DRG is getting underway
The Centre for Classification System (CCS) is gradually setting the contours of DRGs in Slovakia. In the first steps, we focus on understanding the processes followed by the Health Care Supervisory Authority (HCSA). We define a uniform and transparent process for the calculation of relative weights, the creation of the list of medical procedures and the approval of changes to the definition manual. We are working on a new CKS DRG website, which is now available. We are concluding Programme I. DRG Conference and we are just waiting for confirmation from the Institut für das Entgeltsystem im Krankenhaus (InEK).
The statute of the Steering Committee has been approved and the first meeting is planned for 10.3.2021. In 2020 we have asked the European Commission, in the framework of a call, for an expert consultation for the correct setup of the DRG system. The project has been approved and should be launched this year. The setup needs were also consulted with the new members of the steering committee.
Feedback is key to the DRG system. We have therefore held meetings with around 50 inpatient healthcare providers (IHCPs) and professional societies to ascertain the status of DRGs and possibly coordinate for feedback input. The deadline for reviewing the proposals for changes was set for 16 March 2021.
As the DRG was in no way adapted to the current epidemiological situation, we prepared a guideline for the creation of the DRG benefit for 2020 and identified the first topic of the economic working group for the correct costing of the costs caused by the COVID-19 pandemic. We also updated the new dials for the creation of the DRG benefit for 2020, where we corrected various inconsistencies, such as the absence of the PHCS. We have also updated the 2021 attributable item codebook where we have identified duplicate codes, for example. Finally, we issued the codebook with inconsistencies, as historically it was issued by the health insurance companies (HIs).
Within the IT part of the team, we are continuing to migrate data from the DHSS to the CKS. We have specified the IT infrastructure requirements needed to run the DRG systems, import and database. The IT department of the Ministry of Health will continue the tender process.
We have released the new dials needed to create the DRG benefit for 2020 as well as the dials for the 274b benefit for 2021, which we have published on the eDRG portal page. They are also already published on the new CKS DRG website, which we are also working hard on.
We are working on defining the concept as well as the exact methodology for validating the data from the PHCP, which is necessary to cleanse the data from errors of a formal as well as economic and clinical nature. Indeed, if we want the DRG system to truly reflect the current clinical situation and also the real cost, correct data are essential for the calculations. We performed initial validations and identified PHCUs with missing data. Next, we seek to identify any missing, incomplete or erroneous data.
We are seeing a basic improvement in data submissions from the PHCS for 2019 compared to 2018. The improvement is that all monitored PHCUs in the DRG system have uploaded the annual batch. In 2018, 14 hospitals did not submit cost data. In 2019, 13 hospitals did not report financial recognition, also 13 hospitals did not report staffing levels and bed capacities and 8 PHCUs were missing all the above mentioned data. While in 2018 there were 11 hospitals that had cases with unlisted DRG group, in 2019 there are 5 PHCUs.
We have expanded our team dedicated to the vast medical field with two new colleagues. We have managed to navigate through the many documents, versions and analyses we have received from the OHSS as part of the transfer of competences. We are analysing the documents that need revision most acutely. However, the DRG database migration process is more lengthy than we anticipated, and we have not yet been able to perform comprehensive analyses over the medical and economic data from the PHCS. We plan to start the comprehensive analyses in the next few days.
We have contacted individual PHCPs for feedback on the DRG system. We are listening to your practice concerns and welcome any suggestions for solutions. After all, two things are crucial for the full functioning of the DRG: the right medical and economic data, as well as knowledge of all the problematic parts. We are working to establish a logical, clear and transparent process for approving individual comments - so that each request is considered not only on the basis of the specific expertise and sub-need, but also on the overall logic of the DRG, and that all responses are then published and available in the same way, and changes are reasonably incorporated.
We have finalized the methodology for recalculating relative weights (RW) and other parameters from the KPP based on the G-DRG. However, some simulations and analyses still need to be performed on the PHCS data to set some specific parameters and formulas, which we plan to address as soon as the DRG database is available.
We analysed the evolution of the attributable items in the KPP as well as the duplication of some of their values in the dials. Over the last year, 32 new drug items, 27 NHS items were added to the KPP and 56 duplicate codes were detected. We finally issued the codebook with the discrepancies as historically it was issued by the health insurance companies (HIs) and we did not want to cause chaos in the codebooks. We will address the issue in the DRG Data Working Group.
We have addressed the identification of changes in the Definitions Manual (DM) for each year. We set about setting up processes for its revision. We are planning to start with the revision of MDC 05 - as this is one of the most costly and numerous MDC hospital admissions for 2019.
When comparing the first version of the DP with the most recent version, we found changes in the tables of medical procedures and main diagnoses. Changes have also been made at the level of DRG-groups, the most significant of which are the change of the name or the assigned segment of the group, the deletion of a DRG-group, the extension of a DRG-group to include a specific medical procedure. The tables of medical procedures in the MDC 05 have been significantly changed compared to the first version, as in 2015 there was a reclassification of HAIs. For example, MDC05-1 has undergone a complete transformation - none of the original 8 procedures in version 1.0 remain in this table and have been replaced by 15 procedures in version DP 2021, the procedures in MDC05-2 have also been changed - version DP 1.0 contains procedures with codes 5k110 to 5k398.0 and version DP 2021 contains codes from 5k510.2 to 5k79x. In comparing the third performance table of MDC05-3, we identified 26 added performances in DP version 2021 compared to version 1.0 and 6 deleted performances. This suggests that unless the performance tables were different throughout, a high number of new performances were added. Likewise, the MDC 05 principal diagnosis table also underwent changes, the most significant of which were the addition or change of more than ten HDg.
We focused on understanding the detailed development of the list of medical procedures (LMP). This process gave us insight not only into the background of the creation of the BOM but also into the historical development of the BOM by comparing changes from previous versions with the current version, and allowed us to understand the processes involved in modifying the BOM for DRGs.
Although the codes of medical procedures (MP) were based on the German OPS (equivalent to the MP in the G-DRG), it can be seen at a glance that the Slovak MP-DRG codes were compiled in a different way. We therefore plan to take a closer look at the OPS in an attempt to find similarities but also differences.
The meaning of the individual characters used in the code varies across chapters and there does not appear to be a uniform logic for the creation of the ZV code. The original ZZV differs significantly from today's ZZV. Hundreds of WGs were added per year. The 2015 version has undergone a major revision. Over 1000 performances were deleted, the coding was changed, and following the annual trend, performances were also added. As a result, today's ZZV has 8,000 more performances than the original one from 2011. Chapter 2 (laboratory procedures) has been removed in its entirety. An effort will be made to standardize coding principles across the entire list.
Further efforts will be made to locate the problems mentioned in the feedback (e.g. duplication of performances), and gradually incorporate their solutions into the new version of the ToR.
CKS DRG team