Case #385

Implantation of loop recorder

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

Status:AcceptedStart date:2015-02-09
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

Title: Implantation of loop recorder
Forum ID: If known (i.e. in reactivation of an old case)
National ID: C585
Initiated: 2015-01-11
Initiator: Cecilia Rorsman et al., Varberg Hospital & Lund University Hospital, Sweden
Responsible at National organization: Mats Fernström
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
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Problem
See the enclosed ”ILR - application for outpatient tariff 09 01 2015.doc”. In short it is about that the procedure code FPK00 ‘Inläggande av elektrokardiograf med loop recorder’ (NCSP+ code = FXF020 ‘Implantation of loop recorder for examination of cardiac arythmias’) in outpatients is grouped to DRG E39O/120O 'Other circulatory system o. r. procedures, short therapy'(Andra åtgärder vid sjukdomar i cirkulationsorganen, öppenvård) which the initiators mean is wrong since the DRG weight (reimbursement) don’t cover the costs. The initiators present cost data (KPP) from three hospitals (74 patient cases) where the mean cost is 37 682 SEK but the reimbursement is only 10 639 SEK. The cost for the implant is told to be 17 000 SEK, which will increase to 20 000 SEK during 2015.

Analysis
NPK, Sweden – 2015-01-27
FPK00 has PROCPR= 05S19 and OR= 1, which leads to DRG E39O/120O in outpatients and DRG E39C-E/120C-N 'Other circulatory system o. r. procedures w cc/without CC (Andra operationer vid sjukdomar i cirkulationsorganen, komplicerat / ej komplicerat’ for inpatients.
DRG E39/120 is a surgical residual group in MDC 05 and like all residual groups, the content is heterogeneous, both in a medical and a cost perspective, and the DRG text provides limited medical information. To get a better medical description it may be justified to lift the FPK00 out from DRG E39/120.
The table below shows the costs (SEK) for FPK00 in relation to all cases in the DRG E39/120.

The average cost of the cases with FPK00 in the DRG E39O/120O (15 294 SEK) appears to be 23% higher than the average for the whole group (12 428 SEK) but in reality the difference must be significantly larger. It is obvious that the cost for the cases with FPK00 must be greater than 15 294 SEK since only the implant cost is about 17 000 SEK. Initiators cost information on 37 682 SEK is probably more accurate. The average cost of the cases with FPK00 in the DRG E39E (28 083 SEK) is also probably wrong.
Thus, the study shows that cases with FPK00 fit poorly in DRG E39O (outpatients) but better in the DRG E39/120 for inpatients. The majority of the cases with FPK00 are done in outpatients so it is important that the grouping of outpatients will be as good as possible.

In summary, there are both medical and economic reasons to lift out FPK00 from DRG E39/120. However, it is less convenient to construct a new DRG for a single procedure code so we examined the possibility to instead placing FPK00 in any other existing DRG. From a description standpoint, FPK00 fits pretty good together with implantation of a pacemaker because the basic problem (cardiac arrhythmia) is similar. At present there is no specific outpatient group for pacemaker implantation. DRG E28O/115O, where the pacemaker operations are included, also includes defibrillators, which are much more expensive. In the case with NPK ID 584, however, we propose a division of DRG E28O with the formation of a new group, DRG E26O/116O, for insertion and replacement of pacemakers and from a medical perspective FPK00 fits very well in this new DRG E26O/116O. Cost data shown in the following table.

The reported average cost of E26O/116O (17 312 SEK) is only somewhat higher than that of E39O/120O (12 428 SEK) but the real cost of E26O/116O must be higher because only the cost of materials for pacemaker should be at least 15 000 SEK. Regarding inpatients, we see that the average cost of the DRG E39E/112N and E26E/116N is about the same.

Summary: The investigation shows that cases with FPK00 can be moved to the DRG E26/116 to obtain a better description but it requires that the DRG E26O/116O is introduced according to the issue with NPK ID C584.

Suggestion
NPK, Sweden – 2015-01-27
FPK00 is transferred from DRG E39/120 to DRG E26/116 provided that DRG E26O is introduced according to the issue with NPK ID C584. To achieve this, the PROCPR value for FPK00 is changed from 05S19 to 05S41.
To be introduced in NordDRG SWE 2016.
Technical change
The PROCPR value for FPK00 is changed from 05S19 to 05S41. The text for 05S41 should then be changed from “Implantation of pacemaker” to “Implantation of pacemaker or loop recorder” and in the texts to DRG E26/116 the loop recorder is enclosed.
DRG change
Cases with FPK00 that previously was grouped into DRG E39/120 will instead be grouped into DRG E26/116 but there will be relatively few cases involved. In the KPP database it is about 194 outpatients (0.01% of all outpatient cases) and 125 inpatients (0.04% of all inpatient cases).

See Decision_ C585.xlsx for details.

C585 Decision_ C585.xlsx (19.7 KB) Anonymous, 2015-02-09 10:34

C585 to Forum.docx (21.3 KB) Anonymous, 2015-02-09 10:34

ILR - application for outpatient tariff 09 01 2015.docx - Implanted loop recorder - clinical view (405 KB) Martti Virtanen, 2015-02-11 11:16

Mean_cost_per_patient_of_ILR_cases_in_NordDRG.jpg (90.5 KB) Martti Virtanen, 2015-02-11 11:22

Mean_cost_per_patient_of_pacemaker_cases_in_NordDRG.jpg (91.2 KB) Martti Virtanen, 2015-02-11 11:22

Decision2_C585.xlsx - New (23 KB) Anonymous, 2015-03-25 17:45

Case #385 Technical changes.xlsx - Updated 2015-04-17 (25.4 KB) Martti Virtanen, 2015-04-17 13:26

History

#1 Updated by Martti Virtanen almost 5 years ago

  • File ILR - application for outpatient tariff 09 01 2015.docx added

#2 Updated by Martti Virtanen almost 5 years ago

  • File deleted (ILR - application for outpatient tariff 09 01 2015.docx)

#3 Updated by Martti Virtanen almost 5 years ago

  • File Mean cost per patient of ILR cases in NordDRG.png added
  • File Mean cost per patient of pacemaker cases in NordDRG.png added

#4 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Mean cost per patient of ILR cases in NordDRG.png)

#5 Updated by Martti Virtanen almost 5 years ago

  • File Mean_cost_per_patient_of_ILR_cases_in_NordDRG.jpg added
  • File Mean_cost_per_patient_of_pacemaker_cases_in_NordDRG.jpg added

#6 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Mean cost per patient of pacemaker cases in NordDRG.png)

#8 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#9 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#11 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Mean_cost_per_patient_of_ILR_cases_in_NordDRG.jpg)

#12 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Mean_cost_per_patient_of_pacemaker_cases_in_NordDRG.jpg)

#13 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

2015-02-11 Martti Virtanen
I have made some stilistic changes to the basic proposal.
I support the proposal

#14 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#15 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#16 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#17 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#18 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#19 Updated by Martti Virtanen over 4 years ago

2015-03-13 Expert group/MV
The case was not accepted by other countries but Sweden needs the change to be made in NordDRG 2016 SWE.

Technical change
A new procedure property 05S44 'Implantation of loop recorder' is created.
This property is given to the intervention FXF020/FPK00.
A new rule is created to the Drglogic SWE before the current rule 105D11011. It is copy of current rule 105D11011 but procprop1 is changed to 05S44.

DRG change
As proposed.

#20 Updated by Martti Virtanen over 4 years ago

  • File Case #385 Technical changes.xlsx added

#21 Updated by Anonymous over 4 years ago

Mats Fenström:
NPK, Sweden, 2015-03-24
Marttis technical changes are not correct. The purpose of our suggestion is that implantation of loop recorder (FXF020/FPK00) shall be grouped to the same DRGs as implantation of pacemakers, which means DRG E26, both for in-patients and out-patients. The out-patient DRG E26O is decided in case #374 so there is no need to involve DRG E28O in this case. The new rule for DRG E26A must be placed after the existing rules because a case with simultaneous implant of biventricular pacemaker and loop recorder must be grouped to DRG E26A even without MCC factor.
The technical changes in the Drglogic table should look like this.

We include an updated version of our file Decision2_C585.xlsx

#22 Updated by Martti Virtanen over 4 years ago

2015-03-13 Martti Virtanen
Yes I made a mistake, but that is not the only mistake!
For outpatient care DRG 115O/E28O combines the outpatient cases similar to inpatient DRG's 115x/E28x, 116x/E26x and 117N/E25N. There is no DRG 116O/E26O currently in NordDRG SWE. Thus without other changes the new DRG 116O/E26O would only bee the 'loop recorder' cases.

Sweden has to decide if you want to have all 3 DRG's also as outpatient versions (115O/E28O, 116O/E26O & 117O/E25O), should there be a separate 116O/E26O and the rest in 115O/E28O, or should we keep all in 115O/E28O.

I modified the technical changes now according to the middle model (116O/E26O & 115O/E28O, no 117O/E25O), but Sweden of the option is yours!

In addition the E28O rules ord-codes need to be corrected (if necessary in all versions)j

The complete list of Swedish DRGnames (including these DRG's) needs to be delivered to Nordic Casemix Centre latest in August.

The techincal chganges document is updated according to this model.

#23 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #385 Technical changes.xlsx)

#24 Updated by Martti Virtanen over 4 years ago

  • File Case #385 Technical changes.xlsx added

#25 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #385 Technical changes.xlsx)

#26 Updated by Martti Virtanen over 4 years ago

  • File Case #385 Technical changes.xlsx added

#27 Updated by Mats Fernström over 4 years ago

2015-04-09 NPK, Sweden
This case concerns only Sweden and there is no reason to involve DRG E28O in the technical changes. It is decided in case #374 that DRG E28O shall be deleted and replaced by DRG E25O, E26O and E27O.

#28 Updated by Martti Virtanen over 4 years ago

2015-04-17 Martti Virtanen
Understanding comes slowly and sometimes it needs several rounds.
As Liselotte has noted, the case #374 is missig form combined Technical Changes 2016 which results partly in the point that this was not noticed.
The modification to make a separate Swedish mocel possible is that FXF020/FPK00 gets a new propert 05S44. It keeps 05S19 for other versions. Then we need new rules for all E26/116 DRG's (O, E, C and A in NordDRG SWE). This is the way #385 is still related with E28O. The rules of E28O are however already deleted in case #374.

Sweden has not changed the name of DRG E26O that will no also include 'loop recorder' (as it did according the Swedish proposal also).

The names are changed accorging to case #374 and there are now name changes in case #385. The english names will not include 'loop recorder' bacause it is not included in all models. The Swedish names are delivered by Sweden.

I have modified the Technical changes accordingly!

#29 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #385 Technical changes.xlsx)

#30 Updated by Anonymous almost 4 years ago

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

#31 Updated by Martti Virtanen over 3 years ago

2016-03-15 Expert group (MV)
The additional changes were accepted without further discussions.

#32 Updated by Anonymous over 3 years ago

  • Status changed from Active to Accepted

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