It is time for a change

CKS DRG

All experts agree that the DRG classification system needs to undergo extensive changes, specifically addition and removal of medical procedures (MP), classifications of code of diagnosis (CD) and MP in the Definition handbook, a way of defyning suplementary remuneration, specification of synthetic accounts in the Calculation handbook as well as the control and collecting process of DRG data.

Significant changes are expected in the training of DRG system users. Several health care providers has implemented current trends, mainly trained DRG coders. Proposed changes were discussed with experts from various organisations. Expected changes in education will be introduced in June on web CKS DRG after obtaining comments and possible approval by the Management Committee.

Changes were made in uniform coding of hospitalised cases (HC) diagnosed with COVID-19.

Economic field

Economic team continues to update the Calculation handbook which is being discuseed during working group meetings of the calculation costs per HC. In May, two meetings of working groups were held as well as personal meetings in the University hospital Bratislava, Faculty hospital Trencin and University hospital Martin, in which economic team discussed possible ambiguities or procedures in suggested changes.

CKS DRG team in collaboration with the working group begun adding and updating the 4th Chapter in the Calculation handbook, in which defined groups of cost centres were checked. Currently, the team is working on the second out of three parts. On the basis of feedback, a meeting with representatives of - the National Institute for Cardiovascular Diseases, the Central Slovak Institute for Cardiovascular Diseases and the East Slovak Institute for Cardiovascular Diseases, was held in which methods of cost calculations of unclassified medical procedures in the Catalogue of lump sums, were discussed. While updating attachments in the Calculation handbook, the economic team begun to collaborate with experts to define a term and to compile a list of transplants. The team participated in several meetings of expert groups concerning income recognition and relationship between health insurance companies and the Ministry of Finance of the Slovak Republic.

IT field

The deadline of the annual data submission was officially on 31 May 2021 for data obtained in 2020. Almost all health care providers met the deadline. Only 2 health care providers out of 86 did not submit the annual DRG data.

The methodology of data validation and script validation has been finalised up to 87 per cent. The only remaining task is to complete validation to health insurance companies and control of clinical binding.

CKS begun to form new import range of data collection obtained in 2021. The goal is to achieve data validation right after the annual data import, so data will be correct in formal and content way. The primary reason is to improve the data quality which will incrase the complexity of data creation in a way that data will be controlled in every area. Without data verification, data can not be imported. Health care providers will be provided feedback of specific mistakes identified by validator.

CKS DRG continues on extensive data validation from previous years.

Medical field

Medical team held 5 working group meetings and focused on feedback analysis as well as on preparation of various methodologies and revisions that are described below.

The DRG Catalogue

In May, another working group meeting of the DRG Catalogue was held to create unified methodology of suplementary remuneration. CKS presented feedback summary concerning suplementary remuneration items and several methodological variants that are currently in a commenting phase. Standpoints will be sent in following weeks, since it depands on the final approved version.

The Definition handbook

CKS DRG team analysed and processed suggestions obtained in feedback. Experts were contacted to provide their standpoint on proposed suggestions. CKS held III. working group meeting of the definition handbook (WG DH), in which first processed suggestions were introduced and put for voting by per rollam to members of WG DH.

Out of 39 suggestions concerning the Definition handbook (DH), only 17 suggestions were processed, out of which 4 suggestions refered to DRG classification, which did not reflect real costs. 2 suggestions were about the mapping of main diagnosis and medical procedures by algorithm in the Definition handbook. 6 suggestions suspected the incorrect medical classification of hospitalised cases into DRG groups. 1 suggestion was to remove a erroneous duplicate of a medical procedures from the algorithm in DH. 22 suggestions are still to be processed.

Coding rules

In the working group meeting of coding rules, a proposal for coding patients diagnosed with COVID-19 was approved. The proposal was consecutively presented to the Management Committee and currently, it is about to be approved by vote using per rollam form.

The List of medical procedures

During May, CKS continued to analyse feedback, contacted experts, from whom standpoints were obtained; and held IV. meeting of WG LMP, in which method to solve specific suggestions was introduced. Consecutively, suggestions were sent to be approved by members with voting right in per rollam form.

Out of 42 feedback suggestions concerning LMP, 23 were processed to WG LMP to be voted, 10 suggestions were answered (not concerning changes in LMP, rather had general or infomative character). 9 suggestions are still to be processed.

CKS was gradually working on the revision of LMP which is planned for the summer months. WG LMP agreed that the group 8r of the current LMP needs to be "demolished and rebuilt" in close cooperation with specialised institutes.