Case #512

New DRG for Transurethral incision of prostate, TUIP

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

Status:AcceptedStart date:2017-01-20
Priority:MajorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2017
Initiator:Finland Target year:2018
MDC: Owner / responsible:National organisations
Target Grouper:COMMON Old forum status:

Description

Original title
DRG 345O Other male reproductive system o. r. procedures, short therapy – splitting into three groups + revising DRG 311O Transurethral procedures, short therapy
Problem
DRG 345O Other male reproductive system o. r. procedures, short therapy is a heterogeneous group, both, in terms of cost but also in terms of clinical content.
DRG 345O (as its name reveals) contains different OR procedures which are not always clinically meaningfulness and economically homogenous.
Based on that the further analysis of DRG 345O was carried out.

Analysis
The variation coefficient of DRG 345O is 123% in 2014 and 130% in 2015. There are many peaks within the group showing the uneven distribution of the cases based on cost but also based on clinical meaningfulness.
During the analysis the subgroups were analyzed, and the results show that it would be possible to separate three different groups, based on clinical and economical meaningfulness.

1) The cases with procedure code KED33/KESD33 Transurethral incision of prostate, TUIP. Some of those cases are currently also grouped to DRG 311O Transurethral procedures, short therapy. The reason for this is that KED33 has two PROCPROPs, 12S08 Other male reproductive system OR procedure, and 11S05 Transurethral procedures (no prostatectomy). Depending on main diagnosis, the cases with KED33 group whether to DRG345O (MDC12) or 311O (MDC11).
2) The cases with procedure code KEB00/KESB00 Biopsy of prostate. Vast majority of cases are currently in DRG 345O.
3) The remaining cases DRG 345O.

In terms of costs, the mean cost of TUIP cases is 1 771 EUR in 2014, and 1 632 EUR in 2015.
The prostate biopsy cases (KEB00) are the cheapest, mean cost 278 EUR in 2014, and 321 EUR in 2015.
The rest of the cases have the mean cost 2 352 EUR in 2014, and 2 441 EUR in 2015.
Thus, there are clearly three different subgroups based on cost and on clinical meaningfulness.

Suggestion
Based on the analysis we suggest following changes:

a) The cases with procedure code KED33 (from DRGs345O and 311O) create a new DRG;
b) The cases with procedure code KEB00 create a new DRG;
c) Rest of the cases in current DRG 345O remain in current DRG 345O.

DRG change
After the suggested change the cases currently in DRG 345O and partially in DRG 311O will be grouped into three separate DRGs depending on performed procedures.

Technical changes
Description of technical changes is challenging because codes KED33 and KEB00 both have the PROCPROPs of two different MDCs (11 and 12).
We suggest to discuss the content of the case in Expertnetwork first and only then come up with technical changes.

Cost analysis
Appendix 1. Cost analysis is based on five university hospital data of 2015, grouped with Finnish 2017 grouper, data of 2014, grouped with 2016 grouper, and data of 2013, grouped with 2014 grouper.

MDC12_DRG345O_split_Appendix1.xlsx - Appendix 1 (13.7 KB) Kristiina Kahur, 2017-01-20 08:08

#512_FIN_technical_changes.xlsx - Appendix #512_FIN_technical_changes (23.4 KB) Kristiina Kahur, 2017-03-31 08:53

Technical changes case #512.xlsx (32 KB) Martti Virtanen, 2017-06-27 13:30

History

#1 Updated by Kristiina Kahur over 4 years ago

  • Target Grouper COMMON added

#2 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden, 2017-03-03 (NPK ID C681)
We do not want this change in the SWE version because the groups will be too small. In our outpatient KPP database for 2015 there were only 94 cases with KEB00 and only 50 with KED33 (=KED32 in SWE).

#3 Updated by Martti Virtanen over 4 years ago

2017-03-09 Martti Virtanen
Technical changes document would be usefull.
The difference between Sweden and Finland is suprising. Are there really so few cases even among the outpatients?

#4 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-10

As mentioned in the original suggestion, provision of correct technical changes remains out of our reach given the current competence and experience of the staff of Finnish National DRG-centre with description of technical changes.
Nevertheless, we are eager to learn and would be glad to get some assistance from NCC or other colleagues after the case will be discussed in the meeting.

As for the few number of cases, is it possible that the coding of given procedures is different in Sweden and the actual number might be higher though? What about Norway?

#5 Updated by Kristin Dahlen over 4 years ago

The groups will be too small according to what we observe in the Norwegian data as well, so we do not support the suggested split.

#6 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-29

We would like to make the changes in Finnish 2018 version according to the original proposal.
As mentioned before, the technical changes in that case are challenging but we come up with draft of technical changes asap and kindly ask for Martti’s help to check them and modify if needed.

#7 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-31

Given the big variance in coding of prostate biopsy in Finnish hospitals, we modified the original proposal and would like to introduce one new DRG for Transurethral incision of prostate, TUIP instead of splitting DRG 345O into three new DRGs. It means that we will not introduce new DRG in 2018 for prostate biopsy for reasons mentioned above.

During 2017 we will have closer look at coding of prostate biopsy and map the situation. In addition, we will conduct economic analysis, and come up with new proposal next year if data support it. By doing that the solutions in other countries will be taken into account as well (see case #482).

Thus, the technical changes will concern only the NCSP code KED33/KESD33 Transurethral incision of prostate, TUIP. The rules of new DRG will be between the current rules of DRG 311O and 345O. The procedure code will be given new property -11S12-11S20, OR property will remain the same (OR=1), PROCPROs 11S05 and 12S08 will be removed.
Since the new DRG will use the main diagnosis from MDC11 and MDC12, this will be taken into account in technical changes (see Appendix #512_FIN_technical_changes). In case that approach is not correct, and/or there are mistakes in technical changes, we would be glad to get the feedback and make corrections.

#8 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#9 Updated by Martti Virtanen over 4 years ago

  • Subject changed from DRG 345O Other male reproductive system o. r. procedures, short therapy – splitting into three groups + revising DRG 311O Transurethral procedures, short therapy to New DRG for Transurethral incision of prostate, TUIP
  • Description updated (diff)

#10 Updated by Martti Virtanen over 4 years ago

2017-03-13 Expert group
Expert gorup postponed the case for further analysis by Finland. For other countries the proposal was not acceptable in the current format.

#11 Updated by Kristiina Kahur over 4 years ago

Kristiina Kahur/Finnish National DRG-centre 2017-4-25

Just would like to clarify that the case was postponed for couple of weeks after expertnetwork meeting to allow Finland to conduct more thorough analysis and come up with updated proposal which we did on 3rd of March 2017 (see comment above).
It means that we would like the change in 2018 FIN version to make happen according to updated proposal.

#12 Updated by Martti Virtanen over 4 years ago

  • File Technical changes case #512.xlsx added

2017-04-25 Martti Virtanen
The modified case affects only NordDRG Fin and can therefore be introduced in 2018 version of NordDRG Fin.
However, the properties 11S05 and 12S08 cannot be removed from KESD33 since they are needed for other NordDRG versions and for inpatient assignment even in NordDRG Fin. This is illustrated by the logic table of Technical changes.

#13 Updated by Martti Virtanen over 4 years ago

2017-06-27 Martti Virtanen
The propety 11S12 was already used by Case #503 and must be changed. I made in 11S20 instead.
Technincal changes have been changed accordingly.

#14 Updated by Martti Virtanen over 4 years ago

  • File deleted (Technical changes case #512.xlsx)

#15 Updated by Martti Virtanen almost 4 years ago

  • Status changed from Active to Accepted

Also available in: Atom PDF