Case #666

Split of DRG 294 Diabetes age > 35 into non-CC, CC and MCC

Added by Elina Hermiö 5 months ago. Updated 3 months ago.

Status:AcceptedStart date:2020-01-27
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:-
Initiator:Finland Target year:2021
Case type: Owner / responsible:
MDC:MDC10 Old forum status:
Target Grouper:EST, FIN, ICE, LAT, NOR

Description

Problem
DRG 294 is a heterogenous group with high V% (131% in 2017 and 153% in 2018) and different peaks. The trimming does not improve the situation. There is clearly division into different sub-groups within the DRG 294 with different mean cost. Given that Sweden has divided DRG 294 into three groups, we conducted respective analysis to see if it supports similar split in Finland too.

Analysis
For analysis, the data of five Finnish university was used from year 2018.
All cases grouped into DRG 294 were derived from the data and divided into three groups based on property of secondary diagnoses (non-CC, CC or MCC).
The analysis shows that there is remarkable difference between the groups depending on CC status:
-non-CC 2187EUR
-cc 4065 EUR
-mcc 7806 EUR
V% improves by splitting DRG 294 into three but still remaining above 100%. Trimming by 1% from higher end improves the V%. Yet the concern remains with mcc group. Despite this it seems reasonable to move on with implementation of this split rather than to keep status quo of current situation.

Suggestion
Based on the analysis, we suggest splitting DRG 294 into three DRGs depending on the secondary diagnosis and COMPL property given to each diagnosis.

DRG change
After the suggested changes three new DRG will be created and cases which previously grouped into DRG 294 will group new DRGs 294N, 294C and 294M depending on the secondary diagnosis.
In definition tables three existing Swedish rules will be used for this change:
410D1101001 DRG 294M
410D110105 DRG 294C
410D110109 DRG 294N

Cost analysis
Appendix 1. Cost analysis is based on five university hospitals’ data of year 2018, grouped with FIN 2020PR1 grouper.

Technical changes
Appendix 2.

FIN_3.2-Appendix2.Split_of_294_into_non-CC_CC_MCC.xlsx (16.9 KB) Elina Hermiö, 2020-01-27 14:06

FIN_3.1-Appendix1.Split_of_294_into_non-CC_CC_MCC.xlsx (20.5 KB) Elina Hermiö, 2020-01-27 14:06

Tabell1.JPG (10.1 KB) Kristin Dahlen, 2020-03-06 14:26

Tabell2.JPG (17.9 KB) Kristin Dahlen, 2020-03-06 14:26

EST_294_data_2019.xlsx (88.9 KB) Malle Avarsoo, 2020-03-17 13:47

Technical_changes_666_Split_of_294_into_non-CC_CC_MCC.xlsx (17.2 KB) Kristiina Kahur, 2020-03-20 15:28

Technical_changes_666_Split_of_294_into_non-CC_CC_MCC_2.xlsx (17.4 KB) Kristiina Kahur, 2020-03-24 15:04

Technical_changes_666_Split_of_294_into_non-CC_CC_MCC_3.xlsx (17.4 KB) Kristiina Kahur, 2020-03-25 14:56

Technical_changes_666_Split_of_294_into_non-CC_CC_MCC_4.xlsx (17.9 KB) Kristiina Kahur, 2020-04-07 12:25

Technical_changes_666_Split_of_294_into_non-CC_CC_MCC_5.xlsx (17.9 KB) Kristiina Kahur, 2020-04-09 17:16

History

#1 Updated by Martti Virtanen 5 months ago

2020-01-28 Martti Virtanen, Nordic Casemix Centre
The proposal follows the Swedish model with MCC and CC originally copied from US. The result is a clear improvement of cost variation but maybe not quite enough. The high cost variation of the MCC cases clearly indicates that not all cases with MCC level secondary dx have high reesource use. The same may be true for the CC level cases. May be a further step would be to consider what are the really complication secondary dx's for these situations?

#2 Updated by Kristin Dahlen 4 months ago

Analyses from Norway show that the length of stay for cases with complicated diagnosis are longer than the group that does not have complicating diagnosis. The average length of stay for the last group is 3.02, while for the complicated cases the average length of stay is 4.38.

Without complicating diagnosis:

With complicating diagnosis:

Our costdata (based on average cost per DRG per hospital) show some variations between hospital, but may indicate that there is cost variation between the complicated and the more uncomplicated cases.

#3 Updated by Martti Virtanen 4 months ago

  • Status changed from Active to Further active

2020-03-09 Expert group
The proposal was accepted for Fin version. Swe is already using this model. Other countries may join this model by informing us trough this case.
To remind about the possibility we retain the case as further active.

#4 Updated by Malle Avarsoo 4 months ago

Estonia would like to get this change for EST version. Our data supports the divison of the group: similar dependance on LOS as found in Norway ( attached in file ).

#5 Updated by Kristiina Kahur 4 months ago

Nordic Casemix Centre/Kristiina Kahur 20-3-2020

The technical changes are updated and attached to the ticket as Estonia joined and supports this change too.
DRG names in Estonian version are in English at the moment. We are looking forward to receiving the national names.
English ones looks like follows:
294M Diabetes age > 35 w mcc
294C Diabetes age > 35 w cc
294N Diabetes age > 35 w/o cc

#6 Updated by Kristin Dahlen 4 months ago

Norway want this change to be implemented in the Norwegian version based on our earlier analysis and the discussions in the expert group.

#7 Updated by Kristiina Kahur 3 months ago

Nordic Casemix Centre/Kristiina Kahur 24-3-2020

The technical changes have updated and changes into Norwegian version have added.
Could you please also provide the Norwegian names for new DRGs:
294M Diabetes age > 35 w mcc
294C Diabetes age > 35 w cc
294N Diabetes age > 35 w/o cc

#8 Updated by Kristin Dahlen 3 months ago

Norway only want the w/o cc and w cc split, and the Norwegian names are as follows:

DRG 294C Diabetes >35 år m/bk
DRG 294N Diabetes >35 år u/bk

#9 Updated by Kristiina Kahur 3 months ago

Nordic Casemix Centre/Kristiina Kahur 25-3-2020

Technical changes updated.

#10 Updated by Kristiina Kahur 3 months ago

Nordic Casemix Centre/Kristiina Kahur 7-4-2020

The 2021 tables have been updated in NDMS based on LAT request. This changes is made now in LAT, FIN, EST and NOR 2021 tables.
Updated TC are attached to the ticket.

LAT, EST and FIN versions have the split of DRG 294 into three new DRGs: 294M, 294C and 294N
NOR version has the split of DRG 294 into two new DRGs: 294C and 294N

#11 Updated by Malle Avarsoo 3 months ago

EST version will have following names for these DRG-s:

294M Suhkurtõbi, vanus >35, oluliste kht-ga
294C Suhkurtõbi, vanus >35, kht-ga
294N Suhkurtõbi, vanus >35, kht-ta

#12 Updated by Birna Björg Másdóttir 3 months ago

Iceland would like to split DRG 294 into two groups like Norway.
294C Sykursýki, 36 ára og eldri, með aukakvillum
294N Sykursýki, 36 ára og eldri, án aukakvilla

#13 Updated by Kristiina Kahur 3 months ago

Nordic Casemix Centre/Kristiina Kahur, 9-4-2020

This change is now implemented in all national versions with some modifications (SWE had it implemented already earlier).
Case will be closed.
Updated TC are attached.

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