11 Working Group Meetings
There were 11 working group meetings by the end of April. The CKS team is mainly focused on opinions on Feedback and setting up the revision of the main DRG outputs. At the same time, the CKS team participated in 2 meetings with experts from the English Natianal Health Service (NHS) and the Polish Narodowy Fundusz Zdrowia (NFZ) under the auspices of the European Commission.
A key topic for the CKS is the calculation of relative weights, the deadline for which is slightly delayed mainly due to various inconsistencies in DRG benefits and their poor data quality for 2019. The validation of DRG data is still not completed.
Various technical issues have been experienced in importing DRG benefits, which we will be looking to resolve with the new IT infrastructure towards next year.
Inconsistencies were identified in defining a uniform coding procedure for inpatients. The proposed changes will go into effect on June 1, 2021 after approval by the workgroup and the steering committee.
The Economics team continues to update the Calculation Manual and its annexes. A second meeting of the Costing Working Group was also held to discuss proposals for separating COVID departments by creating a new group of cost centres.
It is currently in the commenting phase. The CKS team is working on updating and supplementing the chart of accounts for inpatient health care providers (IHCPs) , which they plan to standardise. A list of direct costs is being prepared and will be defined and incorporated in the Calculation Manual.
The working group will hold its third meeting in early May to discuss the proposals. Input from feedback was also being processed.
The CKS DRG IT team continues to collect DRG data from the PHCP after the annual benefit submission deadline. Some PHCPs did not manage to submit the benefits by this deadline for various reasons. Some had problems with accounting and tax return filing deadlines, and some even lacked staff to generate the data. Therefore, CKS granted them a grace period until April 30, 2021, by which date all data should be available. So far, 66 DRG benefits have been registered. 7 PHCS have accepted the request for extension until 30.4.2021. From the remaining 13 PHCS they are waiting for comments on the deadline for sending the annual benefit.
A new methodological guideline will be defined in the DATA WG to address the current data heterogeneity. The ambition of the CKS, in collaboration with the WG members, is to improve data quality to the highest possible level. At present, a large group of data that do not pass validation will need to be excluded. Based on the changes agreed in the WG, the data for this year will already be of much higher quality.
The CKS team is also continuing with the development of a comprehensive data validation methodology with 2019 data. So far, 85 validation checks have been performed on form and content in DRG data. 35 checks identified inconsistencies. The largest number of error records were identified when checking the items of medical procedures, which. are validated against the benefit codes. At the same time, a relatively large proportion of erroneous entries were found in the reimbursement and cost tables.
We held up to 7 working group meetings in the medical team, dedicated to processing feedback and preparing various methodologies and revisions, which are described below.
In April, a further meeting of the working group on the Catalogue of case lump sums was held, which highlighted the important need to incorporate the methodology for imputable items into the methodology for the recalculation of relative weights.
The CKS will work on the methodology in the coming weeks, together with the processing of feedback on this issue as well as on the analyses needed to specify some of the parameters of the relative weighting methodology itself.
DEFINITION GUIDE
The CKS DRG team has been working on the analysis and elaboration of the suggestions from the feedback. A Working Group on the Definitions Manual (WG DP) was held and a plan for the revision of the Definitions Manual for 2021 was presented.
Training was provided on the operation and use of the Pflegetool, which produces the Definition Manual. The CKS DRG team is grateful for the meetings with their colleague Ms Pipisek from the Health Care Oversight Office.
A draft coding proposal with COVID-19 has been developed and presented to the Working Group on Coding Guidelines and Rules (WG MUPK), which is currently in the comment phase.
Figure 1: HP types divided by reason for admission and confirmed COVID-19 disease and overview of coding options for clinical situations related to COVID-19
In April, feedback from the PHCP was processed. The processed submissions are now being circulated to the experts for an opinion. The agreed proposals will then be presented to the Working Group on the List of Health Performances.
The WGZV has started to set up the review process. Most procedures were coded by 1 specialty - internal medicine and 10 - surgery. We selected the procedures used by these specialties together and the significant codes from them. Thus, we obtained 1 169 procedure codes from the current PHR. These codes are in the process of revision (looking for duplications, non-specific procedures, etc.). CKS contacted 14 specialty societies among which these procedures were distributed. An effort was made to present to the professionals the way in which the revision should be carried out. The review is planned for early summer.
CKS DRG team