Case #511

Merging DRGs 036A Other retinal procedures and DRG 036B Extensive procedure for retinal detachment

Added by Kristiina Kahur over 3 years ago. Updated over 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:SWE

Description

Problem
Originally the cases of retinal detachment procedures have had separate DRG 036B Extensive procedure for retinal detachment, and cases with other retinal procedures are grouped into DRG 036A Other retinal procedures.
DRG 036A is a group with small number of cases (<30 per year). Based on the opinion of ophthalmologists, it would be clinically meaningful to merge all inpatient cases with retinal procedures into one group, without keeping separate DRG for few cases meant for other retinal procedures.

Analysis
Cost analysis shows that the cases of DRG 036A and 036B differ to some extent from each other. By merging two groups the new mean cost would remain close to the mean cost of DRG 036B cases though which create the vast majority of the cases of the merged DRG. The variation coefficient remains relatively low as well (34% in 2014 and 38% in 2015).

Suggestion
Based on the analyses we suggest to merge DRGs 036A and 036B.

DRG change
After the suggested change the cases of DRG 036A will be grouped to DRG 036B. The name of DRG 036B could be Retina procedures.

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_DRG036A+036B_merge_Appendix1.xlsx - Appendix 1 (10.8 KB) Kristiina Kahur, 2017-01-18 16:14

MDC2_Oftalmology_DRG036A+036B_merge_Appendix2.xlsx - Appendix 2 (15.7 KB) Kristiina Kahur, 2017-01-18 16:14

MDC2_Oftalmology_DRG036A+036B_merge_Appendix2_update.xlsx - Appendix 2 (22.2 KB) Kristiina Kahur, 2017-03-09 12:08

TC #511 C686.xlsx (34.7 KB) Ralph Dahlgren, 2017-04-12 14:31

Technical changes case #511.xlsx (55.8 KB) Martti Virtanen, 2017-04-26 11:28

Technical changes case #511.xlsx (55.8 KB) Martti Virtanen, 2017-05-19 13:00

Technical changes for Sweden #511, C686 20170809.xlsx (14.4 KB) Ralph Dahlgren, 2017-08-09 08:16

History

#1 Updated by Kristiina Kahur over 3 years ago

  • Target Grouper COMMON added

#2 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden 2017-03-03 (NPK ID C686)
We support this splendid suggestion and it is already implemented in our outpatient logic (DRG B04O Operationer på retina, öppenvård).
The corresponding Swedish inpatient groups to DRG 036A and 036B are DRG B03N (Andra operationer på retina) and DRG B02N (Operationer vid retinaavlossning), respectively. In KPP 2015 we had only 63 cases in DRG B03N and the average cost for these cases differed by just 4 % from the average cost for DRG B02N (untrimmed). In the Swedish version we will delete both DRG B02N and DRG B03N since the merged group will be DRG B04N.
(If the merging is done in all versions there is no longer need for both 02S02 and 02S21. Procedures with 02S21 can be given 02S02 (most of them already have 02S02) and 02S21 can be deleted from the system.)

#3 Updated by Martti Virtanen over 3 years ago

2017-03-09 Martti Virtanen
The technical changes lacks the procedure property changes. The codes without 02S02 but with 02S21 need consideration. 02S21 becomes inactive with the proposed change.

#4 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-centre 2017-3-9

Technical changes are updated and added to the proposal.
It might be that technical changes still are not correct. If so, some additional training is needed.

#5 Updated by Ralph Dahlgren over 3 years ago

20170412. Sweden has tried to make technical Changes to this case #511.
Se file "TC #511 C686.xlsx"

#6 Updated by Martti Virtanen about 3 years ago

2017-03-13 Expert group
Accepted in principal but need checkup for the procedure propeties. In the proposed format, the procedure property 02S21 becomes inactive since all codes with 02S21 will have 02S02 instead.
Countries may still react to this, and an alternative model can be devoled.

#7 Updated by Martti Virtanen about 3 years ago

2017-04-26 Martti Virtanen
Based on proposals from Sweden and Finland I have completed the technicak changes of the combined version for this case.
Automatically inactivated properties remain in the system but do not appear in the produced definition tables.
The affected national codes can be listed from ICD+ and NCSP+ sheets.
The DRG code for the modified group in NDMS is 036E (not 036B) because Sweden has defined a new DRG code for the modified group.
The national names and codes of the modified DRG for Sweden and Finland (036E/036B?) are available in the proposals from these countries
The national DRG code for the modifed DRG can also be defined in the DRGnames table.
National names are the responsibility of the national organisations.

#8 Updated by Ralph Dahlgren about 3 years ago

2017-04-28
Going through the case again Sweden realised that the DRG name for the Swedish DRG B04N had in the Swedish technical Changes gotten the wrong name. The long and short text should be "Operationer på näthinna" and "Operationer på näthinna".

#9 Updated by Kristin Dahlen about 3 years ago

As we understand from the technical changes 02X03 will be inactivated. This property is in use by a rule for DRG 36O. Do this rule need a change?

#10 Updated by Ralph Dahlgren about 3 years ago

2017-05-04.
Thank you Kristin for noticing this.
Sweden uses the same grouping property for the Swedish DRG B04O Operationer på retina, öppenvård, this corresponding to DRG 036O Retinal procedures, short therapy.
To correct this the technical changes should be changed for this case. All the diagnosi that have dg prop 02X03 should keep this property and naturally the property itself should be kept.
Martti, please correct me if I am wrong, we need to get this right.

#11 Updated by Martti Virtanen about 3 years ago

2017-05-19 Martti Virtanen
The comment from Kristin is obviously correct. The diagnosis properties that will not disappear. I had already marked, that no active inactivation will be done. However, this means that the properties will stay active.
I have corrected the definition tables accordingly.

#12 Updated by Ralph Dahlgren almost 3 years ago

20170809
This is a clarification concerning the Swedish definition tables and are a clarification of the Swedish Technical changes that concerns only changes in DRG logic, an “ord” change for Sweden concerning DRG B01N Andra större operationer på ögat.
This “ord” change are only done in Sweden.
The other technical changes that concerns this case are the same as before.
This clarification is done after Liselott Säll made a good and adequate comment about the fact that Sweden made a change in the Swedish definition tables in DRGlogic "ord".concerning this case without making a comment on Forum so that everyone can see what has been done.
The change in “ord” for DRG B01N is done so that the Swedish data will be grouped properly and in a way Sweden understood. After the change the cases involved are grouped to the right DRGs.

#13 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Accepted

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