Terminology

Casemix (CM) is sum of cost weights of all hospitalisation cases for a certain period.

Casemix index (CMI) is arithmetic mean of all cost weights of all hospitalisation cases for a certain period and shows averrage economiv (cost) difficulty of case during the time period.

Definition manual contains detail description of specific DRG system version with graphic depiction of sorting algorithms with their logic expressions and used tables.

DRG  is abbrevation for "diagnoses related groups" arising from original title.

DRG system is a classification system that allows to sort hospitalisation cases due to diagnoses, diagnostic and terapeutic procedures to groups with similar clinical course and with similar economic costs.

Effective cost weight its calculatation is based on catalogue cost weight, i. e. taking into account increasing and decreasing catalogue cost weight because lenght of stay is out of interval set.

Effective casemix and effective casemix index their calculation is based on effective cost weights, i. e. taking into account increasing and decreasing of cost weight due to outliers in terms of lenght of stay or because patient transfer between health care providers.

Grouper is software tool (computer program) used to classify hospitalisation case, i. e. assigning the DRG.

Main diagnostic category (MDC) stands for first level of classification in DRG system. It is based on similarities of cases, mainly due to organ systems.

Main diagnose is a diagnose, that is meant to be major reason of hospitalisation of the patient and is chosen due to analysis.

Hospitalisation case is hospitalisation of a patient in inpatient medical facility (hospital) with a start date (first day of hospitalisation) and a release date (last day of hospitalisation).

Catalogue of lump sums is a list of specific DRG groups which contains cost weights and more relevant information for DRG remuneration, e. g. lenght of stay with upper and lower interval border values for each DRG, increases and decreases of cost weights, possibly suplementary remuneration.

Classification DRG system is economic-medical classification system that sorts hospitalisation cases based on diagnoses, procedures and other parametres, to medical and cost similar and homogenous groups (DRG´s).

Comorbidity is current occurance of two or more unrelated diseases.

Complication is disease process (or event) that occurs during the disease, but is not essential part of this disease, event though it can arrise from the disease , or can have independent causes.

Complications and comorbidities (CC) are secondary diagnoses that usually leads to significantly increased resource consumption.

Coding rules is document with methodology for medical stuff describing the rules of coding the diagnoses and procedures of hospitalisation case.

Lump sum is a sum in euros for hospitalisation case that is classified by grouper to one specific DRG. Lump sum is calculated as multiplication of base rate of health care provider times effective cost weight possibly with other suplementory remuneration due to lump sum catalogue.

Cost weight is empirically setted value that relatively describes averrage costs of hospitalisation case of specific DRG. Cost weight setting is based on cost data of hospitalisation cases from health care providers.

Patient complications and comorbidity level (PCCL) is measure of cumulative effect of complications and comorbidities of one patient (CCL) calculated for hospitalisation case. The calculation itself is a bit complex and should serve as control point, so same circumstanc.s will not be taken into account more than once.

Complications and comorbidity level (CCL) is a value that in DRG system is calculated for each secondary diagnose. CCL can take values between 0 and 4 (including) for cases with surgeries and for newborns. In other cases the rnge of values for CCL is 0 to 3. Meaning of values: 1=slight CC, 2=moderate CC , 3=severe CC, 4=extremly severe CC.

Secondary diagnose is a diagnose that occurs together with main diagnose, or appeared during hospitalisation.

Reimbursement based on procedure is financial reimbursement for healthcare provider for curement connected to hospitalisation. I. e. hospital (inpatient medical facility) is not payed for each partial procedure performed or hospitalisation in department, but is payed for whole hospitalisation case that reflects to clinical and economic difficulty of comparable cases with emphasis on effectivity and is not derived from costs of specific hospital.

Base rate is a sum in absolute value that is reimbursed via DRG system for single hospitalisation case with cost weight 1,0. Base rate calculation is based on available financial source.