Questions and answers #513

Possible change of the PROCPROP of KGV30 and KGV40 (implementation or revision of penile prosthesis)

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

Status:ActiveStart date:2017-01-20
Priority:MajorDue date:
Assignee:Kristiina KahurSpent time:-
Category:-
Initiator:Finland Target year:2018
MDC:MDC12 Owner / responsible:National organisations
Target Grouper:COMMON Old forum status:

Description

Problem
According to current logic the cases with procedure code KGV30/KGSV30 Implantation of prosthesis into penis and KGV40/KGSV40 Revision of penile prosthesis both have OR=1, and PROCPRO 12S02 (Penis procedure). In addition, code KGV30 has PROCPRO 11S07 (Other kidney or urinary tract OR procedure). The cases end up in DRG 341/341O (Penis procedures/short therapy) depending on the care setting.
The mean cost of DRG 341O is 1 429 EUR, while the cases with KGV30/40 in the same group cost in average 13 007 EUR. The difference is remarkable. The same applies to inpatient cases, the mean cost of DRG 341 is ca 6 000 EUR while the mean cost of KGV30/40 cases is twice as much.
The analysis was conducted to find out alternatives for accommodating the cases with procedure code KGV30/40.

Analysis
As the number of cases with procedure code KGV30/40 is relatively low (# 21 in 2015) it is not recommended to create a separate DRG for those cases.
The other option is to add the cases with KGV30/40 to DRG 307P Artificial urethral sphincter procedure, short therapy, or 307N Artificial urethral sphincter procedure. For that the cost analysis was performed.
The results of the cost analysis show that the mean cost of outpatient cases of KGV30/40 is almost two times higher than mean cost of DRG 307P. Inpatient cases are more comparable, 12 048 EUR (KGV30/40 cases) vs 10 553 EUR (DRG 307N).
Thus, the cost analysis does not support too much merging the KGV30/40 cases into DRGs 307P/N, especially, when it comes to short therapy cases.

Suggestion
Based on the cost analysis we could not find the best solution for cases with procedure code KGV30/40, still we are not satisfied with current grouping rules either.
We would like to discuss the case in Expertnetwork and see if it is the problem in other countries too and what would be the solution.

DRG change
No changes until the case will be discussed in Expernetwork meeting.

Technical changes
Will be provided later if needed.

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

MDC12_KGV30_40_into_307P_N_Appendix1.xlsx - Appendix 1 (12.3 KB) Kristiina Kahur, 2017-01-20 11:33

History

#1 Updated by Kristiina Kahur over 2 years ago

  • Target Grouper COMMON added

#2 Updated by Martti Virtanen over 2 years ago

  • Tracker changed from Case to Questions and answers

2017-03-09 Martti Virtanen
No proposal, no case. Question is relevant.

#3 Updated by Kristiina Kahur almost 2 years ago

Finnish National DRG-Centre 11-1-2018

We would like to keep that case active but postpone it to 2019 unless any other country has found a good solution for that.
There is increasing number of cases with procedure code KGV30 or KGV40 - 17 in 2014, 21 in 2015, and 24 in 2016. Yet, it is not enough for separate DRG, so we would wait another year to see whether or not the increasing trend will continue and come up a decision.

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