Task #11: Delivery of minor update proposals for NordDRG 2015
ECLA/ECHLA (/ECMO) indicates high level intensive care
|Target version:||Expert Group 2014|
|Case type:||Owner / responsible:||Nordic Casemix Centre|
|MDC:||Old forum status:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE|
A new DRG 483B 'Intensive circulatory support' was established in 2014. Some of the Norwegian hospitals are claiming that the new DRG might have substantial cost variation. The problem seems to be that treatment with intra-aortal balloon pump (IABP) is cheaper than treatment with other kinds of circulation support.
The ”technical” problem is that the procedure FXG00 (use of IABP) is handled in the same DRG as the more expencive procedures FXD00 (ECHLA), FXE00 (ECMO) and FXJ00 (PABP).
We want to reopen #95 for discussion. In addition to the complaints from the hospitals, we are not sure if the actual case is according to the decision. Our impression is that the original change only included moving of cases with ECHLA/ECLA from DRG 103 Heart transplantation to the new DRG 483B. In addition of this, also cases with IABP/PABP have been moved from DRG 110 and other DRG’s.
The Norwegians Directorate of Health – 2014-01-27
We don’t have national cost data on patient level about the use of different circulatory support methods/technology, but some of our hospitals who use these methods indicate that the costs of IABP are significantly lower than for the other methods. We also have received some cost data from Sweden that seems to reinforce our hypothesis.
Table 1 shows the number of patients treated with IABP in 2010-2012. Data from the Norwegian patient register shows that use of IABP is increasing, and that the use of IABP is decentralized. IABP is thus not only in use in university hospitals, but also in several other hospitals.
Table 2 show the results of an analysis of lenght of stay (LOS) where patients with IABP are compared with patients treated with other circulatory support systems (PABP, ECMO, ECHLA. The patients treated with IABP seem to have a shorter LOS which also means lower costs.
The difference in mean length of stay varies from 1 to 4 days whereas the difference in median LOS seems to be 1-2 days.
The Norwegians Directorate of Health – 2014-01-27
We want to reopen the case and discuss whether the use of IABP (procedure code FXG00) should be grouped to other DRG’s than 483B. The need of change and the final change needs to be verified with Swedish and Finnish cost data.
The cases with cases with IABP (FXG00) ”alone” (not in combination with tracheostomy or other circulatory supportive procedures like ECHLA, ECLA, PABP) move from DRG 483B back to DRG 110.
NordDRG [year] [version]
#1 Updated by Martti Virtanen almost 6 years ago
2014-03-13 Martti Virtanen
The proposed technical change is to remove the new property 00S20 'Intensive circulatory support' from FZSG00 'Insertion and use of intra-aortal balloon pump (IABP) and all linked national codes.
We need confirmation to the Norwegian data that this intervention is less resource intensive than the other interventions in the group.
#4 Updated by Martti Virtanen over 5 years ago
Mats Fernström, NPK, Sweden, 2014-03-20
To judge the total effect of the suggested change by just looking at the Drglogic table is almost impossible since there are more than 700 rules between the rules for DRG 483B/W02 and DRG 110/E10. We therefore re-grouped the Swedish KPP database (inpatients) after removing 00S20 from the procedure code FXG00 (FZSG00).
Approximately 50 % of the cases disappeared from DRG W02 and these cases were substantially less expensive than the remaining cases (see table 1).
!271 SWE comment 1.jpg!
All of the cases that left DRG W02N did not go to DRG E10, however. Table 2 (below) shows all receiving DRGs and the numbers and the average costs for the transferred cases.
!271 SWE comment 2.jpg!
We can ignore the minor changes (four or less transferals) but out of the 184 transferred cases 105 (57 %) went to DRG E10 and they seem to fit very well there in a cost perspective. However, 64 cases (35 %) went to DRG E04 or E07 and these cases are much more expensive than the average for these DRGs. The mean cost for these cases is 432 505 SEK and as a matter of fact they fit better in the original DRG W02N.
Our conclusion is that we can partly support the suggested change but cases with FXG00 (FZSG00) combined with heart valve operations or coronary bypass operations should remain in DRG 483B/W02. Technically this can be arranged by giving FXG00 (FZSG00) a new procedure property (for example 05S90) instead of 00S20 and by constructing new rules for DRG 483B/W02 with the demands 05S90 plus 05S02 (Cardiac valve procedure) or 05S90 plus 05S09 (Coronary bypass). These two new rules should be placed immediately after the present rule for DRG 483B/W02.
#5 Updated by Anonymous over 5 years ago
- Priority changed from 23 to Minor
- Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE added
Comment Expert Group 2014-03-25
No need to re-open the older case #95. The issue is handled here.
Norway supports the swedish counter proposal.
Proposal accepted by all countries.
#6 Updated by Martti Virtanen over 5 years ago
2014-03-26 Martti Virtanen
A new PROCPRO 00S21 ‘Use of IABP’ is created
The new property 00S21 is given to procedure FZSG00 and all linked codes of the national versions.
Property 00S20 is removed from FZSG00 and all linked national codes.
Two new rules are created in all NordDRG logic versions immediately after the current rule 400D300810.
The new rows are copies of the current rule 400D300810 but Procpro1 is changed to 00S21 on both rows.
On fist row the secproc1 gets the value 05S02 and on the second row 05S09
Patient cases with FZSG00 and linked national codes are assigned to DRG 483B (W20N) ‘Intensive circulatory support’ when performed in combinatin with 05S02 or 05S09.
Other patient cases with FZSG00 are assigned to different DRG’s based on diagnoses and other interventions performed. If FZSG00 is performed as the only intervention the patient case is assigned to DRG 110-111 (E10x) Major cardiovascular procedures.
Outpatient grouping is not changed.
#7 Updated by Ralph Dahlgren over 5 years ago
When doing the technical changes we noticed that the procedure code DF005 Annläggande av aortaballongpump in Swedish KPP data cost just as much as FXG00. We therefore suggest that DF005 gets the same procedure properties as FXG00.
The new PROCPRO 00S21 should have "extens =1". This means that FXG00 and DF005 still will have 99S90.