Case #585

DRG hierarchy change for pacemaker intervetions and percutanoeus cardiovascular procedures (DRG's 112x, 115x, 117x)

Added by Kristin Dahlen 10 months ago. Updated 6 months ago.

Status:ActiveStart date:2018-01-26
Priority:NormalSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:-
Initiator:Norway Target year:2019
Case type:Minor Owner / responsible:Nordic Casemix Centre
MDC:MDC05 Old forum status:
Target Grouper:COMMON

Description

Problem
A couple of hospitals in Norway is claiming that it must be wrong that if you do a percutaneous coronary intervention (PCI) together with an ablation procedure the DRG will be 112C-F even though the ablation procedure is more expensive than the PCI. The cost weight for DRG 112B and 112O are also, at least in Norway, higher than the weights for DRG 112C-F.

In addition we see that if you do a pacemaker procedure in the same operation, the DRG result will be a pacemaker DRG with lower cost weight (DRG 115A or 115B).

This case relates to some extent to case 563, where Sweden suggests a split of DRG 112O. We support the split and together with a change in hierarchy as we suggest, the new logic will in a better way reflect the costs for the DRGs.

Analysis
The table following the case shows the DRGs with the current hierarchy and the Norwegian cost weights for 2018. The problem is primarily related to the DRGs covering the ablation procedures (112B and 112O.

Suggestion
We suggest a change in the DRG logic hierarchy putting the DRGs covering the ablations procedures higher in the hierarchy. The hierarchy shall take into consideration the changes suggest in Case 563 if these changing is accepted.

Case 585 Hierarchy DRG 112A_F og 115A_C.xlsx - Table showing 2018 hierarchy and suggested 2019 hierarchy (13.6 KB) Kristin Dahlen, 2018-01-26 16:05

Technical changes HD-212.xls (107 KB) Kristin Dahlen, 2018-01-29 14:02

Technical changes case #585.xlsx (23.8 KB) Martti Virtanen, 2018-03-06 14:29

TC_C748_2018-04-12.xlsx (13 KB) Mats Fernström, 2018-04-12 15:00

Technical changes case #585-2.xlsx (24 KB) Martti Virtanen, 2018-05-22 15:25

History

#2 Updated by Kristiina Kahur 9 months ago

Finnish National DRG-Centre 8-2-2018

Finnish cost data show the same as indicated by Norway that the cases having the ablation and PCI simultaneously are more expensive compared to the cases when only PCI is performed.
We support the change in the hierarchy but based on the cost data we would locate the DRG 112B rule after the DRG 115A and before DRG 115B.

#3 Updated by Veronika Stemme 9 months ago

Veronika Stemme, NPK, Sweden
Sweden will make a revision of DRG E16N/112A ‘Other percutaneous cardiovascular procedures’ since the procedures assigned to this group are rather heterogeneous. We do not want to change the hierarchy before this revision is finished.

#4 Updated by Martti Virtanen 8 months ago

  • File Technical changes case #585.xlsx added
  • Subject changed from DRG hierarchy for DRG 112x and 115x to DRG hierarchy change for pacemaker intervetions and percutanoeus cardiovascular procedures (DRG's 112x, 115x, 117x)

2018-03-06 Martti Virtanen
This proposal is fairly simple. I have mainly rewritten the technical changes to include all versions.
The tables are now based on the norwegian model and I hope we can agree on one model although Sweden has already moved DRG's 112A and 112B.

#5 Updated by Mats Fernström 7 months ago

Mats Fernström, NPK Sweden 2018-04-04 (Swe ID C748)
We regret ourselves and will follow the Norwegian suggestion partly, which means that we will move the rule for DRG E17N/112B (Percutaneous ablations for cardiac arrhythmia) to above the rule for DRG E19N/112C (PCI w/o myocardial infarction). If we only take into account cost data, the rule for DRG E17N/112B should be placed above the rule for DRG E18E/112E (PCI w myocardial infarction, w/o CC) but below the rule for DRG E18C/112F (PCI w myocardial infarction, w CC) but we usually try to keep the rules for “with CC” and “without CC” together (it is easier to read the table and understand the differences between the rules) and it will probably not occur cases with both PCI and ablation when there is an ongoing myocardial infarction. I include Swedish technical changes (TC_C748_2018-04-12.xlsx) for information.

#6 Updated by Martti Virtanen 6 months ago

2018-05-22 Martti Virtanen
There was a concer from Finland of no changes for this case. The only change is for rule 105D111201 that had dur <1 which is a Swe type rule. Other changes do not affect Fin version (both OUT and IN include Fin).
The Swedish change is inluded in the latest Technical changes.

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