Case #510

Merging DRGs 038 Primary iris procedures and DRG 042 Intraocular procedures except retina, iris and lens

Added by Kristiina Kahur almost 5 years ago. Updated almost 4 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
MDC:MDC02 Owner / responsible:National organisations
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE Old forum status:

Description

Problem
The number of cases in DRG 038 Primary iris procedures is low and presumably will be decreasing even more in coming years as shows the trend of the last three years when the number of cases has been decreased from 29 in 2013, 18 in 2014 to 12 in 2015. Given the small number of cases it would make sense to merge DRG 038 with another DRG.
The rationale behind the change is to merge decreasing number of inpatient cases with iris procedures into another DRG.

Analysis
Currently, there is separate groups for inpatient cases with iris procedure (DRG 038) and for intraocular procedures except retina, iris and lens (DRG 042).
DRG 042 is rather big and homogeneous group. The mean cost differs from DRG 038 to some extent.
By merging those two DRGs the V% would remain still relatively low since the number of cases in DRG 038 is low and the impact on cost data of merged groups is low as well.

Suggestion
Based on the analyses we suggest to merge DRGs 038 and 042.
The name of the merged DRG will be provided after the discussion in Expertnetwork meeting.

DRG change
After the suggested change the cases of DRG 038 will be grouped to DRG 042. The new name of the DRG 042 could be Intraocular procedures except retina and lens.

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_DRG038+042_merge_Appendix1.xlsx - Appendix 1 (10.7 KB) Kristiina Kahur, 2017-01-18 15:23

MDC2_Oftalmology_DRG038+042_merge_Appendix2.xlsx - Appendix 2 (15.6 KB) Kristiina Kahur, 2017-01-18 16:04

TC #510 C685.xlsx (22.2 KB) Ralph Dahlgren, 2017-04-11 12:02

TC #510 C685 updated.xlsx (19.8 KB) Mats Fernström, 2017-04-27 12:43

Technical changes case #510.xlsx (20.1 KB) Martti Virtanen, 2017-07-06 14:22

Technical changes case #510-2.xlsx (20.7 KB) Martti Virtanen, 2017-12-14 11:20

History

#1 Updated by Kristiina Kahur almost 5 years ago

  • File deleted (MDC2_Oftalmology_DRG038+042_merge_Appendix2.xlsx)

#3 Updated by Kristiina Kahur over 4 years ago

  • Target Grouper COMMON added

#4 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden, 2017-03-03 (NPK ID C685)
We support this. The corresponding Swedish DRGs are B11N (Primära operationer på iris) and B20 (Intraokulära operationer utom på retina, iris och lins). The latter is divided in B20C (complicated) and B20E (not complicated). In our KPP data for 2015 we had only 108 cases in DRG B11N and the average cost for these cases differed less than 20 % from the average cost for DRG B20.
The suggested DRG text “Intraocular procedures except retina and lens” is OK. In the SWE version we have to make a new DRG code. We cannot use B20 because our principle is that DRG codes on 3-digit levels shall have the same medical content and after this merging, the new group differs from both DRG B11O and B20O. We will instead have DRG B22C (Intraocular procedures except retina and lens w cc) and DRG B22E (Intraocular procedures except retina and lens w/o cc).

#5 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden 2017-03-09
If the changes suggested in case #516 and #517 are implemented, the remaining cases in the outpatient groups DRG 038O/B11O and DRG 042O/B20O will be very similar in costs according to Swedish cost data (see case #516) and they can also be merged like the inpatient groups in this case (#510). Then we don’t have to invent the new DRG codes B22 that was mentioned above.

#6 Updated by Ralph Dahlgren over 4 years ago

Ralph Dahlgren The National Board of Health and Welfare 2017-04-11
In the technical changes for Sweden some changes will be to the Swe-dish DRG B20E, B20C and B11N. This change is only in the table DRGlogic. There the change will be for the DRG code in column DRG. The DRG Swedish B20E and B20C will change to B22E and B22C. The two rows for the Swedish DRG B11N are also changed to B22E.
There are added a row for B22C directly above the existing lines for the old DRG rows for B11N. It is given the ord 402D060900. The only change compared to the line below is that it gets in the column compl "1".

In DRGnames tables are the 3 DRG codes and kodtexts removed. The new DRG will DRG B22E Intraocular surgeries except on the retina and lens, not complicated
and
B22C Intraocular surgeries except on the retina and lens, complicated
No other changes need to be made in the definition tables.
A test case is also done (may work?)..
See "TC # 510 C685.xlsx”

#7 Updated by Martti Virtanen over 4 years ago

  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR added

2017-03-13 Expert group
The mergin of inpatient DRG's 038 and 042 was accepted for all versions

#8 Updated by Martti Virtanen over 4 years ago

  • File Technical changes case #510.xlsx added

2017-04-26 Martti Virtanen
Technical changes for combined NordDRG based on Swedish and Finish proposals.

#9 Updated by Mats Fernström over 4 years ago

Mats Fernström, The National Board of Health and Welfare, Sweden 2017-04-27
For the sake of simplicity, we in principle accept Martti's technical changes, which means that we refrain from creating a new DRG (B22) and instead merely change the text to the existing B20C/E as specified in the attached Excel file (TC #510 C685 updated). Note that the English short texts for DRG 042C and 042N must be corrected in Martti’s file. "Except iris" is wrong because surgery on iris is included in the group.

#11 Updated by Martti Virtanen over 4 years ago

  • File deleted (Technical changes case #510.xlsx)

#12 Updated by Martti Virtanen almost 4 years ago

2017-12-14 Martti Virtanen
The content of the DRG 042(X) has been modified in this case and name was not changed accordingly.

042X 'Other Intraocular procedures'

Is more correct and corresponds with the change to DRG 042P (from 042O) in case #516.

#13 Updated by Martti Virtanen almost 4 years ago

  • Status changed from Active to Accepted

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