Case #374

Reorganizing pacemaker procedures for outpatients (Split of DRG E28O /115O)

Added by Anonymous almost 5 years ago. Updated over 3 years ago.

Status:AcceptedStart date:2015-01-27
Priority:MajorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type:Major Owner / responsible:National organisations
MDC: Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

National ID: NPK ID C584
Initiated: 2015-01-14
Initiator: NPK, Sweden
Responsible at National organization: Mats Fernström
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
----------------------------------------------------------------------------------------------------------------

Problem
The inpatient DRG's for pacemaker and defibrillator interventions were reorganized in NordDRG 2006 (Case 2005-MDC05-06, #419). This proposal is based on the same principles.
Another related case is Case 2007-MDC05-02, #420.
Note also that the changes according to this case will be further changed if the suggestion in the case with NPK ID C585 is accepted.

Inpatient cases with implant, revision or removal of pacemaker or defibrillator are grouped into three different base DRG:
• E25N Insertion or replacement of defibrillator
• E26 (A, C, E) Insertion or replacement of permanent pacemaker
• E27 (A, E) Removal of permanent pacemaker or defibrillator
The reason for the split is primarily significant differences in implant costs.
Outpatient cases with the same procedures, however, are lumped together into one single group, DRG E28O (Insertion, replacement or removal of permanent pacemaker or defibrillator, outpatient). Implant costs, and the differences between them, are the same as in inpatients why this DRG is very cost heterogeneous. See table below where the procedures included in the DRG E28O have been divided according to the same principle as in inpatient logic. (The table is on the word document and also included in Appendix C584.xlsx.)

Analysis
NPK, Sweden – 2015-01-14
See table above. It is obvious that insertion/replacement of defibrillator (procedures with procedure property 05S40) do not fit in the group. As many as 67% become outliers! It is also obvious that the costs of insertion or replacement of pacemaker (procedures with procedure property 05S41) are underestimated. Probably implant costs are missed in many cases in the cost calculations.
Thus, DRG E28O is cost heterogeneous and should be divided in the same way as in the inpatient logic. The group would then be deleted and replaced by
• E25O/115P Insertion or replacement of the defibrillator, outpatient
• E26O/115O Insertion or replacement of permanent pacemaker, outpatient
• E27O/115Q Removal of permanent pacemaker or defibrillator, outpatient
The criteria for split concerning relative numbers (relative to the original group) and the cost differences are fulfilled. The advantage of this split is a better medical and economic description and we have a better opportunity to see the degree of policlinisation when we have the same grouping logic for inpatients and outpatients. The only objection might be that the absolute number of cases in DRGs E25O and E27O are not so large (262 or 261) but it is not an absolute obstacle for splitting. Of the 507 outpatient groups in the KPP database for 2013 as much as 141 groups (28%) have less than 261 cases.

Suggestion
NPK, Sweden – 2015-01-14

DRG E28O is replaced by
• E25O/117O Insertion or replacement of the defibrillator, outpatient
• E26O/116O Insertion or replacement of permanent pacemaker, outpatient
• E27O/115O Removal of permanent pacemaker or defibrillator, outpatient
To achieve this, changes must be made in the tables Drglogic and Drgnames as described below and specified in the included file Suggestion C584.xlsx.

To be introduced in Sweden in NordDRG 2016.

DRG change
Cases that used to be grouped to DRG E28O will instead be grouped to one of the following groups:
• E25O/115P Insertion or replacement of the defibrillator, outpatient
• E26O/115Q Insertion or replacement of permanent pacemaker, outpatient
• E27O/115R Removal of permanent pacemaker or defibrillator, outpatient
The number of cases in the Swedish KPP database for 2013 that are affected by such a change is only 0,1 % of the total number of cases.

Technical change
In the table Drgnames three new DRGs are inserted and DRG E28O becomes inactivated :
• E25O/115P Insertion or replacement of the defibrillator, outpatient
• E26O/115Q Insertion or replacement of permanent pacemaker, outpatient
• E27O/115R Removal of permanent pacemaker or defibrillator, outpatient
(Swedish texts and short texts are specified in the included file Suggestion NPK ID C584.xlsx.)

In the table Drglogic, the DRG is changed to 115P(E25O) in the rules with ORD 105D11010 and 105D110101 and to 115Q(E26O) in the rule with ORD 105D110110 and to 115R(E27O) in the rules with ORD 105D111200 and 105D111201.
All changes are specified in the included file Suggestion C584.xlsx.

C584 Suggestion C584.xlsx (16.4 KB) Anonymous, 2015-02-05 14:20

C584 to Forum.docx (26.9 KB) Anonymous, 2015-02-05 14:20

Cost_analysis_NPK_C584.jpg (400 KB) Martti Virtanen, 2015-02-10 14:19

Cost_analysis_NPK_C584.xlsx (12.3 KB) Martti Virtanen, 2015-02-11 09:54

Case #374 Technical changes.xlsx - Updated 2015-05-01 (23.5 KB) Martti Virtanen, 2015-05-01 15:26

Case #374 Technical changes.xlsx - Updated 2015-05-28 (23.5 KB) Martti Virtanen, 2015-05-28 15:42

History

#1 Updated by Anonymous almost 5 years ago

  • Description updated (diff)

#2 Updated by Martti Virtanen almost 5 years ago

  • File Cost analysis NPK C584.xlsx added
  • Description updated (diff)

#3 Updated by Martti Virtanen almost 5 years ago

  • File Cost analysis NPK C584.xlsx added

#4 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Cost analysis NPK C584.xlsx)

#5 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Cost analysis NPK C584.xlsx)

#6 Updated by Martti Virtanen almost 5 years ago

  • File Cost analysis NPK C584.jpg added
  • Description updated (diff)

#7 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Cost analysis NPK C584.jpg)

#9 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#10 Updated by Martti Virtanen almost 5 years ago

  • File deleted (C584 Appendix C584.xlsx)

#12 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#13 Updated by Martti Virtanen almost 5 years ago

  • Subject changed from Split of DRG E28O (former DRG 115O) to Reorganizing pacemaker procedures for outpatients (Split of DRG E28O /115O)
  • Description updated (diff)

2015-02-11 Martti Virtanen
This case is related to an old case for inpatient grouping. The DRG's need to defined with the traditional NordDRG coding (which again is demonstrated to be outdated).
I have made the changes inside the proposal now.
In principal i support this proposal

#14 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#15 Updated by Anonymous over 4 years ago

  • Description updated (diff)

#16 Updated by Martti Virtanen over 4 years ago

  • File Case #374 Technical changes.xlsx added

2015-03-13 Expert group/MV
The case was accepted as proposed for all versions of NordDRG.
Please note that the national names of the DRG's should be delivered to Nordic Centre latest in August.

#17 Updated by Martti Virtanen over 4 years ago

2015-03-24 Martti Virtanen
The Drgnames (in English) for SWE version were obviously wrong. They must also be corrected.

#18 Updated by Veronika Stemme over 4 years ago

2015-04-16 NPK, Sweden:
We assume that NCC will make the English text-Changes.

#19 Updated by Martti Virtanen over 4 years ago

2015-04-17 Martti Vitanen
This case is now also included in the combined list Technical changes 2016. The names are changed (see also #385).

#20 Updated by Martti Virtanen over 4 years ago

  • File Case #374 Technical changes.xlsx added

2015-05-01 Martti Virtanen
As noted by Liselotte, the Norwegian verssion already includes the groups created in this case. Only the coding is diffrent.
For NDMS to maintain the comparability we change the DRG-code in NDMS. The local code is not changed and the definition tables will not change for Norway. See updated technical changes.

#21 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #374 Technical changes.xlsx)

#22 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #374 Technical changes.xlsx)

#24 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#25 Updated by Martti Virtanen over 4 years ago

  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR added

#26 Updated by Martti Virtanen over 4 years ago

2015-05-28 Martti Virtanen
The names of DRG's 116O and 117O had been switched in the english text of DRGnames-sheet. The DRGlogic was correct, but the names have been taken from the DRGnames sheet.
This needs to be corrected in next version (also the finnish one) but no new PL version is needed for this.

#27 Updated by Anonymous almost 4 years ago

  • Target version changed from Major-Proposals-for-2016 to Expert Group 2015

#28 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

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