Discrepancy in DRG system

CKS DRG

DRG data from 2019 in current database are considered to be incorrect whereas during controls major abnormalities were found (read more HERE). CKS DRG team has found 5 errorneous datasets during the control process of all datasets. Import of corrective datasets to obsolescent database would be technically difficult. Due to this fact, whole database was migrated to new infrastructure.

Equally serious discrepancy was found in Calculation handbook, mainly in charts of accounts and matching the cost centres to groups and it´s allocation keys.

Analysis done so far shows surprising outputs, f. e. homogenity of DRG groups is highly variable, about 400 DRG groups has homogenity lower than 50% and 284  DRG groups contained less than 30 hospitalisation cases during 2019. However, CKS DRG team is a bit worried about relevancy of outputs for next year because of low quality data from hospitals. Another problem occurs with the software tool used for Definition Handbook and Grouper creation – Pflege tool. The tool only runs on Windows XP or Windows 7, what slows down whole updating process.

During second half of the July, the meeting with czech colleagues from ÚZIS ČR took place to share know-how and present next planes for updates of DRG systems in both countries. During the summer, 11 grantees joined the CKS DRG team. They contribute greatly to cultivation of SK-DRG system.

ECONOMIC PART

Draft of the Calculation handbook has been sent to membrs of Working group Cost calculations of hospitals per hospitalised cases. All chapters were revised. The most serious changes in Calculation handbook were found in various discrepant statements in original attachment 1 – chart of accounts and it´s assignment to groups of cost centres, attachment 3 – assignment of cost centres to groups of cost centres and attachment 4 – allocation keys for allocation of costs from indirect cost to direct cost centres. Explanation of irregularities and detailed specification was recorded mostly in chapter 4 Calculation of costs for defined groups of cost centres. Revision was primarly aimed to definition of terms and formula completisation. New attachments were created – attachment 3a Segmentation of cost centres and attachment 8 Definition of direct costs, where items to be calculated directly per patient have been defined

Serious and extensive irregularities were identified in individual attachments – mostly in attachment 1, and between attachment 3 and 4. Attachment 1 was revised to have uniform logic, analytical accounts were added, duplicate accounts were deleted, accounts were sorted to individual levels and content of each account was defined. In attachment 2, interventional radiology was added to group of cost centres 6a and 6b. Due to discrepancy between attachment 3b and 4, codes of cost centres were unified, duplicates were deleted, cost centres redefined due to actual information (33 DRG non-relevant cost centres were defined as relevant cost centres). In attachment 7, conditions to calculation of drugs below 300 € were deleted (multiple providers calculated even these costs), same with the condition of 50 € for material. Units for measurements were added, and also groups of cost centres and groups of cost types.

In future, criteria for sorting the hospitals to DRG relevant groups will be introduced.

After agreement of the Working group Healthcare financing about the criteria, document will be published on the web of CKS DRG.

IT PART

Methodology of validation is almost at it´s end and CKS is preparing analytical report about data quality. CKS DRG plans to provide feedback to each hospital separately with identification of the most frequent mistakes. Validation dokument is almost 400 pages long and contains results of individual controls.

After launching first validation control, that contained about 600 scripts, more severe irregularities were found. The one, considered to be the most serious, is out of date database, that was taken from Health care supervisory authority (HCSA). CKS DRG found extreme irregularities in data provided by one hospital, and then immidiatelly contacted others to check the accuracy of the data. 4 more hospitals have been found, whose datasets were not in database or their corrective datasets were not considered previously. 1 hospital sent corrective dataset, because of realisation, that their way of calculation of direct costs of implants is not correct.

Due to problems with uploading DRG datasets to database of HCSA, all datasets of hospitals have been uploaded to new database with modern infrastructure even with the Health care Insurance companies (HICs) data as reference data for comparison. 

MEDICAL PART

Medical team of CKS DRG continued processing feedback and prepared methodologies and revisions described below.

CATALOGUE OF LUMP SUMS

Analysis for finalisation of methodology of calculation of cost weights and for listing the suplementory remuneration took place at the and of june. Scripts for calculation of cost weights are being prepared. Data provided to CKS shows really unexpected low homogenity coefficients for DRG´s. CKS DRG team is a bit worried about relevancy of outputs for next year because of low quality data from hospitals.

DEFINITION HANDBOOK

CKS DRG is dedicated to implementation of relevant comments on feedback proposals and prepares 3rd round of voting per rollam of Working group the Definition handbook.

Simultaneously CKS preliminary identifies groups with low homogenity and other problematic characteristics due to Definition handbook revision using time series of abundance in DRG´s and preparation of analysis that can be applied once the validation of data is done. CKS also controls similarity of meaning of algorithms in Definition handbook with names of DRG´s as we have been warned that they may not be consistent.

CKS updated the explanatory document about Definiton handbook. Chapters focused on the problemacy of the order of demand and other and error DRG´s („900´s“) (together with the visualisation of comparison of current cost weights for each MDC and their segments with average value of cost weights of all groups).

CODING RULES

Uniform way of coding of artificial lung ventilation is being prepared. To this day, there is still discrepancy about healtcare provision in terms of artificial lung ventilation.

LIST OF MEDICAL PROCEDURES

Slovak nefrological society (SNfS) and Slovak hematology and transfusion society (SHaTS) presented their comments to group 8r of medical procedures (elimination methods and transfuzions related group). CKS analysed them with the latest data. Few intersting findigs may be stated.

SHaTS pointed out that list of medical procedures (LMP) nowadays allows providers to code 1 095 transfusion units (TU) of autologous erythrocytes (8r233.10-8r233.n0), while for autologous blood plasma (8r252.1-8r252.9) providers can code together 45 TU. Analysis showed, that not a single case shows more than 9 TU coded during hospitalisation.

SNfS reported that LMP is missing suitable codes for few often used methods (f. e. SCUF). Moreover, CKS found out that nomenclature of elimination methods contains two types of intervals. Sometimes they are given in days, sometimes in hours, but borders of the intervals are the same (f. e. peritoneal dialysis 6-11 days, hemodialysis 144-264 hours which is the same as 6-11 days). Therefore CKS prepared uniform nomenclature for these procedures with intervals given uniformly in days for LMP version 2022.

Adjustments of procedures of interventional radiology is a though and difficult process. CKS in collaboration with Slovak radiology society (SRS) works intensively on the changes. The goal is to have only procedures with clear meaning, so coders do not struggle because of duplicity codes when they have to choose the right procedure from LMP. Simultaneously, CKS supervises procedures, so codes cause classification to correct DRG´s.