Newsletter October 2023
A summary of the latest information on the activities of the CKS DRG.
DRG 2024 UPDATE
The biggest change is a complete overhaul of medical procedures in interventional radiology. Procedures related to actual or potential attributable items have been added, and the associated linking of newly created procedures for SNFs to the SNF categorization list. Requests from experts from different specialties based on the expert working groups for optimisation of the hospital network or on feedback to the DRGs were also incorporated. New procedures have been created for the hospital network optimisation team in order to correctly classify hospital admissions in medical services - expansion of 93-group procedures. We are starting to use notes more extensively in terms of defining the correct coding of medical procedures through inclusions and exclusions.
The Definitions Manual mapped the changed performance from the 2024 ZZV and the revised ADRGs B03 and K06. These groups were changed as the calculated relative weight value did not match the clinical severity ranking of the DRGs in the ADRG group and also the low-numbered DRG was deleted. These changes were approved by both the Working Group and the Steering Committee.
The Steering Committee approved a methodology for the calculation and convergence of base rates for 2024 that reallocated groups of characteristically similar hospitals. At the same time, preliminary base rates for individual health care providers will be published as part of the RV enrollment. In particular, the portion of the methodology relating to the available resources for inpatient health care for 2024 will be updated and published along with the final base rates for individual health care providers in November 2023.
The system users have agreed to implement the SK-DRG system as a reimbursement mechanism from 2024 for selected DRG groups related to deliveries, physiological newborns with and without complications, total hip and knee arthroplasties, and selected oncological and cardiovascular DRG groups representing 10%-15% of inpatient healthcare production. The procedural implementation of reimbursement is described in the Expert Guidance of the Ministry of Health of the Slovak Republic on the implementation of reimbursement according to the SK-DRG classification system.
The first official Slovak relative weights for 2024 were approved at the Steering Committee. The specific feature of the new relative weights is their approach to address the weaknesses of the previous year's calculation. This year we focused on the calculation of relative weights for as many DRGs as possible. Inpatient cases from 2021 were added to the calculation as well as the use of the XGBoost decision tree algorithm to model non-valid inpatient cases. The new relative weights are scaled from highest to lowest confidence by approximations from 1 to 5.
Attributable items have been changed in all parts. A new methodology has been applied in the MES which examines NWCM outputs reported in 2022. The new methodology represents a new vision in the form of identifying inhomogeneity in costs - a legitimate cost variance that is not covered by relative weighting. The NWCM without medical performance in 2022 will be examined subsequently based on the medical performance generated and the data delivered. Health performances describing complex procedures/examinations/surgeries will not be part of the PP.
New PPs were created for drugs as per the requirements from the feedback, the percentage of UUC on which the calculations were based was changed to a uniform 90% in the calculation. Required elimination methods were added and all EM prices were indexed by 6%-9%, in line with the feedback requirement. Transfusions were aligned with the MoH price measure. All ATMPs have been included in the PP limit for inpatient care in the new Innovative Medicines Annex in accordance with the law. This step prevents situations of inability to report ATMPs during hospitalization. However, innovative medicinal products can only be reported under the statutory conditions to which we refer in reimbursement type F. In all sections, a technical adjustment has been made - the use of asterisk designations for medical procedures has been discontinued.
Coming.....