Case #563

New outpatient DRG for catheter ablation

Added by Veronika Stemme over 2 years ago. Updated over 1 year ago.

Status:AcceptedStart date:2017-12-11
Priority:NormalSpent time:-
Assignee:Veronika Stemme
Category:-
Target version:Target version 2019
Initiator:Sweden Target year:2019
Case type:Major Owner / responsible:National organisations
MDC:MDC05 Old forum status:
Target Grouper:SWE

Description

Problem CPK-ID 713
Cardiologists have noted that catheter ablation procedures in outpatient health care are grouped to DRG E19O Perkutan kardiovask åtgärd (112O Percutaneous cardiovasc procedures, short therapy), this DRG contains many other procedures than ablations. Since the catheter ablations are more expensive than the mean of the other procedures in that DRG we suggest that a new DRG is created, corresponding to the inpatient DRG E17N Perkutan ablation för hjärtarytmi (112B Percutaneous ablation for cardiac arrhythmias). We suggest that the new DRG is called E17O Perkutan ablation för hjärtarytmi, öppenvård.
The outpatient DRG E19O does not correspond directly with the inpatient DRG E19N Perkutan vidgning av kranskärl, ej hjärtinfarkt (112C PCI w/o myocardial infarction, w/o CC). We suggest that E19O is deleted and replaced with a new DRG E22O ’Annan perkutan kardiovaskulär åtgärd, öppenvård’ (Other percutaneous cardiovascular procedure, short therapy), for percutaneous cardiovascular procedures other than ablation.

Analysis
National Board of Health and Welfare, Sweden – 2017-12-11
Data from Swedish KPP (cost per patient) 2015, DRG-grouper 2017):
Number of cases in DRG E19O/112O= 3059 cases, mean cost 35 828 SEK
Number of cases in DRG E19O/112O with ablation procedures (procpro 05S20 'Percutaneous ablation for cardiac arrhytmias') = 1272 cases, mean cost 44 542 SEK
Number of cases in DRG E19O/112O without ablation procedures = 1787 cases, mean cost 20 352 SEK
The cases with ablation procedures are more expensive than the other cases in DRG E19O/112O and it makes sense also for the medical description to lift out these cases to a separate DRG.
See file “Cost-data CPK-ID 713.xlsx”

Suggestion
A new outpatient DRG is created: E17O Perkutan ablation för hjärtarytmi, öppenvård. DRG E19O Perkutan kardiovask åtgärd (112O Percutaneous cardiovasc procedures) is deleted. A new DRG E22O ’Annan perkutan kardiovaskulär åtgärd, öppenvård’ (Other percutaneous cardiovascular procedure, short therapy) is created.
See ‘Technical changes CPK-ID 713.xlsx’

Decided changes
Sweden wants this change to be introduced in the Swedish NordDRG 2019.

DRG change
Outpatient cases with percutaneous cardiovascular procedures are now directed to DRG E19O Perkutan kardiovask åtgärd (112O Percutaneous cardiovasc procedures).
These cases will after the change be directed to the new DRG E17O ‘Perkutan ablation för hjärtarytmi, öppenvård’ if they have procpro 05S20 'Percutaneous ablation for cardiac arrhytmias'. The other cases (with 05S16 'Other percutaneous cardiovascular procedures' or 05S25 'Percutaneous dilatation of coronary arteries') will be directed to the new DRG E22O ’Annan perkutan kardiovaskulär åtgärd, öppenvård’.

Technical change
DRG E19O ’Perkutana kardiovaskulära åtgärder, öppenvård’ is deleted.
DRG E22O ’Annan perkutan kardiovaskulär åtgärd, öppenvård’ is introduced, for procedures with PROCPR 05S16 or 05S25.
DRG E17O ’Perkutan ablation för hjärtarytmi, öppenvård’ is introduced, for procedures with PROCPR 05S20.

See ‘Technical changes CPK-ID 713.xlsx’

Cost-data CPK-ID 713.xlsx (11.4 KB) Veronika Stemme, 2017-12-11 14:33

112O_SWE_FIN.xlsx - Appendix 1 (9.09 KB) Kristiina Kahur, 2018-01-05 15:21

Technical changes CPK-ID 713.xlsx (19.6 KB) Veronika Stemme, 2018-02-22 13:21

Technical changes case #563.xlsx (18.2 KB) Martti Virtanen, 2018-02-26 14:33

Technical changes case #563-2.xlsx (18.9 KB) Martti Virtanen, 2018-05-22 23:14

Technical changes case #563-3.xlsx (127 KB) Martti Virtanen, 2018-12-12 12:08

History

#1 Updated by Veronika Stemme over 2 years ago

  • File Technical changes CPK-ID 713.xlsx added

#2 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-Centre 5-1-2018

Finnish cost data support this change.
The cases in DRG 112O with ablation (PROCPR 05S20) are remarkably more expensive compared to the ones w/o ablation (PROCPR 05S16 and 05S25).
In Sweden the difference in mean cost between the cases with or without ablation is 2.2 times whereas in Finland 1.5 times.
The comparison can be seen in appendix 1.

#3 Updated by Veronika Stemme over 2 years ago

  • File deleted (Technical changes CPK-ID 713.xlsx)

#4 Updated by Veronika Stemme over 2 years ago

Veronika Stemme, NPK Sweden
We send new Technical Changes for this case. We have changed the ORD for DRG E17O ’Perkutan ablation för hjärtarytmi, öppenvård’ and E22O ’Annan perkutan kardiovaskulär åtgärd, öppenvård’ to put the DRG for ablations higher in the hierarchy than the DRG for other percutaneous cardiovascular procedures.

#5 Updated by Martti Virtanen over 2 years ago

2012-02-26 Martti Virtanen
The proposed change is supported by cost data from both Finland and Sweden. It would be interesting to se the effect on variation (V%) but even this indicates that the change good.
The technical changes must include the ID of the rules to allow follow-up of rules.

#6 Updated by Martti Virtanen about 2 years ago

2017-05-23 Martti Virtanen
At the expert group Finland expressed the wish to use the same model as Sweden
The Finnis rules are different because the short therapy cases include all cases with duration < 2 days.
The Technical changes have been modified accordingly.

#7 Updated by Mats Fernström about 2 years ago

Mats Fernström, Sweden, 2018-05-23.
I have checked the lines in the table Drglogic that are relevant for the Swedish version in the file "Technical changes case #563-2.xlsx". There, the letter N is missing in the DISCH column. Otherwise it looks OK.

#8 Updated by Anja Fagervold about 2 years ago

This case was accepted for everybody according to the Minutes from Maisa (March 12th). Norway is not included in the technical changes, but we also want this change.

#9 Updated by Martti Virtanen over 1 year ago

2018-03-13 Expert group
The proposed change was accepted for all versions.
Thus the logic changes become less complex. To illustrate the question I have however added the sheets Proc and NCPS+ that include all affected codes. The Drgnames change is automatic, since DRG 112O will no more be used, it will dissappear.

#10 Updated by Martti Virtanen over 1 year ago

  • Status changed from Active to Accepted

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