Case #509

Merging DRGs 040N Extraocular procedures except orbit age >17and DRG 041 Other interventions for problems in eye region, age 0-17

Added by Kristiina Kahur about 3 years ago. Updated about 2 years ago.

Status:AcceptedStart date:2017-01-18
Priority:NormalSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2017
Initiator:Finland Target year:2018
Case type:Major Owner / responsible:National organisations
MDC:MDC02 Old forum status:
Target Grouper:COMMON

Description

Problem
The number of cases in DRG 041 Other interventions for problems in eye region, age 0-17 is very low (4-5 per year) and the cost of the cases vary remarkably (1 000-13 943 EUR). With the aim to merge DRG 041 with suitable other DRG an analysis was carried out.

Analysis
Based on the grouping logic the respective DRG for adults would be 040N Extraocular procedures except orbit age >17.
The mean cost of DRG 041 vary throughout the years ranging from 1 000 to 13 943 EUR, as does V% (19%-124%).
The cases of DRG 041 are random with high cost variance, the mean cost does not differ from this of 040N remarkable though. Therefore the cases of DRG 041 do not have essential impact on DRG 040N in case two DRGs were merged. Based on 2015 data the V% of merged DRGs would even decrease. Same with 2014 on in case the most expensive case in DRG 041 would be removed.

Suggestion
Based on the cost analyses we propose to merge DRGs 040N and 041.
The name of the DRG should be corrected. The suggestion is to name it ‘Extraocular procedures except orbit’ since the driver for grouping in both DRGs (040N and 041) are the procedures with PROCPROP ‘Extraocular procedure but not procedure of the orbit’.

DRG change
After the suggested change the cases of DRG 041 and DRG 040N will be grouped into the same DRG.

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.

MDC2_Oftalmology_DRG040N+041_merge_Appendix1.xlsx - Appendix 1 (11.4 KB) Kristiina Kahur, 2017-01-18 14:26

MDC2_Oftalmology_DRG040N+041_merge_Appendix2.xlsx - Appendix 2 (15.6 KB) Kristiina Kahur, 2017-01-18 14:26

Technical changes case #509-517-2.xlsx (66.4 KB) Martti Virtanen, 2017-06-15 14:09

History

#1 Updated by Kristiina Kahur about 3 years ago

  • Target Grouper COMMON added

#2 Updated by Susann Berggren almost 3 years ago

Susan Berggren NPK, Sweden 2017-03-02
Sweden has no age limit, so this is not an issue for Sweden

#3 Updated by Martti Virtanen almost 3 years ago

2017-03-13 Expert group
Accepted for all. (No effect on NordDRG Swe)
Countries may still react to retain the two groups in the national version(s).

#4 Updated by Martti Virtanen almost 3 years ago

  • File Technical changes case #509-517.xlsx added

2017-04-26 Martti Virtanen
This case is also closely related to the other ophtalmological changes. I have therefore combined the technical changes with cases #514, #515, #517 and #517.
The order of the rules is complicated and it has been changed from the proposal.

#6 Updated by Martti Virtanen over 2 years ago

  • File deleted (Technical changes case #509-517.xlsx)

#7 Updated by Martti Virtanen about 2 years ago

  • Status changed from Active to Accepted

Also available in: Atom PDF