Review of the ar-drg classification Case Complexity Process
Download 483.86 Kb.
|
Review of the AR-DRG Classification Case Complexity Process: Final Report1 August 2014 Prepared for the Independent Hospital Pricing Authority This page intentionally left blank Contents Review of the AR-DRG Classification Case Complexity Process: Final Report 1 Glossary of Abbreviations 4 Executive Summary 8 Overview 9 Aims of the Review of the Case Complexity Process 10 1Review the current Patient Clinical Complexity (PCCL) process and identify improvements and modifications. 10 2Determine the codes considered significant (currently the Complication and Comorbidity (CC) codes) in measuring case complexity. 10 3Determine whether there is a need for separate CC codes and/or matrix for paediatric and geriatric age splits. 10 4Determine whether more levels of complexity for significant diagnoses are required (currently for medical DRGs there are three Complication and Comorbidity Level (CCL) values and for surgical DRGs there are four CCL values). 10 5Examine whether more levels of complexity for the overall episode PCCL score are required (currently there is a maximum value of four). 10 6Determine whether the condition onset flag (COF) data should impact the case complexity score when the COF value indicates that the condition arose during the current episode of care. 10 7Validate codes that are to be significant to the DRG classification and the clinical reasonableness of the final case complexity results through clinical consultation. 10 Important terminology 11 Methodology 12 Key Findings and Recommendations 13 Implications 16 Stability of the Episode Clinical Complexity Model 17 Episode Clinical Complexity Model implementation 18 Changes to episode grouping 19 Private Hospitals 20 Education about the Episode Clinical Complexity Model and its implications 21 Next steps 22 8Introduction 23 9Determine the codes considered significant (currently the Complication and Comorbidity (CC) codes) in measuring case complexity. 25 10Determine whether there is a need for separate CC codes and/or matrix for paediatric and geriatric age splits. 25 11Determine whether more levels of complexity for significant diagnoses are required (currently for medical DRGs there are three Complication and Comorbidity Level (CCL) values and for surgical DRGs there are four CCL values). 25 12Examine whether more levels of complexity for the overall episode PCCL score are required (currently there is a maximum value of four). 25 13Determine whether the condition onset flag (COF) data should impact the case complexity score when the COF value indicates that the condition arose during the current episode of care. 25 14Validate codes that are to be significant to the DRG classification and the clinical reasonableness of the final case complexity results through clinical consultation. 25 14.1Background 26 14.2Brief history and development of DRGs in Australia 27 14.3Use of costing data in DRG Refinement 28 14.4Current case complexity definitions 30 14.5Case complexity processing within the current AR-DRG classification 31 14.6Approaches to DRG development taken internationally to account for complications and comorbidities 32 14.6.1The United States 33 14.6.2Germany 34 14.6.3France 35 14.6.4Canada 36 14.6.5England 37 14.6.6Other 38 14.6.7In summary 39 14.7Episode Clinical Complexity Model terminology 40 14.8Governance and consultation process 41 14.9Project Overview 44 15Data preparation 45 15.1Source data 46 15.2ICD-10-AM mapping 47 15.3Data exclusions 48 16Using Adjacent DRG and diagnosis cost profiles to evaluate AR-DRG Version 7.0 Complications and Comorbidities Levels 49 16.1ADRG cost profiles 50 16.2Diagnosis cost profiles 52 16.3Evaluation of AR-DRG V7.0 CCLs using diagnosis cost profiles 54 17The Episode Clinical Complexity Model 57 17.1Summary of the development of the Episode Clinical Complexity Model 58 17.1.1Measuring relative changes in cost associated with diagnosis cost profiles 59 17.1.2Standardising the diagnosis relative costs within each ADRG 62 17.1.3Combined diagnosis relative cost associations at the episode level 63 17.2Formal development of the Episode Clinical Complexity Model 64 17.2.1Diagnosis exclusions 65 17.2.2Modelling of ADRG costs 66 17.2.3Estimation of relative costs associated with diagnoses within the context of ADRGs 75 17.2.4Derivation of the Diagnosis Complexity Level 77 17.2.5Combining Diagnosis Complexity Levels across episodes and derivation of the Episode Clinical Complexity Score 89 17.2.6ECCS formula 91 18Treatment of the Principal diagnosis in classification design 96 18.1The DRG Classification Process 97 18.2Did the diagnoses include acute quadriplegia or paraplegia? The role of the Principal diagnosis in AR-DRG development 100 18.3Principal diagnosis impact on cost 102 19Guiding principles for Diagnosis Complexity Level assignment 107 19.1Diagnosis Complexity Level Assignment 108 19.2DCL scope guiding principle 1 109 19.2.1Group 1: Chapter 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 110 19.2.2Group 2: Chapter 21 Factors influencing health status and contact with health services (Z00-Z99) 111 19.2.3Group 3: Unacceptable principal diagnoses 112 19.2.4Group 4: Special case exclusions 113 Codes that add descriptive information to an already assigned ICD-10-AM code 113 Sequelae (late effect) codes not appearing in Group 3. 113 Full-time dagger (aetiology) codes. 113 Conditional Exclusions (CEs) 113 19.3DCL scope guiding principle 2 115 19.3.1Codes identified as ‘in scope’ for DCL assignment from Groups 1– 3 above 116 20The use of condition onset flag in classification design 118 20.1Background 119 20.2Is there a potential role for COF in classification development? 121 20.3Other Considerations 123 20.3.1Retaining the integrity of the COF information 124 20.3.2Treating at risk patients 125 20.4In summary 126 21Evaluation of performance of the ECC Model 127 21.1Comparison of the 5-category ECCS models against the PCCL model 131 21.2Comparison of the 5-category ECCS models against the AR-DRG classification 133 21.3Comparison of performance across all models 136 21.4Comparative performance on paediatric episodes 141 21.5Comparative performance on geriatric episodes 144 22Continued refinement of ECC Model 148 22.1Ongoing evaluation and refinement of methodological and technical components of the ECC Model 149 22.1.1Enhancing DCL precision 150 22.2Ongoing evaluation and refinement of empirically derived components of the ECC Model 151 22.2.1Sample variation and DCL stability 152 23Conclusion 156 24References 159 25Appendices 162 26List of Figures 163 27List of Tables 164 Directory: sites -> files sites -> Memorandum of agreement files -> Information security policy university administration and services (uas) files -> Chris ham: reforming the nhs lessons from the past and pointers to the future files -> - files -> A guide for parents and carers files -> Ariel M. Sheetrit files -> Chapter Calendar of Events –July 2017 For the benefit of our members and customers please coordinate the scheduling of dates to prevent overlapping events. In the event of conflicting dates it is recommended to personally notify the other chapter of the files -> Collective redress in england & wales files -> County No Treasurer’s Elderly and Disabled property tax credit request affidavit Download 483.86 Kb. Share with your friends:
|