Case #505

DRG 458 Non-extensive burns with skin graft– splitting into two groups– with and without general anesthesia

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

Status:AcceptedStart date:2017-01-17
Priority:NormalSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2017
Initiator:Finland Target year:2018
MDC:MDC22 Owner / responsible:National organisations
Target Grouper:COMMON Old forum status:

Description

Problem
The variation coefficient of DRG 458 has been high throughout the years (170% in 2015, 123% in 2014) which was the indication for further analysis of the content of DRG 458.

Analysis
The results of the analysis show that the cases with general anesthesia (procedure code WX408/WAA408 Balanced anesthesia) appear to be in average 2,5 times more expensive than the cases without anesthesia (ca 25 000 EUR versus 10 000 EUR in 2015).
Nevertheless, the homogeneity of cases with anesthesia within DRG 458 remains relatively high, 158% (2015). By trimming 1% of the high-end cases, the V% decreases by more than 30% (158% -> 123%).
The cases without anesthesia in DRG 458 create relatively homogeneous group, V% 97% (after trimming 72%).

Suggestion
Given the big difference of mean cost between two groups within DRG 458 depending on use of general anesthesia, we propose to split DRG 458 into two:

a) Non-extensive burns with skin graft with general anesthesia
b) Non-extensive burns with skin graft without general anesthesia

DRG change
After the suggested change the cases in current DRG 458 will be grouped into separate DRGs depending on whether or not general anesthesia has been performed, 458A and 458B respectively.

Technical changes
Appendix 2. The technical changes may contain mistakes and have to be used with caution.

Cost analysis
Appendix 1. Cost analysis is based on five university hospital data of 2015, grouped with Finnish 2017 grouper, and data of 2014, grouped with Finnish 2016 grouper.

MDC22_Burns_DRG458_split_Appendix1.xlsx - Appendix 1 (11.7 KB) Kristiina Kahur, 2017-01-17 11:48

MDC22_Burns_DRG458_split_Appendix2.xlsx - Appendix 2 (15.2 KB) Kristiina Kahur, 2017-01-17 11:51

Appendix #505 SWE 2017.xlsx (9.15 KB) Mats Fernström, 2017-03-02 15:38

Technical changes case #505.xlsx (26.5 KB) Martti Virtanen, 2017-05-02 15:22

History

#1 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden 2017-03-02 (NPK ID C677)
We do not want this change in the Swedish version for several reasons:
• To split inpatient DRGs into “with” and “without” anesthesia is a new principle that we don’t like. The principle could be applied on several DRGs which will create too many groups and the system becomes more like a reimbursement system than a descriptive system.
• In this particular case, the number of cases in the group with anesthesia will be too small in Sweden; only 23 cases (see Appendix #505 SWE 2017.xlsx).
• Swedish KPP data does not show that the cases with anesthesia are more expensive (see Appendix #505 SWE 2017.xlsx).

#2 Updated by Anja Fagervold over 4 years ago

We agree with Sweden in the principle of not splitting DRGs into groups "with" and "without" anesthesia. Also in Norway the number of cases with anesthesia in this DRG is very small.

#3 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#4 Updated by Martti Virtanen over 4 years ago

2017-03-13 Expert group
Expert group accepted the change only for NordDRG Fin.
The division by anaesthesia vs not was regarded as doubtfull.

It is worth to note that the interventions with OR=2 will be assigned with anaesthesia to DRG 458A, without anaesthesia to DRG 822O. Leaving away the OR=S on rule 422D041002 woul result in DRG 485B for these cases.

#5 Updated by Martti Virtanen almost 4 years ago

  • Status changed from Active to Accepted

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