High time for changes
The DRG classification system needs to undergo extensive changes. All experts agree on this statement. Changes are being developed for the addition and removal of medical procedures (MPs), in the changes to the classification of diagnosis codes (CDs) and MPs in the Definition Manual, in the approach to defining attributable items, the specification of synthetic accounts in the Calculation Manual as well as the control and processing of DRG benefits.
Fundamental changes are also expected in the approach to education of DRG system users. Some inpatient health care providers (IHCPs) are already implementing current trends, which mainly concern trained DRG coders. The proposed changes have been communicated with experts from different organisations. The expected changes in training will be presented in June on the CKS DRG website after receiving comments, possible approval by the steering committee.
There has also been a change in the uniform coding of hospitalised cases (HP) with COVID-19.
The economic team is continuously updating the costing manual, which is consulted at the HP Costing Working Group meetings. In May, there were two Working Group meetings, face-to-face meetings at the University Hospital in Bratislava, the University Hospital Trenčín and the University Hospital in Martin, where the economic team consulted on any uncertainties or proposed change procedures.
The CKS DRG team, in collaboration with the Task Force, began work to complete and update Chapter 4 in the Calculation Manual, revising the defined cost center groups. They are currently working on the second of the three parts. Based on feedback, a meeting was also held with representatives from the National Institute of Heart and Vascular Diseases, the Central Slovak Institute of Heart and Vascular Diseases and the Eastern Slovak Institute of Heart and Vascular Diseases to discuss costing procedures for medical procedures not included in the Catalogue of Medical Procedures. As part of the update of the annexes in the Costing Manual, the economic team started cooperation with experts to define the concept and compile a list of transplants and also participated in several meetings of expert groups on revenue accounting and relations with health insurance companies and with the Ministry of Finance of the Slovak Republic.
The data collection for 2020 officially ended on 31.5.2021. By this date almost all PHCS have managed to send the data. Two PHCPs out of 86 did not manage to send the annual DRG batch.
CKS DRG has completed the data validation methodology and the validation scripts are 87% finalised. Validation against health insurers and checking of clinical linkages remain to be completed.
For the 2021 data collection, the CKS DRG has started building a new import interface. The aim is to achieve data validation already when importing the annual batch, so that not only the formal correctness of the data but also the content of the data is respected. The primary reason for the CKS DRG team is to improve the quality of the data, while also increasing the complexity of creating the annual levy in the sense that the data will be checked in each area. Without data verification, the benefit will not be able to be imported. Feedback will be provided to the PHCS on what specific errors the validator has identified.
The CKS DRG also continues to extensively validate data from previous years.
The medical team held 5 working group meetings, furthermore the CKS DRG team worked on processing feedback and preparing various methodologies and revisions, which are described below.
In May, another meeting of the working group on the Catalogue of case allowances took place with a view to establishing a uniform methodology for imputable items. The CKS presented a summary of the feedback on the add-on items and several variants of the methodology, which are currently in the commenting phase. Opinions on the feedback will be sent in the coming weeks as they will depend on the final version of the approved methodology.
The CKS DRG team has been working on the analysis and elaboration of the suggestions from the feedback. CKS contacted the experts for their opinion on the proposed solutions to the stimuli. The 3rd meeting of the Working Group on the Definitions Manual (WG DP) took place, where the first drafted suggestions were presented and sent to the members of the WG DP for a per rollam vote.
Of the 39 feedback suggestions regarding the Definitions Manual (DM), 17 suggestions have been processed so far, including 4 suggestions regarding DRG assignments that do not reflect actual costs, 2 suggestions regarding the mapping of major diagnoses and medical procedures in the DM algorithm, 6 suggestions regarding suspected medical misclassification of inpatient cases into DRG groups, and 1 suggestion to correct an erroneous removal of a duplicate medical procedure from the DM algorithm. 22 suggestions are still in the process of resolution.
A proposal for coding patients with COVID-19 was approved at the Coding Rules Working Group. The proposal was subsequently presented to the Steering Committee and is currently being approved by per roll call vote.
During the month of May, the CKS continued its analyses for the processing of feedback, contacted experts from whom it collected comments on the proposed solutions and presented the way of dealing with specific suggestions to its members at the 4th meeting of the WGWP. Subsequently, the suggestions were sent to the voting members for a per rollam vote.
Of the 42 feedback submissions on the TOR, 23 were sent to the TOR WG for voting, 10 were responded to (they did not concern proposals for changes to the TOR, they were more of a general or informative nature) and 9 are still in the process of being addressed.
CKS has also been gradually working on the revision of the TOR, which is planned for the summer months. The CKS WG agreed that the Group 8r of the current CKS is in a state that needs to be addressed in a "tear down and build up" manner in collaboration with the professional societies.