First historical meetings
In March, the 45th meeting of the Steering Committee (SC) for reimbursement mechanisms and price regulationtook place, the first ever at the Ministry of Health of the Slovak Republic.
CKS also opened 5 working groups (WGs) (out of a total of 7 WGs), to which the members of the Steering Committee nominated their representatives and started to work together on the improvement of the DRG system in Slovakia. Individual members and minutes of the WG meetings can be found here.
Historically I. DRG Conference in Slovakia was held on 23.3.2021 under the auspices of the Secretary of State Mr. Peter Stachura. The conference had almost 200 participants and due to the epidemiological situation it was held online. It was attended by representatives of hospital associations, health insurance companies, professional societies and also foreign experts from the European Commission and the Institut für das Entgeltsystem im Krankenhaus. A recording of the conference can be found HERE and the individual presentations HERE. The CKS DRG team is also looking forward to the arrival of 2 new colleagues: for the economic area and the administrative umbrella of the Classification System Centre, together with the training area.
The deadline for reviewing proposals for changes to the DRG (Feedback) was 16.3.2021.
175 requests have been sent, which will be the primary focus of the CKS (with one request often containing multiple requests). To date, 244 requests have been registered. All opinions on the Feedback will be published HERE. The CKS has drafted uniform rules for the assessment of proposals for change, which it has presented to the various working groups for comment. They have started to address the various analyses presented below by individual colleagues.
Going through the different areas in detail, it is to be noted that the rules and guidelines are not uniformly set, understood and followed by the DRG participants, which largely distorts the proper functioning of the DRG system.
In March, the CKS DRG team gained access to the servers where the DRG data is stored. The operator of the servers for the time being is the Health Care Supervisory Authority (HCSA). The CKS DRG team has made progress on the validation methodology, which is being worked on intensively. At the same time, the data validation process according to the methodology has started, with outputs showing unfilled baseline data. Completion of data will be requested from the Inpatient Health Care Providers (IHCPs) once the complete data validation is completed.
The first DRG data working group was held. Input from members as well as external members will be incorporated and presented at the next WG in mid-April. WG members also have the opportunity to comment on the validation methodology mentioned above. At the end of March, the e-DRG portal for uploading the PHCS benefits for the year 2020 was launched, the DRG benefit upload is available HERE
In the medical area, the CKS DRG team was mainly involved in processing feedback suggestions and preparing submissions to the RC, DRG Conference and individual WGs. For the medical area, 3 WGs have been opened so far - on the Catalogue of Case Rates (CCR), the Definition Manual and the List of Medical Procedures. CKS presented the methodologies to the members of the WGs, which they currently have the opportunity to comment on. The next WG meetings are scheduled immediately after Easter, where the methodologies are already to be modified according to the comments, approved and presented to the RC. Other parts of the methodologies, on which the DRG team is working intensively, will also be presented by the CKS.
In the feedback on the Catalogue of Case Premiums (CCP), most suggestions were made on changes to the relative weights, some treatment periods, and attributable items. The global recalculation of relative weights and treatment periods, which is planned in the near future, will be the basis for resolving these issues. The basic methodology for the recalculation is currently in the comment phase of the WG. At the same time, the plan is also to prepare a methodology for the fair addition and pricing of attributable items.
The CKS DRG team has been busy collecting and analysing feedback on the Definitions Guide and subsequently developing criteria for evaluating and incorporating the suggestions from the feedback. These criteria have been prepared for the Working Group on the Definitions Manual (WG DP) and are currently in the process of being commented on.
The WG members discussed the issue of the revision of the Definitions Manual, which the CKS would like to undertake this year. In proposing the main diagnostic categories that should be subject to revision, they focused on those that contain the most hospital cases (HP), the most reimbursements, but also compared from (preliminary) data the proportion of reimbursements that PHCUs have with HP. A detailed plan for the review will be presented to the PS DP and subsequently to the RC.
Different HP coding methods were compared with COVID-19 abroad. The CKS DRG team is preparing a proposal for the above mentioned coding within the Coding Rules WG so that the data reported by the PHCS is unified. A document summarizing the main principles of the operation of the Definition Guide has been finalized and is published HERE.
The CKS DRG team focused on finding the most used parts of the list of medical procedures. They assigned a specialty to the medical procedures reported for the PHCS, and looked at the two most numerous : internal medicine (specialty code 1) and surgery (specialty code 10). These specialties use over 6,000 codes from the whole of the PHC, of which 2,490 are used together.
In addition to the list of health interventions from the PHCS, the feedback included a number of complaints about the Interventional Radiology Area (IRA), which has a number of problems. Codes are duplicated, poorly specified, or missing altogether for some processes implemented in hospitals.
More than 80% of the codes that were reported to the PHCS as problematic fall within the aforementioned 2 490 codes used together in specialties 1 and 10.
In March, a Working Group on the List of Health Outcomes (WG HOE) was established. At the first meeting, the CKS presented the criteria it intends to apply to future feedback submissions. Next, they plan to talk about the revision of the CQS at the CQS WG, where they plan to invite professional societies, according to the CQS areas concerned. The review should start with the 2490 codes mentioned above (they are the most frequently used and cover more than 80% of complaints).
A document has been finalised, the essence of which is a summary of the main principles of the operation of the List of Healthcare Performances, which is published HERE.
CKS DRG team