Case #391

Problem with shoulder and hip DRG in DRGlogic

Added by Anonymous almost 5 years ago. Updated almost 2 years ago.

Status:AcceptedStart date:2015-02-11
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Target version 2018
Initiator:Sweden Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC:MDC08 Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

National ID: C458
Initiated: 2014-12-10
Initiator: Ralph Dahlgren

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Problem
The clinicians have pointed out a problem that follows. A patient who needs an operation to get a prosthetic shoulder will get grouped to DRG H26E-A/491N 'Larger re implantations or joint prosthesis surgery on upper limb, not complicated / very complicated' (Större reimplantationer eller ledprotesoperationer på övre extremitet, ej komplicerat/mycket komplicerat), but when the necessity occurs that you also have to do surgery of a newly discovered hip injury the patient get grouped to DRG H18E-C/210-211 'Other operations on the pelvis, hip and femur except joint replacements, > 17 years, not complicated/complicated' (Andra operationer på bäcken, höft och femur utom ledproteser, >17 år, ej komplicerat/komplicerat).
This is not a good scenario out of a medical perspective, nor at a resource perspective either.

Analysis
The Swedish National Board of Health and Welfare 2014-12-10
DRG H18E-C/210-211 have lower reimbursement than H26E-A/491N.

Suggestion
The Swedish National Board of Health and Welfare 2014-12-10
Change of the order of the rules in the Swedish DRGlogic for DRG H26E/A so that it is placed above DRG H18E/C.
There is no need to do an ord change in daycare due to the fact that this type of surgery is not done in daycare.

The changes should be introduced to the Swedish NordDRG for 2016.

Technical change
The DRGlogic sheet will have an ord change for DRG H26E/A ( Former DRG 491N ) from ord 408D091000/ 408D091009 to a position after urrent rule 408D05209 (f.ex. ord 4408D052097/ 408D052098, current rule 408D05209 needs to be changed to 408D052090 ).
DRG change
Very few cases will be changed from DRG H26E-A/491N to DRG H18E-C/210-211 ) .

For detail description see Excell-File “Decision, Technical changes, NPK C458”

NPK C458 to Forum.docx (17.4 KB) Anonymous, 2015-02-11 11:27

NPK C458 Decision Technical changes NPK C458.xlsx (13.3 KB) Anonymous, 2015-02-11 11:27

Case #391 Technical changes.xlsx - Updated version (18.4 KB) Martti Virtanen, 2015-03-31 12:20

#391 Technical changes in version 2018.xlsx (13.2 KB) Mats Fernström, 2017-02-23 14:29

TC #391_C458.xlsx (16.7 KB) Mats Fernström, 2017-03-28 17:16

Technical changes case #391 add.xlsx (17.8 KB) Martti Virtanen, 2017-05-19 15:59

History

#1 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#2 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

2015-03-02 Martti Virtanen
The proplem is obvious and the solution sounds correct.
Further analysis
Could you please check (in all countries) the cost weights of DRG 212/H08 and 216H42 in addition to 210-211/H18 and 491/H26.
Maybe one should also analyze the corresponding outpatient groups?

#3 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#4 Updated by Ralph Dahlgren over 4 years ago

We want our suggestion to be introduced for 2016 and will continue to investigate Marttis suggestion for 2017. Marttis comment on DRG DRG 212/H08 and 216/H42 is correct but maybe other DRGs might also have to be included.

#5 Updated by Martti Virtanen over 4 years ago

  • File Case #391 Technical changes.xlsx added
  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR added

2015-03-13 Expert group/MV
The proposal was accepted. The questions will be analyzed by Sweden (and other countries) and reported back next year. Finland will consider the case before any change.

#7 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #391 Technical changes.xlsx)

#8 Updated by Anonymous almost 4 years ago

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

#9 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

#10 Updated by Mats Fernström over 2 years ago

Mats Fernström, NPK, Sweden, 2017-02-23
The case is reactivated because of Marttis comment on DRG DRG 212/H08 and 216/H42. According to Swedish cost data DRG H08 is more expensive than DRG H42, but despite that, the rules for DRG H08 come after the rules for DRG H42. DRG H42 contains biopsies which of course can be performed during the operations in DRG H08 so it is extra important that we have a hierarchy that follows the costs/weights. DRGs in MDC 08 further down in Drglogic are cheaper than DRG H42 so it is OK to place the rules for DRG H42 immediately after the rules for DRG H08. This is achieved by the ORD changes specified in the file #391 Technical changes in version 2018.xlsx

#11 Updated by Mats Fernström over 2 years ago

Mats Fernström, NPK, Sweden 2017-03-28
If it can be of any help, I attach technical changes (TC #391_C458.xlsx) according to the new NCC template including an update of test data.

#12 Updated by Martti Virtanen over 2 years ago

2017-03-13 Expert group
Changes for Swe have already been done.
Nor version will follow the Swe.
Finland will look at the model.

#13 Updated by Martti Virtanen over 2 years ago

2017-05-19 Martti Virtanen

This is an addition to the previous decission.
Technical changes for combined NordDRG Com.
The id' are not changed, because, the rules are exactly the same, only the place (order) is changed.
NordDRG Nor rule (DRG 216X) has been moved similarly as the Swedish rules.
NordDRG Fin rules and other version rules have not been touched.

Test cases for Sweden presumably work for other versions too.

#14 Updated by Martti Virtanen almost 2 years ago

  • Status changed from Re-activated to Accepted

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