Case #669

Change of grouping the hemodialysis cases with main diagnosis from MDC10 from DRG 810O to 317O

Added by Elina Hermiö 8 months ago. Updated 6 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: Old forum status:
Target Grouper:EST, FIN, ICE, LAT, SWE

Description

Problem
Currently the cases having main diagnosis from MDC10 and procedure code with property 11S09 Dialysis, are grouped into DRG 810O Non-extensive procedures of endocrine, nutritional & metabolic disorders, short therapy. Those cases do not fit to DRG 810O in terms of cost and should be rather be grouped into DRG 317O Admit for renal dialysis, short therapy.

Analysis
For analysis, the data of five Finnish university was used from year 2018. The cases having procedure code with PROCPR 11S09 were separated from DRG 810O.
The analysis shows that Hemodialysis cases within 810O are cheaper (402 EUR vs 315 EUR) and fit better to DRG 317O (mean cost 290 EUR).
Regrouped cases into DRG 317O create a homogenous group with mean cost 291 EUR and V% 76%.
DRG 810O remains very heterogenous group and needs additional analysis.

Suggestion
Based on the analysis, we suggest the short therapy cases with main diagnosis from MDC10 and procedure code with property 11S09 Dialysis will group into DRG 317O.

DRG change
After the suggested changes the MDC10 cases with hemodialysis will be grouped into DRG 317O. In definition tables an additional rule (110D109992) will be added above the current rule (110D109990) of DRG 810O and this will be complemented by PROCPR 11S09.

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_6.2-Appendix2.Hemodialysis_cases_from_810O_to_317O.xlsx (20.1 KB) Elina Hermiö, 2020-01-27 14:16

FIN_6.1-Appendix1.Hemodialysis_cases_from_810O_to_317O.xlsx (9.51 KB) Elina Hermiö, 2020-01-27 14:16

Technical changes case #669.xlsx (20.2 KB) Martti Virtanen, 2020-03-03 11:18

TC C827.xlsx (13.7 KB) Mats Fernström, 2020-03-25 19:15

Technical changes case #669_2.xlsx (16.1 KB) Kristiina Kahur, 2020-03-26 11:10

Technical changes case #669_3.xlsx (16 KB) Kristiina Kahur, 2020-04-14 11:21

History

#1 Updated by Mats Fernström 8 months ago

Mats Fernström, the National Board of Health and Welfare, Sweden
Swe ID C827.
We have a similar problem in the Swedish version so we support this suggestion, but with a small modification. There are more than 500 diagnosis codes in MDC 10 and in the majority of these conditions it is not indicated to give dialysis. Therefor we suggest that the suggested rule 110D109992 is modified so that MDC = 10 is deleted and instead PDGRO 11P01 is inserted in the appropriate column. PDGRO 11P01 ‘Diabetes complicating urinary system’ was introduced last year and the codes with 11P01 are:
E1020 Insulin-dependent diabetes mellitus with renal complications
E1120 Non-insulin-dependent diabetes mellitus with renal complications
E1220 Malnutrition-related diabetes mellitus with renal complications
E1320 Other specified diabetes mellitus with renal complications
E1420 Unspecified diabetes mellitus with renal complications
SWE har subcodes!

#2 Updated by Kristiina Kahur 7 months ago

Finnish National DRG-Centre/Kristiina Kahur 24-2-2020

Finland supports this modification.

#3 Updated by Martti Virtanen 7 months ago

2020-03-03 Martti Virtanen
Is the technical changes what Mats meant?
Whic counries will join to the change?

#5 Updated by Ralph Dahlgren 7 months ago

2020-03-03 Ralph Dahlgren
This case is in Sweden connected to #689 C757 Merging the Swedish outpatient DRGs M32P & M32Q for dialysis.
When the case, #689 C757, mentioned above has gotten the technical changes approved we want our row with Mats suggested changes in this case #669, Procpro 11S09 pdgprop 11P01, to be placed just below our open daycare DRG rows for dialysis (SWE DRG M32).
Mats has already prepared Technical changes where we want the row for this case to be placed aswell what they will look. But another thing is that we have 'dur <1'.
So your suggestion for the Swedish row in this case has to be done after the decision for #689 C757.

#6 Updated by Malle Avarsoo 6 months ago

Estonia supports the change to EST version.

#7 Updated by Martti Virtanen 6 months ago

  • Status changed from Active to Further active

2020-03-09 Expert group
The expert group accepted the proposal with the Swedish modification.
The new rules will be based on principal diagnosis property 11P01 that is given to 5 ICD+ codes listed by Swe.
The change is valid for Fin and Swe but any country may join (Estonia already has)
The case will be retained open to remind for the possibility.

#8 Updated by Kristiina Kahur 6 months ago

  • Initiator Estonia, Sweden added

Nordic Casemix Centre/Kristiina Kahur 24-3-2020

This is a call for Swedish colleagues - for sake of clarity, could you updated the technical changes so that we get the order of the rows in Swedish version correct. Thank you.

#9 Updated by Mats Fernström 6 months ago

Mats Fernström, the National Board of Health and Welfare, Sweden 2020-03-25 (Swe ID C827)
We don’t like the suggested ORD of the rule because then it will be placed before the rules with ID 111D1401124 and 111D1401125 that also handle cases with PDGRO 11P01 and those rules lead to DRGs that are more expensive than the DRGs for dialysis. Indeed, the rules with ID 111D1401124 and 111D1401125 demand procedures with 11S17 and such procedures are probably not performed at the same time as dialysis but that is not guaranteed. To avoid problems with an inappropriate grouping of such cases with combination of dialysis and other procedures we want the rule to be placed directly before the existing rules for DRG 317O. In the SOS version ID and ORD will be 111D149000.
We also want a rule for primary care. See the attached file TC C827.xlsx.

#10 Updated by Kristiina Kahur 6 months ago

Nordic Casemix Centre/Kristiina Kahur 26-3-2020

The changes have been implemented into NDMS in EST, FIN and SWE versions according to the technical changes described in Technical changes case #669_2.
The countries concerned are kindly asked to double-check the TC.

#11 Updated by Birna Björg Másdóttir 6 months ago

Iceland would like this change in its groupper.

#12 Updated by Kristiina Kahur 6 months ago

Nordic Casemix Centre/Kristiina Kahur, 14-4-2020

Based on the feedback after the expert group meeting, this change is implemented EST, FIN, ICE, LAT (confirmation via email) and SWE 2021 tables.
TC have been updated and attached.

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