Case #618

Splitting DRG 243 Medical back problems based on CC/non-CC

Added by Kristiina Kahur 11 months ago. Updated 9 months ago.

Status:AcceptedStart date:2019-01-21
Priority:MajorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:-
Initiator:Finland Target year:2020
Case type: Owner / responsible:National organisations
MDC:MDC08 Old forum status:
Target Grouper:FIN

Description

Problem
DRG 243 Medical back problems is a heterogeneous group with V% 151% in 2015, 224% in 2016, and 198% in 2017.
In order to understand the reason for heterogeneity, an analysis was conducted.

Analysis
For analysis, the data of five Finnish university hospitals was used from years 2015, 2016 and 2017.
To start with, the cases of DRG 243 were separated based on presence/non-presence of secondary diagnoses which have the COMPL property. CC cases were flagged and all cases were divided into two groups: 1) cases with CC and 2) cases without CC.

The homogeneity analysis was conducted in both groups. The analysis showed that the cases flagged with CC were twice or more as expensive as the ones of non-CC in all three years.
After trimming 1% of expensive end cases, the difference of average cost between CC and non-CC remained remarkable (see more precisely Appendix 1).
Trimming also decreased the coefficient of variation in both groups:
-in CC group: from 193% to 145% (2017), from 259% to 124% (2016) and from 155% to 69% (2015)
-in non-CC group: from 115% to 94% (2017), from 116% to 76% (2016) and from 101% to 45% (2015)
The number of cases in both groups remained sufficient after split.

Suggestion
Based on the analysis, we suggest splitting DRG 243 into two groups depending on presence of CC/non-CC.

DRG change
After the suggested changes two new DRGs will be created instead of one as follows:
1) DRG 243 Medical back problems, with CC
2) DRG 243 Medical back problems, without CC.

Cost analysis
Appendix 1. Cost analysis is based on five university hospitals’ data of years 2015, 2016 and 2017.

Technical changes
Appendix 2. The technical changes may contain mistakes and have to be double-checked.

Appendix1_Splitting_DRG_243_based_on_CC.xlsx - Appendix 1 (43 MB) Kristiina Kahur, 2019-01-21 12:26

Appendix2_Splitting_DRG_243_based_on_CC.xlsx - Appendix 2 (23.3 KB) Kristiina Kahur, 2019-01-21 12:26

History

#1 Updated by Martti Virtanen 9 months ago

  • Status changed from Active to Accepted

2019-03-11 Expert group
The case was accepted for Finland.

The changes is done by adding /Fin tho nat_ver to rules 408D470005 and 408D470009 (currently for Swe only). /Fin is removed from 408D470000.

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