Newsletter December 2024
A summary of the latest information on the activities of the CKS DRG.
One-day healthcare
After 3 years of intensive work, the CKS DRG team has succeeded in integrating overnight healthcare into the SK-DRG. PHC is being piloted in the DRG, for 2025 reporting of PHC in the SK-DRG will be voluntary. In the coming years, the aim is to collect good economic and medical data on the NICU, which will be used to calculate a reimbursement mechanism based on providers' costs for overnight care.
Definition guide
Intensive work has also been underway during this year to revise and expand the Definitional Manual for 2025.The changes to the DP consist of three main areas - the creation of new NHS DRGs, revisions to selected categories, and other changes resulting from Feedback suggestions or technical corrections to the algorithms. There are 147 new JHS DRGs in DP 2025 based on approximately 3700 procedures. The algorithms for these groups contain individual combinations of conditions that a hospital case must meet to be included in a JHS DRG. The principle of operation of the ADR DRG algorithms is described in more detail in subsection 4.11 of the first volume of the DP. The revision specifically concerned the Pre-MDC, MDC 01, MDC 02, MDC 04 - it was mainly aimed at adjusting the low-volume and low-performance ADRG groups for which it was difficult to calculate relative weights without using approximation. This approach revised 33 ADRGs across the aforementioned categories. In collaboration with the Working Group, the diagnoses in Appendix D in Volume 5 of the DP were also updated and the principle of assigning an unavoidable error ("fatal flag") for gender-conflicting diagnoses was modified. Feedback suggestions were also addressed through the revision and other changes to the algorithms, with 24 suggestions made this year.
Catalogue of case lump sums
Relative weights for inpatient care have been agreed for 2025, along with relative weights for overnight care. There has been an update to the methodology for calculating the relative weights, with the addition of a new approximation and adjustment to the lower bounds of treatment times for a selected number of DRG groups. The attributable items were also updated based on feedback from users of the SK-DRG system.
Coding rules
Suggestions from feedback and real-life experience have been incorporated into the 2025 CP. The biggest changes were made to sepsis coding and neonatal HP coding.
Base rates and contracts
After several months of intensive work and discussions, the base rates including the basis for DRG contracts were agreed by the Steering Committee at the end of November. The novelty of the calculation of the base rates is that they reflect the cost and production of health care providers in addition to previous reimbursements.
Education and debate for better healthcare
On November 29, 2024 , the Vision for Hospital Categorization and Pricing by 2025 conference was held. We thank all presenters and participants very much for the stimulating discussions and professional dialogue. Both the recording and the presentations are available on our website.
The SK-DRG Coding News Workshopwas held in December and was attended by over 410 participants, Thank you for your participation and for the fruitful and constructive discussion. We will continue to meet with coders next year, right from the beginning of January.
We wish you an enjoyable Christmas holidays, good luck, good health and success in the New Year!❄☃