Newsletter June 2024

A summary of the latest information on the activities of the CKS DRG.

One-day healthcare

Work on the implementation of the concept of the UHC is ongoing. The CKS DRG is preparing its documents for the inclusion of same-day healthcare in the SK-DRG so that pilot testing can take place from 1 January 2025 for the PHC and PPs that will participate in the testing. The calculation manual and the data interface were voted by the working groups and the steering committee in the first half of the year. The JHS DRG groups with their respective relative weights and base rate are under negotiation and will be voted on in the autumn.

HP pooling rules

We are planning a more extensive analysis of inpatient case-mix aggregation. Currently, inpatient cases are merged according to three methods (see the document Rules Defining Case Rate Calculation and Rules for Merging Inpatient Cases) that provide for merging inpatient admissions when a patient is untreated. We observed that in some situations, HP merging can occur even if the patient has been treated and the second hospitalization is not a consequence of the first. For this reason, we are currently looking at possible solutions - if you know of any specific groups or cases where a similar situation is occurring, please let us know about them via the Feedback Questionnaire, in the 'Hospitalization Case' section.

Catalogue of case lump sums

Based on input from the PHCS and users of the SK-DRG system, we have carried out a medical-analytical review of the lower OD thresholds for all DRG groups. The CKS-DRG suggested 245 DRG groups in which the lower OD limit could be fixed at 1 day. The analysis was sent to all members of the CCP WG for comment. The reduction of the lower OD limit to 1 day is proposed in order to reduce waiting times and to equitably set reimbursement for PHCPs that efficiently implement the DRG groups.

Calculation guide

The 2025 Calculation Manual was approved at the Steering Committee. The changes resulted from requests from users of the SK-DRG system and concerned 3 main areas. The first area was a change to the method of cost allocation for deliveries, in which the approved method of cost allocation was linked to the number of doctor minutes in the delivery room and the duration of the delivery in minutes. This modification also included an appendix describing the standardization of data collection in obstetrics. Another area was the adjustments relating to balancing and the proposal for the concept of separately recorded costs in groups of cost types identified by the letter 'z' . The third area was the modifications to the CP for the purpose of incorporating overnight emergency care into the DRG and reporting under the annual benefit. An updated version of the CP with all the changes incorporated is now available on the CKS website.

Data interface

In the Data and Calculation Manual Working Group we have prepared and agreed on an update of the Data Interface for reporting inpatient healthcare services by DRG (DR274e).

The main changes are:

• Extension of the benefit content for inpatient providers to include same-day care,
• Extension of the content of the benefit for non-residential providers to include same-day care,
• Extension of the interface with new DRG marker entries.

The update is part of our project to incorporate the One Day Emergency Care into the SK-DRG system. We would like to thank all the discussants from the Data WG for their substantive and expert discussion in the preparation of the DR274 update.

Education

The Faculty of Medicine of Comenius University has successfully launched the first course for certified coders from 1 April. The limited capacity of the course has been completely filled and thus the first 30 candidates for certified coders are currently being trained. The next course to be opened by LF UK has also been filled. You will be informed about the opening of further courses via the LF UK website or the CKS DRG.