,11),(10,12),(11,12 ),(17,18),(17,19),(18,19),(50,51).< br /> Draw an ER diagram that illustrates the relationships among PATIENT (id, patient name, address, phone, date of birth, and gender), HCC_Code (code number, description), and the business rules that relate HCC codes to other HCC codes. Note that patients are assigned zero or more HCC codes.