Case #163
Case 2010-GEN-01 DRG 929O for doctors only
| Status: | Accepted | Start date: | 2014-01-09 |
|---|---|---|---|
| Priority: | Normal | Spent time: | - |
| Assignee: | - | ||
| Category: | - | ||
| Target version: | Expert Group 2010 | ||
| Initiator: | Sweden | Target year: | 2011 |
| MDC: | GEN | Owner / responsible: | |
| Target Grouper: | SWE | Old forum status: | CLOSITEM - Closed item |
Description
Last updated: 2010-02-01
Status: CLOSITEM - Closed item
For information, concerns only Sweden
Initiated: 2008-09-03
By: Stockholms läns landsting (SLL)/CPK, Sweden
Expert Network
Board
BACKGROUND
CPK ID 271
Problem
So far consultation per telephone has been grouped to DRG 929O (Brev och telefonrådgivning, öppenvård), no matter who is giving the consultation. The costs for consultations with doctors increase the weight for DRG 929O because doctors often order laboratory tests or other medical services in connection with the telephone consultation. This results in that the weight for DRG 929O is higher than the weights for several DRGs for physical visits to nurses, physiotherapists etc. Therefore the Stockholm County Council (SLL) has decided to limit DRG 929O to doctor consultations only. Principally one can also question that all care providers are included in one DRG for telephone consultations. That is not the case for physical visits.
Analysis by CPK
The table below shows rather big cost differences within DRG 929O depending of the profession category. It is not only doctors that increase the average cost but they are responsible for 63 % of the total cost for DRG 929O.
How are the conditions to split DRG 929O on different profession categories? Well, if we only see to the number of patients, both “doctors”, “nurses” and “almoners” fulfil the criteria for split (> 3 % of the original group). The tables below show how the average cost per patient for each of these profession categories differ from the rest.
The only split that fulfils the cost demands (> 20 % cost difference) is a split on “doctors” and “other”.
Thus, the analysis supports the split that already has been done in SLL.
Recommendation by CPK
DRG 929O is limited to only doctor consultations in the Swedish version of NordDRG 2011. This is easily achieved by adding 99V35 in the secproc1 column in the rule with order nr 270D250000.
COMMENTS
Expert group 2013-03-12
The expert group noted the case - there is no proposed change to DRG system but the problem still exists in the Swedish system. The case should be closed if there is no new input.