|Target version:||Expert Group 2015|
|Case type:||Major||Owner / responsible:||National organisations|
|MDC:||Old forum status:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE|
National ID: C439
Initiator: Olafr Steinum, The Swedish National Board of Health and Welfare
Responsible at National organization: Mats Fernström & Ralph Dahlgren
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
Swedish ophthalmologists question the grouping of strabismus surgery. Most cases are outpatients and they are grouped to DRG B15O/041O "Extraokulära operationer exkl ögonhåla, öppenvård" /"Extraocular procedures except orbit, short therapy". Ophthalmologists mean that a DRG with the text “except orbit” is clinical wrong since strabismus surgery means surgery on the extraocular muscles and they are inside the orbit. We agree. The grouping of operations on extraocular muscles has to be revised.
The Swedish National Board of Health and Welfare – 2015-01-16
Operations on extraocular muscles have a NCSP code beginning with CE. They all have OR = 1 and procedure property 02S03 which leads to DRG B15O/B15C/B15E (041O/040/041).
The cases in DRG B15C/041C ‘Extraokulära operationer exkl ögonhåla, komplicerat’ (Extraocular procedures except orbit, complicated) are very rare in the Swedish cost data (KPP) database and are therefore not included in this analysis.
The tables below show the average costs for cases with extraocular muscle operations and other cases in DRG B15 and cases in DRG B09/037 ‘Operationer i orbita’/‘Orbital procedures’.
Outpatient cases with extraocular muscle operations are far too expensive to fit in DRG B15O/041O. They fit better in DRG B09O/037O ‘Operationer i orbita, öppenvård’/‘Orbital procedures, short therapy’.
Inpatient cases with extraocular muscle operations fit very well in DRG B15E, however, and they are not expensive enough to fit in DRG B09E.
It is obvious that the outpatient grouping logic has to be changed. We considered moving the extraocular muscle operations to DRG B09O/037O but to keep the compatibility between outpatient and inpatient grouping, we then have to do the same for inpatients and that is not very good in a cost perspective. We suggest instead that DRG B15O/041O is divided into two new DRGs, one for “Surgery for strabismus” (most operations on the extraocular muscles are for strabismus) and one for “Other surgery for problems in the eye region” which will be the new outpatient rest group in MDC 02.
Such a split in the inpatient grouping logic is not motivated for cost reasons and if we do it, we will get very small groups. Therefore we suggest only that the texts for DRG B15C and B15E (and corresponding DRGs in the common version) are changed. The text “except orbit” must be omitted. We suggest “Surgery for strabismus and other surgery for problems in the eye region”, which is a combination of the texts for the new outpatient groups.
The Swedish National Board of Health and Welfare – 2015-01-16
Proposal for inpatients
No change concerning the grouping logic. Only a change of the text of DRG B15E/C to “Operation för skelning och andra operationer vid problem i ögonregionen, ej komplicerat/komplicerat” (Surgery for strabismus and other surgery for problems in the eye region")
Proposal for outpatients
DRG B15O/041O is divided to two new groups: DRG B16O/041P “Operation för skelning , öppenvård (Surgery for strabismus, short therapy) and DRG B17O/041Q “Andra operationer vid problem i ögonregionen, öppenvård “ (Other surgery for problems in the eye region, short therapy).
Sweden wants this to be introduced in the NordDRG SWE 2016.
For inpatients there will be no change.
Outpatients that before were grouped to DRG B15O/041O will be grouped to one of the new DRGs depending on what type of surgery that is done:
DRG B16O “Operation för skelning , öppenvård (Surgery for strabismus, short therapy)
DRG B17O “Andra operationer vid problem i ögonregionen, öppenvård “ (Other surgery for problems in the eye region, short therapy)
For DRG B15E/C//041N/C a text change to “Operation för skelning och andra operationer vid problem i ögonregionen, ej komplicerat/komplicerat”/"Surgery for strabismus and other surgery for problems in the eye region, not complicated/complicated".
DRG B15O/041O is devided to two new groups:
• DRG B16O/041P ’Operation för skelning, öppenvård’/'Surgery for strabismus, short therapy'
• DRG B17O/041Q ‘Andra operationer vid problem i ögonregionen, öppenvård’/'Other surgery for problems in the eye region, short therapy'.
All NCSP+ codes beginning with CES will have a new PROCPRO 02S14 ‘Extraocular muscle procedure’ in addition to 02S03. 02S03 is retained for inpatient logic and for use in other versions of NordDRG.
In all the present rules for DRG B15O the DRG is changed to B17O. A new rule for DRG B16O, based on PROCPRO 02S14, is inserted immediately before the first rule for DRG B17O. Since all NCSP+ codes beginning with CES have OR = 1 there is no need for a separate anesthesia rule (with dgprop 00X10).
All technical changes are described in detail in the Excel-file “Decision C439”.
#5 Updated by Martti Virtanen over 5 years ago
- File ces-intervetions.jpg added
- Description updated (diff)
- Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR added
2015-02-17 Martti Virtanen
I support this proposal. I have modified the basic text to adjust it as general proposal affecting all versions. The other countries need to check the economics for themselves.
The interventions in the NCSP+ group CES include interventions that are not for strabismus.
The name is thus not totally correct now either. This I regard as a minor problem. A more serious question is, does the code CESA00 'Biopsy of extraocular muscle' actually indicate as expensive cases as the others? Maybe it should not have 02S14? The same question applies to less extent for CESW99 'Other operation on extraocular muscle'. Would it be possible to check the cost of these cases separately?
#6 Updated by Anonymous over 5 years ago
- File Case-371-comment.jpg added
Mats Fernström, NPK, Sweden 2015-02-25
Martti requested cost data for CESA00 'Biopsy of extraocular muscle' and CESW99 'Other operation on extraocular muscle' separately. Unfortunately there were no cases with CESA00 in our KPP database but CESW99 is shown in the table below:
Thus cost data support that CESW99 is included in the new DRG B16O/041P. How we do with CESA00 is not very important so we can discuss that on the meeting.
#8 Updated by Martti Virtanen over 5 years ago
- File Case #371 Technical changes.xlsx added
2015-03-25 Martti Virtanen
The proposal had an error. Because the inpatient grouping will not be changed, the CES-group interventions must retain the property 02S03.
The english names are in the #371 Technical changes document. The national names should be delivered to Nordic Casemix Centre before August.