Case #374

Updated by Anonymous almost 5 years ago

National ID: NPK ID C584
Initiated: 2015-01-14
Initiator: NPK, Sweden
Responsible at National organization: Mats Fernström
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
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*Problem*
The inpatient DRG's for pacemaker and defibrillator interventions were reorganized in NordDRG 2006 (Case 2005-MDC05-06, #419). 2005-MDC05-06). This proposal is based on the same principles.
Another related case is Case 2007-MDC05-02, #420. 2007-MDC05-02.
Note also that the changes according to this case will be further changed if the suggestion in the case with NPK ID C585 is accepted.

Inpatient cases with implant, revision or removal of pacemaker or defibrillator are grouped into three different base DRG:
• E25N Insertion or replacement of defibrillator
• E26 (A, C, E) Insertion or replacement of permanent pacemaker
• E27 (A, E) Removal of permanent pacemaker or defibrillator
The reason for the split is primarily significant differences in implant costs.
Outpatient cases with the same procedures, however, are lumped together into one single group, DRG E28O (Insertion, replacement or removal of permanent pacemaker or defibrillator, outpatient). Implant costs, and the differences between them, are the same as in inpatients why this DRG is very cost heterogeneous. See table below where the procedures included in the DRG E28O have been divided according to the same principle as in inpatient logic. (The table is on the word document and also included in Appendix C584.xlsx.)

!Cost_analysis_NPK_C584.jpg!

*Analysis*
NPK, Sweden – 2015-01-14
See table above. It is obvious that insertion/replacement of defibrillator (procedures with procedure property 05S40) do not fit in the group. As many as 67% become outliers! It is also obvious that the costs of insertion or replacement of pacemaker (procedures with procedure property 05S41) are underestimated. Probably implant costs are missed in many cases in the cost calculations.
Thus, DRG E28O is cost heterogeneous and should be divided in the same way as in the inpatient logic. The group would then be deleted and replaced by
• E25O/115P Insertion or replacement of the defibrillator, outpatient
• E26O/115O Insertion or replacement of permanent pacemaker, outpatient
• E27O/115Q Removal of permanent pacemaker or defibrillator, outpatient
The criteria for split concerning relative numbers (relative to the original group) and the cost differences are fulfilled. The advantage of this split is a better medical and economic description and we have a better opportunity to see the degree of policlinisation when we have the same grouping logic for inpatients and outpatients. The only objection might be that the absolute number of cases in DRGs E25O and E27O are not so large (262 or 261) but it is not an absolute obstacle for splitting. Of the 507 outpatient groups in the KPP database for 2013 as much as 141 groups (28%) have less than 261 cases.

*Suggestion*
NPK, Sweden – 2015-01-14

DRG E28O is replaced by
• E25O/115P Insertion or replacement of the defibrillator, outpatient
• E26O/115Q Insertion or replacement of permanent pacemaker, outpatient
• E27O/115R Removal of permanent pacemaker or defibrillator, outpatient
To achieve this, changes must be made in the tables Drglogic and Drgnames as described below and specified in the included file Suggestion C584.xlsx.

To be introduced in Sweden in NordDRG 2016.

*DRG change*
Cases that used to be grouped to DRG E28O will instead be grouped to one of the following groups:
• E25O/115P Insertion or replacement of the defibrillator, outpatient
• E26O/115Q Insertion or replacement of permanent pacemaker, outpatient
• E27O/115R Removal of permanent pacemaker or defibrillator, outpatient
The number of cases in the Swedish KPP database for 2013 that are affected by such a change is only 0,1 % of the total number of cases.

*Technical change*
In the table Drgnames three new DRGs are inserted and DRG E28O becomes inactivated :
• E25O/115P Insertion or replacement of the defibrillator, outpatient
• E26O/115Q Insertion or replacement of permanent pacemaker, outpatient
• E27O/115R Removal of permanent pacemaker or defibrillator, outpatient
(Swedish texts and short texts are specified in the included file Suggestion NPK ID C584.xlsx.)

In the table Drglogic, the DRG is changed to 115P(E25O) in the rules with ORD 105D11010 and 105D110101 and to 115Q(E26O) in the rule with ORD 105D110110 and to 115R(E27O) in the rules with ORD 105D111200 and 105D111201.
All changes are specified in the included file Suggestion C584.xlsx.

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