The beginning of DRG in MOH SR and the competencies transfer

CKS DRG

As the Centre for DRG classification system (CKS DRG) in MOH SR, we would like to present our work to professional public in form of monthly blogs. Currently, DRG system is becoming a functional payment mechanism. Since 2019, the Health Care Surveillance Authority (HCSA) begun working on the agenda and has made a great deal of effort for DRG to become a payment mechanism. To achieve the goal, and so to obtain complete functioning of the financing via DRG, it is essential to implement substantial changes that are currently being analysed. CKS DRG team plans to achieve this goal within two years.

It is difficult to understand all relevant document, since there exist more versions as well as to understand the existing methods and rules of HCSA and to obtain an access to the DRG database. The methodology by which relative weights were calculated in 2016 is not clear, thus it will be set equitably so DRG can reflect the reality of providing health care.

Data flow was defined. Our focus is on data control and following adjustment which is considered to be the key step towards DRG implementation. Furthermore, CKS DRG team is preparing its 1st DRG Conference, constituting the Management Committee and planning mettings with all DRG participants to understand a real DRG situation in Slovakia. More information about individual fields can be found below.

IT FIELD

During first month CKS DRG IT team was apprised of data structure that is submitted by health care providers. Moreover, the team studied mechanism of data submission via web portal eDRG in the Health Care Surveillance Authority. A current state of applications as well as data storage and infrastructure used to maintain the portal were introduced to the team. Based on xsd scheme, that is used for validation of xml files with data together with methodological guidance, estimated data model was created.

During the meeting with employees responsible for DRG in HCSA, we came to an agreement on transfer competencies to MOH SR. Once MOH SR is technically prepared, IT topls will be transfered. For now, they will remain on HCSA servers. There has to be secured information structure in collaboration with MOH SR IT department. Database and application server, via which the application Grouper is launched to access eDRG portal as well as eDRG portal - its production and trial version,will be transfered. After the transfer, the main focus will be to extend and improve validation mechnisms, hence, only correct data will be used for following calculations and analysis.

Medical field

First critical sectors that need to be improved and updated so DRG can become functional and equitable mechanism for health care financing were identified after introductory appraisement.

Recalculation of parameters, which have significant impact on pricing individual hospitalization cases - so called relative weights correspond to the individual DRG groups, are in critical need for a change. By analysing the DRG Catalogue (CLS), we discovered that the current relative weights as well as other parameters in CLS that are pricing inputs have not been changed since the pilot set up of DRG system in Slovakia - hence since 2016. The weights were taken and slightly modified from the German institute InEK (G-DRG), from which the whole system has been taken. The weights were based on data taken from German hospitals in 2009. An alarming result suggests that some of the current hospitalisation cases can not be covered by the current pricing of SK-DRG system nor costs of used material. CLS parameters need to be recalculated to present current costs of hospitalised cases based on Slovak data from last two years. Right now, we are finalising the methodology of parameters calculation. After successfull transfer of reamining competences from HCSA, recalculations and analysis will be performed.

Revision of the Definition handbook and the list of medical procedures is another critical aspect that needs to be changed and updated in medical field. However for that, feedback from hospitals is necessary in order to find specific errors and shortages in a practice. For this reason, there is a new way of commenting via survey available on web MOH SR where comments concerning DRG system of any type can be entered. Feedback is an essential aspect by which DRG can become a functional, equitable system that would reflect reality. Thus, all requests and suggestions received via survey will be answered.

CKS DRG team