DRG is launching

CKS DRG

The Centre for DRG classification system (CKS DRG) is gradually setting contours in DRG in Slovakia. Our first steps are focused on understanding processes used by the Health Care Surveillance Authority (HCSA). Uniform and transparent process for calculation of relative weights, compliment of the list of medical procedures and changes approval in the Definition handbook is being defined. We are working on our web CKS DRG, which is now available. A programme of the I. DRG Conference is completed, confirmation is to be made by Institut für das Entgelsystem im Krankenhaus (InEK).

A Statute for the Management Committee is approved and the first meeting is planned on 10 March 2021. In 2020, a request was made to the European Commisssion for expert consultation concerning correct DRG system set up within the call. The project has been approved and it is supposed to be launched this year. Priority settings was consulted with old and new members of the Management Committee.

Feedback is a key aspect of DRG system. Meetings with about 50 health care providers and specialised institutes were held concerning the current condition of DRG and possible feedback collaboration. Deadline for evaluation of suggestions is set on 16 March 2021.

Since DRG was not adjusted current epidemiological situation, a guidance for DRG data creation for 2020 was prepared. The first topic for working group of economic department is the correct costs calculation caused by the COVID-19 pandemic. Several irregularities such as missing health care providers were modified in code lists and new code lists for DRG data creation in 2020 were updated. Similarly, code lists of suplementary remuneration for 2021 were updated as well, specifically, duplicite codes were identified. Afterall, code lists were published with containing irregularities since historically, they were published by health insurance companies.

IT FIELD

IT team continues with data transfer from HCSA to CKS. IT infrastructure conditions, which are needed for operation of DRG systems, import and database, have been specified. IT department of MOH SR will continue in selection procedure.

New code lists needed for DRG data creation for 2020 were issued as well as code list of data 274b for 2021 that is now publishe on eDRG portal. They can also be found on CKS DRG web, on which we are intensively working.

Similarly, we are defyning concept as well as precise methodology of data calidation from health care providers which is essential to clear data formally, economically and clinically. For DRG system to reflect a current clinical situation and real costs, correct data are necessary. After having performed early validations, health care providers with missing data were identified. Moreover, all missing, incomplete or incorrect data are being identified.

There is a slight improvement with data submission from health care providers for 2019 in comparison with 2018, specifically all health care providers in DRG system submitted annual data. In 2018, 14 hospitals had not filled data containing costs. In 2019, 13 hospitals did not state financial recognition and 13 hospital did not state staff contract details and bed capacity;moreover, all above mentioned data were missing in 8 health care providers. While in 2018, DRG group was not stated with some cases in 11 hospitals, in 2019 only 5 health care providers did not state the DRG group.

Medical field

Team that focuses on extensive medical field was expanded by two new colleagues. We succeded to orientate in the enormous number of documents, their versions and analyses that were obtained by HCSA during competencies transfer. Documents that need to be the most accutely revised are currenty being analysed. However, transfering process of DRG database takes longer than expected. Thus, we were not able to preform complex medical and economical analysis. They will begin in following days.

Health care providers have been contacted to provide feedback of DRG system. Your issues from a practice are being heard and possible solutions to solve the issues are welcome. Correct medical and economical data have an essential impact on complete functioning of DRG. We are working on logical, clear and transparent procedure of approving individual suggestions – so that every suggestion is not only evaluated on the basis of specific expertise and particular need, but also on complex logic of DRG. All suggestions will be answered, published and available, and changes will be proccesed.

The DRG Catalogue Methodology

For recalculation of relative weights (RW) and other parameters in CLS based on G-DRG was finalised. To set several specific parameters and formulas, it is essential to perform various simulations and analysis using data provided by health care porviders. They are planned to be performed after getting access to DRG database. We analysed the development of suplementary remuneration in CLS as well as duplicity of various values in code lists. During the last year, 32 new drugs were added in CLS as well as 27 medical material and there were 56 duplicate codes identified. Code lists were published with mentioned irregularities since they were historically issued by the health insurance companies. It would have only created chaos in code lists. DRG data working group will focus on this topic.

The Definition Handbook

The main focus was to identify changes in the Definition handbook (DH) during years. We are setting revision processes. MDC 05 is planned to be revised first since there was the highest number of hospitalisations as well as it was one of the costliest for 2019.

While compating the first version of DH with the current version, changes in tables of medical procedures and main diagnosis were identified. there were also changes in DRG-groups - name change, change of assigned group segement, removal of DRG-group, extension of DRG group by a specific medical procedure. Tables of medical procedures in MDC 05 were significantly changed compared to the first version, since in 2015 there was reclassification of LMP. E.g. MDC05-1 underwent a complete change - from original 8 procedures in 1.0 version, none has remained and they were all substituted by 15 procedures contained in DH 2021; procedures in MDC05-2 changes - DH 1.0 version contains procedures with codes 5k110 up to 5k398.0 and 2021 DH version contains codes from 5k510.2 to 5k79x. After comparing the third table of medical procedures MDC05-3, there were identified 26added procedures in DH 2021 and 6 removed procedures in comparison to 1.0 version. This suggests, if the tables were not completely different, high number of procedures had been added. Similarly, a table of main diagnosis MDC 05 has been changed, specifically addition or removal of more than 10 main diagnosis.

The List of Medical Procedures

Detail understanding of the compilement of the list of medical procedures (LMP) was our main focus. This process has provided an overview not only on the background of the compilement of LMP but also on historical development of LMP - comparison of changes in previous versions with current version has led us to understand a process concerning modifications in LMP for DRG. Codes of medical procedures (MP) were based on German OPS (equivalent to LMP in G_DRG), however, the codes in Slovak LMP-DRG were set differently. We plan to take a closer look on OPS in order to find similarities as well as differences between Slovak codes. Meaning of individual characters used in code differes accross chapters. It seems that there does not exist uniform logic in code creation. Original LMP differs from the current one. Annually, hudreds of MP were added. Version for 2015 underwent a huge revision. More than 1000 procedures were removed, coding changed, and according to annaul trend, procedures were also added. Thus, current LMP contains 8000 more procedures than the first one in 2011. Whole chapter 2 was removed (laboratory procedures). The goal is to unify coding principles across the whole list. Another goal is to localise issues mentioned in feedback (e.g. duplicit procedures), and apply solutions to the new version of LMP.

CKS DRG team