Case #457

Merge of DRGs 481P and 481B

Added by Kristiina Kahur over 5 years ago. Updated over 4 years ago.

Status:RejectedStart date:2016-01-27
Priority:MinorSpent time:-
Assignee:Kristiina Kahur
Target version:Expert Group 2016
Initiator:Finland Target year:2017
MDC:MDC17 Owner / responsible:National organisations
Target Grouper:FIN Old forum status:


There have been no cases in DRG 481P (Allogenic stem cell transfer, short therapy; Allogen stamcellstransplantation, kort vård) in 2013 in five Finnish University hospital. Unlikely there will be any (or if there will be any then very few) mainly due to the clinical characteristics of the patients in need of stem cell transfer.
We suggest merging the DRGs 481P and 481B (Allogenic stem cell transfer, age >17; Allogen stamcellstransplantation, >17 år) so that the length of stay has no effect on grouping anymore.
There have been 72 cases in DRG 481B in 2013, mean cost 63 957 EUR, stdev 17 261 EUR and V% 72%.


#1 Updated by Anonymous over 5 years ago

  • Target version set to Expert Group 2016
  • Case type set to Minor

#2 Updated by Ralph Dahlgren over 5 years ago

Out of Swedish perspective we do not accept this suggestion. And we do not want it to be done for the Swedish NordDRG system.
First of all we do not want the out-patients and incare patients to be grouped to the same DRG. That is one rule that we follow. If other countries wants to do differently that is up to each and everyone to decide.
The corresponding Swedish DRG are R22O Allogen stamcellstransplantation, öppenvård and R20N Allogen stamcellstransplantation, >17 år. We have some cases in DRG R22O and we will look inte what to do with this DRG R22O and the cases. Due to the fact that these cases are very inexpensive compared to DRG 20N which has a mean cost of ~587 000 SEK we definitely do not want the outpatiens to be grouped to the same DRG as inpatients.
Sweden will eventually make a new case concerning R22O but then in a new case to be discussed later.

#3 Updated by Kristiina Kahur over 5 years ago

Finnish National DRG-Centre 2016-2-25

Thank you for your comments and feedback.
We agree on and respect the principle of not merging the outpatient and inpatient DRGs. Therefore we suggest to remove the rule of DRG 481P (100D200000) instead of merging it with one of DRG 481B.
As there have been no cases in DRG 481P so far, this change should not cause any changes in DRG grouping. Nevertheless, in unlikely event the cases which may group to DRG 481P will be grouped to other outpatient DRGs according to diagnosis and procedure codes of given cases.
We are looking forward to discussing this issue once Sweden has come up with new case concerning allogenic stem cell transfer, short therapy.

#4 Updated by Kristin Dahlen over 5 years ago

Norwegian Directorate of Health, 10.03.2016

We agree with Sweden in the principle of not merging the outpatient and inpatient DRGs. We have a few cases in DRG 481P. We suggest to postpone this case as we need to discuss a good solution for grouping these cases.

#5 Updated by Martti Virtanen over 5 years ago

2016-03-15 Expert group (MV)
The case was postponed for further analysis based on the second proposal from Finland.

#6 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden, 2017-03-01
This case is related to case #456 ‘Merge of DRGs 481O and 481A’ because both cases are about stem cell transplantation on outpatients. As said in case #456 we have quite few patients in DRG R22O/481P‘Allogen stamcellstransplantation, öppenvård’/’Allogenic stem cell transfer, short therapy’:
• 2013 – 5 cases with average cost approx. 3 500 SEK
• 2014 – 4 cases with average cost approx. 6 200 SEK
• 2015 – 10 cases with average cost approx. 12 000 SEK which is almost the same as the average cost for the 73 cases in DRG R23O/481O. The median cost was just 5 300 SEK, however, indicating a very wide cost distribution.
One could consider merging DRG R22O/481P to DRG R23O/481O due to the low numbers and the medical similarity but the difference in costs seems too big. We will follow cost data for next year and discuss a merging with the profession. Perhaps a merging is possible despite the cost difference if the proportion of allogenic stem cell transfer in relation to other stem cell transfer is approximately the same all over the hospitals that are dealing with this kind of treatment. But so far we do not want any changes for DRG R22O/481P.

#7 Updated by Martti Virtanen over 4 years ago

  • Status changed from Active to Rejected

2017-03-13 Expert group
Merging outpatient and inpatient is not possible. Other options do not work.
Thus no changes can be done.

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