Revision of DRGs with cardiac catheterization (124A/B and 125A/B)
|Target version:||Expert Group 2015|
|Case type:||Major||Owner / responsible:||National organisations|
|MDC:||MDC05||Old forum status:|
As a result of testing the Swedish CC-grouper on Finnish data and also taking into account the removal of CC-property from emergency/urgent procedures starting from 2014 (see also case http://documents.norddrg.net/issues/65), Finnish DRG-centre had a closer look at and analysed four DRGs related to cardiac catheterization.
It concerns the following DRGs in Finnish 2015 Full version:
124A Diagnostic percutan cardiac procedure w/o circulatory complex dx
124B Emergency diagnostic percutan cardiac procedure w circulatory complex dx
125A Diagnostic percutan cardiac procedure w/o circulatory complex dx
125B Emergency diagnostic percutan cardiac procedure w/o circulatory complex dx
The current grouping is dependent on whether the catheterization has performed as emergency procedure or not. The original idea of that was to create separate DRGs for emergency cases as they were supposed to be more expensive. The cost data do not support it though (see Appendix 1). Therefore it doesn’t make sense to have separate DRGs based on emergency factor.
We also tested Swedish CC-grouper and regrouped the cases of DRG 124A/B and 125A/B to find get ideas and a solution.
There are six different DRGs in CC-grouper for those cases:
124N Cirkulationssjukdomar med hjärtkateterisering, med komplicerande diagnos, ej komplicerat
124C Cirkulationssjukdomar med hjärtkateterisering, med komplicerande diagnos, komplicerat
124M Cirkulationssjukdomar med hjärtkateterisering, med komplicerande diagnos, mycket komplicerat
125N Cirkulationssjukdomar med hjärtkateterisering, utan komplicerande diagnos, ej komplicerat
125C Cirkulationssjukdomar med hjärtkateterisering, utan komplicerande diagnos, komplicerat
125M Cirkulationssjukdomar med hjärtkateterisering, utan komplicerande diagnos, mycket komplicerat
We went through different alternatives (I-IV) and made the cost analysis for every alternative (see also Appendix 1). None of the alternatives is the best one but as we are not happy with current situation either we had to come up with a solution.
Based on the cost analysis and weighing different alternatives the proposal is as follows:
To merge current DRGs 124A+124B, and 125A-125B and create two DRGs instead of four (alternative IV).
124 Diagnostic percutan cardiac procedure w circulatory complex dx
125 Diagnostic percutan cardiac procedure w/o circulatory complex dx
The change would concern only Finnish grouper.
Merging those DRGs the grouping is not dependent on the fact whether the procedure was done as emergency one or not. The grouping depends only on presence of circulatory complex diagnosis.
#5 Updated by Martti Virtanen almost 5 years ago
2015-02-17 Martti Virtanen
Finland is taking back the change it made some years ago.
It would be preferable, if we could agree on a common model for all countries.
The problem with the Swedish model is, that one of the groups (124M)has quite high variation and one is very small (125M, only 19 cases in a year in Finland) and there seems to be no solution for that.
It would be interesting to get data from Sweden regarding these groups.
#6 Updated by Anonymous almost 5 years ago
Ralph Dahlgren, The Swedish National Board of Health and Welfare 2015-02-23, Commets:
Here comes some cost data concerning DRG E43E/C/A and E44E/C/A (Former DRG 124M, 124C, 124N, 125M, 125C, 125N) as requested. The table includes only inliers and not the outliers:
Important to know is that Swedish cost data includes about 70% of all patient cases. The numbers that make out the cost is totally in Sweden approximately 11 100 while the Finnish data contains only around 1 900. Another thing that has to be considered is that the Finnish data has the lower cut of limit set to 1 000 Euro (10 000 SEK) and Sweden have the lower cut of limit 4 000 SEK ( 400 Euro).
If combine the data it will be like below:
It is important to include the fact of the Finnish data that the max cost are higher for 125N compared to 125C and to 125M. Is this due to lack of coding, duration of stay or some other reason? And if the max costs are included when getting the Finnish mean cost the result has to differ compared to Swe-data because in the table below the cost-outliers and time outliers are shown and are naturally not included in the Swedish cost data above. This has to affect some, if not all, differences of the mean cost.
Include also the prospective weights that are in use. The weights are relative weights where the weight “1” is estimated to 45 696 SEK (~ 4 600 Euro ) but is relative towards all DRG weights.
If someone knows statistics good enough some of the differences might be because of the differences in number as well in how the cost data are obtained, how we set the lower limit as well as how we do differently concerning cost outliers and time outliers.