Start of DRG at the Ministry of Health and transfer of competences
We would like to present our work at the Centre for DRG Classification System (CKS DRG) at the Ministry of Health of the Slovak Republic in the form of monthly blogs. We are currently on our way to a functional payment mechanism. The Health Care Supervisory Authority (HCSA) has been working on the agenda since 2009 and has made considerable efforts to make the DRG ready to become a payment mechanism. However, in order to achieve this goal, i.e. to make the DRG-based flat-rate financing fully operational, fundamental changes are still necessary, which we are currently analysing. The CKS DRG team plans to achieve this goal within two years.
It is challenging for the current CKS DRG team to navigate all the relevant documents as they exist in multiple versions, as well as to understand the current procedures and rules of the DRG Office and to gain access to the DRG database. We do not yet know according to which methodology the relative weights were calculated in 2016, which we want to set fairly so that the DRG reflects the reality of healthcare spend.
We have defined the data flow in the DRG and are also focusing on data control and subsequent correction, which we see as a key step in DRG implementation. In addition, we are forming a CKS DRG team, working on I. DRG conferences, we are forming a steering committee and we are planning meetings with all DRG participants in order to know the real situation in DRG in Slovakia. You can read about specific areas in the colleague sections below.
Within the IT part of the CKS DRG team, we spent the first month familiarising ourselves with the structure of the data sent by each PHCS and learning about the mechanism of data transmission via the eDRG web portal to the PHCS. We familiarized ourselves with the current status of the applications and the infrastructure used to operate both the portal and the data repository. Starting from the xsd schema used for validation of xml data files and the methodological guideline, we have created an assumed data model.
At a meeting with the staff responsible for DRGs at the Health Care Authority, we agreed on how the transfer of competences to the MoH will take place. All IT resources will be migrated only when the MoH SR is technically ready for it. For the time being, they remain on the servers of ÚDZS. For our part, we have to ensure the creation of the IT infrastructure in cooperation with the IT department of the MoH SR. The database and application server on which the Grouper application is running for the needs of the eDRG portal will be migrated, as well as the eDRG portal itself - its production and test version. After the migration, we will focus on extending and improving the validation mechanisms so that only error-free data is allowed for subsequent calculations and analyses.
After an initial familiarisation with the current state of the DRG system and its shortcomings, we identified the initial bottlenecks that need to be improved and updated in order for DRG to become a workable and equitable mechanism for financing inpatient healthcare.
We consider the most critical need for change to be a systemic recalculation of the parameters that have the most significant impact on the valuation of individual hospital cases - the so-called relative weights assigned to individual DRG groups. By analysing the Catalogues of case lump sums (CCS), we have found that the currently applicable relative weights and other CCS parameters that enter into the valuation have been valid without changes since the pilot implementation of the DRG system in Slovakia - i.e. since 2016. At the same time, these values were taken and only slightly adjusted from the German InEK (G-DRG), from whom the entire SK-DRG system was adopted, with the adopted values coming from data from German hospitals from 2009. The alarming result is that for some of the current hospital admissions, the valuation assigned by the current SK-DRG system does not even cover the cost of the material used. Thus, the KPP parameters need to be recalculated to match the actual actual cost of hospitalisation cases, based on hospitalisation data from Slovak hospitals over the last 2 years. We are currently finalizing the methodology for recalculating these parameters and after the successful migration of the remaining necessary components from ÚDZS, the actual recalculation and related analyses will take place.
Other critical needs for changes and updates in the medical field that we plan to address in the near term after staffing is strengthened are the revalidation of the Definitions Manual and the List of Medical Procedures. However, feedback from hospitals is also essential for these steps, as this is where they encounter specific errors or shortcomings of the DRGs in practice. We have therefore launched a new way of commenting through a questionnaire directly on the website of the Ministry of Health, where it is possible to enter and describe comments of any kind, on any part of the DRG system. We feel that feedback is an essential element for a functioning, reality-based and fair DRG system, so we will respond to all comments and suggestions that come in.
CKS DRG team