A summary of the latest information on the activities of the CKS DRG.

Summary of DRG changes until 30.6.2023

• Based on past experience and the requirements of the PHCS, the CKS has prepared changes to the Calculation Manual that simplify the data submission requirements and also allow for better DRG cultivation.
• Following the changes to the Calculation Manual, we are also preparing changes to the Data Interface for 2023 Annual Benefits. The changes being prepared affect the breakdown of medical and non-medical infrastructure costs at the medical site cost level. We are also expanding the PHA reporting to provide summary data for DRG-irrelevant costs.
• Other upcoming changes include clarifying the rules for reporting merged inpatient cases.

Checking and correcting annual benefits using validation protocols

The process of validation and correction of annual DRG benefits for 2022 is currently underway. On May 22, 2023, CKS published validation protocols that allow PHAs to correct their annual benefit data. The deadline for the submission of the corrected annual DRG benefit for 2022 is 30.06.2023. After this deadline, PHCS will receive information on the quality of their corrected benefit again in the form of updated validation protocols.

In the future, we plan to extend the validation protocol with benchmark indicators that will provide the PHCS with the possibility to compare key cost performance indicators within the DRG system.

We plan to provide the first such protocols to selected PHAs in 3Q 2023. As a standard, we intend to apply this enhancement to all PHAs when they submit their 2023 annual benefit submissions.

One-day healthcare

Overnight health care will be incorporated into the SK-DRG system. The Steering Committee has approved theConcept Paper on possible approaches for incorporating same-day healthcare into the SK-DRG system. The Working Group on incorporation of PHC into the DRG will look at the phased incorporation of PHC into the DRG over the next few years. DRGs will be created for NHS cases only with appropriate relative weights. The grouper will assign cases to DRG groups for inpatient admissions or ICUs based on algorithms - clearly defined rules based on contraindications for ICUs. The next steps aim to launch the first phase of full reporting and relative weights calculated from modelled costs on an SK-DRG basis from 2025. Read more in the published concept note.

Launch of the Expert Working Group on SK-DRG Disputes

The SK-DRG expert working group on contentious situations has started its work. At its first meeting, the panel dealt with the first disputed situation and successfully reached a common interpretation of the coding rule. The result of its decision will be published in a few days in the Compendium of Decisions of the Expert Working Group on Disputed Situations in the SK-DRG. The Commission is continuing its work and preparing for its next meetings.

The CKS is further engaged in....

• developing a methodology for updating the Definitions Manual,
• the development of the methodology for the calculation of imputables,
• improving the methodology for the calculation of relative weights and other parameters of the Catalogue of case lump sums,
• updating the methodology for the calculation of the basic rates in the context of the United Nations,
• developing feedback loops,
• preparation of the training concept and DRG coders.