Case #419

Case 2005-MDC05-06 Reorganizing of pacemaker procedures

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

Status:AcceptedStart date:2015-03-11
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:-
Initiator:Sweden Target year:
Case type: Owner / responsible:
MDC: Old forum status:CLOSITEM - Closed item
Target Grouper:

Description

Last updated: 2005-04-19
Status:
CLOSITEM - Closed item
Initiated - 2005-03-10
By: Nordic working group "Thorax surgery & percutaneous heart interventions"
Expert Network 2005-04-08 - Change recommended
Steering Group 2005-04-19 - Recommendation accepted

BACKGROUND:
A Nordic working group was established in 2003, to analyse and discuss grouping of thorax surgery and percutaneous heart interventions. It was expected that all relevant DRG's should be discussed with respect to clinical practice and analysed for resource use, and that suggestions for logic rule changes should be presented in February 2005.
The DRG's included were DRG 75, 76 and 77 in MDC 04 and the following DRG's in MDC05: DRG 103, 104, 105, 106, 107, 108, 110, 111, 112, 115, 116, 117, 118, 120, 124, 125.

There were 11 suggestions in total, and all of them are presented in the Forum split into clinical entities.

The suggested reorganizing of pacemaker procedures is presented here.
The group has especially had focus on grouping of ICD. A former suggestion from the first Nordic thorax surgery group for new grouping of biventricular pacemaker is also included.

There is no empirical cost or activity data for biventricular pacemaker so far, but the change is still recommended.

COMMENTS:
Per Sjöli/Mona Heurgren, Sweden 2005-03-31
In the following comments we will give the final results from the analysis of the suggestions in "Hjertegruppen". All the suggestions and discussions can be found in the project report from "Hjertegruppen" written by Leena Kiviluoto. There is also an excel file attached to the comments with the statistics for the DRGs in MDC 5 before and after all the changes, table MDC 05 final proposals 2005

All analyses have been preformed on the national Swedish cost database 2002 and 2003.The overall result of the new grouping suggestion for MDC 4 and 5 is that the explanatory value (r2) increases with 4,4% from 0,593 to 0,619. The suggestion to a new logic for MDC 05 in all comprises 5-7 new groups.

Reorganization of DRG 115-118 - analysis of the new logic according to the suggestion in the case, inliers only:

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The new grouping logic is working from an economical perspective (except from DRG 116) and the new groups fulfill the criteria for split, less variation in most groups (not 1118N), more then 20% difference in average cost and sufficient No of cases in the new groups.

We think there should be no new DRG for biventricular pacemakers since there are no cases in the group. The group 116 can be saved for later when we have more information.
Expert Network 2005-04-08
The meeting recommended that DRG 115-118 are reorganised to 3 new DRG's:
DRG 115A: Revision or explantation of permanent pacemaker or ICD (Implantable Cardiac Defibrillator) (FPE40, FPH00, TFP00, FPJ00)
DRG 115B: Implantation or replacement of permanent univentricular pacemaker (FPEOO, FPE10, FPE20, FPE30, FPE96, FPF*)
DRG 115C: Implantation or replacement of ICD (Implantable Cardiac Defibrillator) (FPG*)
The proposed DRG 116 cannot be created because the necessary code does not exist yet.

CHANGES
Technical changes:
Three new DRG's are created
DRG 115A: 'Revision or removal of permanent pacemaker or defibrillator'
DRG 115B: 'Implantation or replacement of permanent pacemaker'
DRG 115C: Implantation or replacement of cardiac defibrillator

Three new procedure properties are created
05S40 'Implantation of cardiac defibrillator'
This procedure property will be given to all codes in the FPSG (FPG) –group.

05S41 'Implantation of pacemaker'
Following procedures will be given this procedure property:
FPSE00 (FPE00), FPSE10 (FPE10), FPSE20 (FPE20), FPSE30 (FPE30), FPSE25 (FPE26) FPSE96 (FPE96) and all codes in the FPSF –group.

05S42 'Revision or removal of pacemaker or defibrillator'
Following procedures will be given this procedure property:
FPSE42, FPSE44, FPSE49 (FPE40), all codes in the FPSH (FPH) –group, FPXA00, FPXX00 (TFP00) and all codes in the FPSJ (FPJ) –group.

The six rules for DRG 115 (currently 405D11013 - 405D11034) are replaced by three rules.
The first rule can be created from the first of the current DRG 115 rules. DRG is replaced by 115C. The procedure property 05S13 is replaced by 05S40. Dgcat1 05M01 is removed as is Secproc1 05S14.
The second rule can be created from the second of the current DRG 115 rules. DRG is replaced by 115B The Procpro1 05S30 is replaced by 05S41. Dgcat1 05M01 is removed.
The third rule can be created from the third of the current DRG 115 rules. DRG is replaced by 115A The Procpro1 05S13 is replaced by 05S42. Dgcat1 05M03 is removed as is Secproc1 05S14.

All rules for DRG 116 (currently 405D11111 - 405D11121), DRG 117 (currently 405D161) and DRG 118 ( currently 405D171) are inactivated.

The three rules for DRG 115O (currently 105D11010 - 105D11120) are modified in following way:
In the first rule Procpro1 is changed to '05S40' and secproc1 05S14 is removed.
In the second rule Procpro1 is changed to '05S41'.
In the third rule Procpro1 is changed to '05S42'

The rules for DRG 117O (currently 105D170) and DRG 118O (currently 105D160) are inactivated.
DRG change:
Pacemaker and defibrillator procedures will be assigned to the 3 new DRG's.
Cases which earlier have been assigned to 116-118 will now been grouping to conservative DRG
Introduction:
NordDRG 2006

History

#1 Updated by Anonymous almost 5 years ago

  • Old forum status set to CLOSITEM - Closed item

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