Case #568

Division of DRG 359O 'Uterine and adnexal procedures for non-malignancy, short therapy' to 3 DRG's

Added by Kristiina Kahur over 1 year ago. Updated about 1 month ago.

Status:AcceptedStart date:2017-12-28
Priority:MajorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Target version 2019
Initiator:Finland Target year:2019
Case type: Owner / responsible:National organisations
MDC:MDC13 Old forum status:
Target Grouper:FIN

Description

Problem
The case concerns DRG 359O (Uterine and adnexal procedures for non-malignancy, short therapy) which includes clinically heterogeneous procedures which, in turn, create the economical heterogeneity within the group. Currently all procedures in DRG 359O have the property 13S02 (Uterine or adnexal procedure), in total 139 different procedures.

Analysis
For analysis, the data of five Finnish university was used.
Total number of cases in DRG 359O was 8019, V% 80% and mean cost 1656 EUR.
The procedures with property 12S02 were analyzed in order to find the cost differences depending on the general method of the procedure (procedure group). For that, three-character level of NCSP code was used. The procedures with PROCPR 13S02 were divided into 23 different groups based on NCSP structure (see appendix 1).
Based on clinical content and cost, the procedures can be divided into three groups:
1) Excision or reconstructive operation on female reproductive organs (# of cases 1095, V% 34%, mean cost 3230 EUR)
2) Uterine or adnexal procedure (4077, 61%, 1370 EUR)
3) Transfer of embryo (1155, 49%, 434 EUR).
In addition, the cases with procedure LAA06/LASA06 Transvaginal puncture of ovarian cyst, are remarkably cheaper than other cases in DRG 359O and they would fit better to DRG 813O instead of DRG 359O.
The mean cost of cases with LAA06 is 393 EUR, V% 14% and # of cases 647.
The mean cost of DRG 813O is 386 EUR.

DRG 359 was also analyzed. The result shows that 84% of the cases belong to the category Excision or reconstructive operation on female reproductive organs, the group is homogeneous (V% 43%), and there is no need for changes in this DRG.

Suggestion
Based on the analysis, we suggest creating two new DRGs in addition to current 359O. For that, two new PROCPRs have to be created.
In addition, it is suggested to remove the PROCPR 13S02 from procedure LAA06 and replace OR=1 by OR=2 to allow the grouping of the respective cases to DRG 813O.

DRG change
After the suggested changes the outpatient cases with excision or reconstructive operation on female reproductive organs (new PROCPR 13S21), and transfer of embryo (new PROCPR 13S22) will be grouped to respective new DRGs. Other cases with PROCPR Uterine or adnexal procedure (PROPR 13S02) will remain in current DRG 359O.
The codes of new DRGs has to be decided. Preliminary codes used for technical changes are:
359N Excision or reconstructive operation on female reproductive organs, short therapy and
359P Transfer of embryo, short therapy.
The name of 359O should be corrected as follows: Other uterine and adnexal procedures for non-malignancy, short therapy.

The cases with procedure LAA06 and diagnosis from MDC13 will be grouped to DRG 813O.

Technical changes
Appendix 2. The technical changes may contain mistakes and have to be used with caution.

Cost analysis
Appendix 3. Cost analysis is based on five university hospitals’ data of year 2015, grouped with Finnish 2018 grouper.

Appendix3_359O_cost_analysis.xlsx - Appendix 3 (12 KB) Kristiina Kahur, 2017-12-28 10:55

Appendix1_359O_NCSP_codes.xlsx - Appendix 1 (17.5 KB) Kristiina Kahur, 2017-12-28 10:55

Appendix2_359O_technical_changes.xlsx - Appendix 2 (36.9 KB) Kristiina Kahur, 2018-01-15 16:41

Technical changes case #568.xlsx (70.1 KB) Martti Virtanen, 2018-02-27 15:41

Suggestion #568 with SWE data.xlsx (38.5 KB) Mats Fernström, 2018-02-28 17:49

Technical changes case #568&573.xlsx (72.9 KB) Martti Virtanen, 2018-02-28 18:32

TC #434 C616 att använda 20180417.xlsx (21.1 KB) Ralph Dahlgren, 2018-04-18 08:32

Technical changes case #568&573 - 2.xlsx (72.6 KB) Martti Virtanen, 2018-12-17 11:37

History

#1 Updated by Kristiina Kahur over 1 year ago

  • File Appendix2_359O_technical_changes_corrected.xlsx added

Finnish National DRG-Centre 29-12-2017

The technical changes have been updated.
We didn't suggest any changes in DRG 359. However, there is need to correct the rules because two additional PROCPR were added and the procedures with new PROCPRs should still group to DRG 359. Hence the Appendix 2 was replaced with corrected one.

#2 Updated by Kristiina Kahur over 1 year ago

  • File deleted (Appendix2_359O_technical_changes.xlsx)

#3 Updated by Kristiina Kahur over 1 year ago

Finnish National DRG-Centre 15-1-2018

In the text "Transfer of embryo" should be replaced by "Intervention on embryo or ICSI".
The suggested name of new DRG 359P should be replaced by "Intervention on embryo or ICSI, short therapy".

#4 Updated by Kristiina Kahur over 1 year ago

  • File deleted (Appendix2_359O_technical_changes_corrected.xlsx)

#5 Updated by Hanne Osnes-Ringen about 1 year ago

We support a change in the DRG 359O, however we do not support a tripartite of the DRG. Our data on costs are relative homogenous for all the other procedures in DRG359O, except for the fertilization procedures.
We therefore support that the fertilization procedures is taken out the DRG 359O. We would like these fertilization procedures to be included in DRG 813R “Assisted fertilization”.
DRG 813R already includes similar procedures with similar costs.

#6 Updated by Martti Virtanen about 1 year ago

  • Subject changed from Revision of DRG 359O Uterine and adnexal procedures for non-malignancy, short therapy to Division of DRG 359O 'Uterine and adnexal procedures for non-malignancy, short therapy' to 3 DRG's

#7 Updated by Martti Virtanen about 1 year ago

2018-02-27 Martti Virtanen
The proposed change is well described and economically analyzed.

The proposed change will affect other countries.

By a small correction the effects can be minimized.
The property 13S02 is retained by all interventions that currently have it. It is called 'Uterine or adnexal procedure including intervention on embryo or ICSI'.
The new property 13S21 'Excision or reconstructive operation on female reproductive organs' is given to the procedures planned by Finland
The new property 13S22 'Other uterine or adnexal procedure' is given to all procedures that were planned to retain 13S02 in the Finnish model.
In the logic, 2 new rows are created for the new DRG's. If Finland as only country will use the new logic these rows are for Finland only and there will be a third row to adjust for the difference between Finland and Den/Est/Ice/Lat/Nor. Swedish version does not demand any changes.
If Com/Den/Est/Ice/Lat/Nor want to join Finland, they are removed from the original rule and added to the Finnish rules. If Sweden wants to join, 2 new rules must be added for Swe.
The midle level DRG is most close to the original and should have DRG code 359N. Therefor the order of the new rules is mixed.
For inpatients no change is needed except that second Fin rule must be combined with Com/Den/Est/Ice/Lat/Nor because the rule is identical. (An obvious error by me when combining the tables.)

The change for LASA06 'Transvaginal puncture of ovarian cyst' demands that all countries agree. The removal of 13S02 and changing OR=1 to OR=2 will cause a small changes to all countries. Technically it is difficult to do the proposed change in any other way

#8 Updated by Mats Fernström about 1 year ago

Mats Fernström, NPK, Sweden 2018-02-28 (NPK ID C666)
DRG 359O corresponds to the Swedish DRG O15O ’Operationer på uterus och adnex för benign sjukdom, öppenvård’ and we have also noticed the heterogeneity and we had planned a revision but now we can hopefully use this Finnish model instead. We have mapped the NCSP+ codes in Marttis technical changes to Swedish codes and cost data, see Suggestion #568 with SWE data.xlsx and according to our data we want some minor adjustments.
1. We cannot accept the proposed changes for LASA06 ‘Transvaginal puncture of ovarian cyst’ because we don’t have any DRG corresponding to DRG 813O so our cases with this procedure will be grouped to a conservative DRG corresponding to DRG 913O ‘Disease or disorder of the female reproductive system, short therapy w/o significant procedure’. We therefore want LASA06 to remain in the suggested “cheaper” residual group, DRG 359N ‘Other uterine and adnexal procedures for non-malignancy, short therapy’ despite that the mean cost for cases with LASA06 is lower than the average in DRG 359N. It is inevitable that some residual groups are less homogeneous.
2. LASA10 ‘Percutaneous or transvaginal puncture and recovery of oocyte’ and LASA11 ‘Laparoscopic recovery of oocyte’ are proposed for DRG 359N ‘Other uterine and adnexal procedures for non-malignancy, short therapy’ but in a medical perspective especially, and also in a Swedish cost perspective, the fit much better in the proposed DRG for in vitro fertilization, DRG 359Q Intervention on embryo or ICSI, short therapy. (DRG names are decided by each nation but we think that the text “Procedures for in vitro fertilization, short therapy” is more comprehensive and easier to understand for non-professionals).
3. (Less important.) The proposed English text for the more expensive residual group, DRG 359P, is “Excision or reconstructive operation on female reproductive organs, short therapy” but we think that “Major uterine and adnexal procedures for non-malignancy, short therapy” is better because both DRG 359P and 359N have been separated from DRG 359O with the text “Uterine and adnexal procedures for non-malignancy, short therapy” and DRG 359N is called "Other uterine and adnexal procedures for non-malignancy, short therapy". At least should "for non-malignancy" be included in the text because the same procedures are present in DRG 355O and 357O for malignancy. Furthermore, there are actually some excisions and reconstructions also in DRG 359N, for example some codes beginning with LBSF.

#9 Updated by Martti Virtanen about 1 year ago

2018-02-28 Martti Virtanen
Sweden's comments are obviously valid.
The case #573 is so closely related to this case, that I have combined the technical changes. The changes from case #573 have effects on all versions.

#10 Updated by Kristiina Kahur about 1 year ago

Finnish National DRG-Centre 7-3-2018

We carried out additional analysis based on the feedback to the case #573 and #568.

Here are the results:

Code LASA06/LAA06 – as the initial analysis showed, the cases with this code would fit the best in DRG 813O. As we learned from the Martti’s comments, this change can be done if all countries agree on that.
As we also learned, the changes is not acceptable for Sweden. To find the compromise (unless there is no way to find a unique solution only for Finland), we agree with the suggestion Sweden did and let the cases with code LASA06/LAA06 group to new DRG 359N (residual group).

Codes LASA10/LAA10 and LASA11/LAA11 – LASA11 has not been used in Finland. So we could use only the data of the cases with code LASA11. From cost perspective, the cases are between DRGs 359N and 359Q. From clinical point of view they might fit into DRG 359Q as suggested by Sweden. That said, we agree with Swedish suggestion the make the changes accordingly.

We also agree with Swedish comments on new DRG names.

#11 Updated by Ralph Dahlgren about 1 year ago

2018-04-18 Ralph Dahlgren
Sweden wants to be included in the split of DRG O15O Operationer på uterus och adnex för benign sjukdom, öppenvård (359O Uterine and adnexal procedures for non-malignancy, short therapy ) into 3 new DRG. So the Technical Changes has to be alittle different than Marttis last ones.

As far as we can understand the technical Changes concerning Sweden will be like enclosed Excellfile.

This will also mean that Sweden will incorporate 3 new rows in out DRGlogic with the same content as the Finnish rows except dur <2, Sweden has dur <1. We will also make the rows in an order that makes the DRG that uses most resources to be on top, see the sheet DRGlogic.

The sheet proc contains the changes that has to be done to the procedures according to the decision that Finland agreed to the Swedish changes concerning a few codes. These changes have not been done in the changes from the centre. They are done in these changes for Sweden (lacking some Finnish codes).

In conclulsion:

LAA06 Transvaginal punktion av ovarialcysta (LASA06 Transvaginal puncture of ovarian cyst ) will go from OR "1" to "2", PROCPR will change from 13S02 to 13S22.

LAA10 Perkutan eller transvaginal punktion med uthämtning av ägg (LASA10 Percutaneous or transvaginal puncture and recovery of oocyte ) and LAA11 Laparoskopisk uthämtning av ägg (i) (LASA11 Laparoscopic recovery of oocyte ) should not have PROCPR 13S22

The proposal will affect the following Swedish codes:

DL008 Intrauterin insemination (i) ( LCXA00 Insemination ) will get OR 2

DL002 Embryotransfer med frysta och tinade embryon (i) ( LCXA12 Insertion of stored embryo ) will get PROCPR 13S02 and OR 2

DL007 Intracytoplasmatisk spermieinjektion (ICSI) (i) (LCXA30 Intracytoplasmic Sperm Injection (ICSI)) will get PROCPR 13S02 and OR 2

There are some codes that Finland have that not excist in Sweden, those I do not comment on for obvious reasons.

#12 Updated by Martti Virtanen 4 months ago

2018-03-13 Expert group
The expert group accepted the changes for Finland and Sweden. The countries accpepted som modificiations to the changes after the meeting (see above).
Sweden has proposed changes to the names of the DRG's that should be shortly discussed at next meeting.
Therefore the case remains open. Other countries may join to use the changes if sow wished.

P.s. The attached technical changes file from Sweden is not included for this case - the included file is wrong. However, I created a corrected version of technical changes that should include all accpted changes. Note that all linked codes in national versions are affected.

#14 Updated by Martti Virtanen about 1 month ago

  • Status changed from Active to Further active

#15 Updated by Martti Virtanen about 1 month ago

  • Status changed from Further active to Accepted

2019-03-11 Expert group
The case was open to remind countries of need form correction of names of the DRG's.
It is accepted and will be closed now.

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