Organ transplant AN-DRGs: Modifying the exceptions hierarchy in casemix classification

Antioch, Kathryn; Zhang, Xichuan

doi:10.1071/ah000137

Cited by 4 publications

(3 citation statements)

References 1 publication

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“…Methodologies and statistical criteria used to develop the grouper for Australian DRGs have been described elsewhere and have also been deemed to 'world leading' [4,6]. The methodologies are considered rigorous,valid and sound.However,DRG development processes are unable to capture, or adjust for, the effects of a small group of very expensive patients related to State-wide referral services that likely occur in only a few hospitals nationally.…”

Section: Developments In Germanymentioning

confidence: 99%

“…In developing Australian DRGs the R 2 statistic was explored for the major diagnostic category,including medical and surgical partitioning [6]. Further, explanatory variables are also considered at the level of two or three partitions of a group [4] or new DRG splits for chemotherapy [16].There may be great value in further analysing the explanatory power of DCGs at more refined levels of the classification system itself,for example, perhaps at the level of the Aggregated Clinical Conditions, its sub-components of CCs, or for patient sub-groups such as cystic fibrosis patients using Australian data. Potential uses of DCGs for risk adjustment at the national level are feasible for the AHCA re-negotiations and also the reinsurance pool arrangements.…”

Section: Risk-adjustment Applications For Coordinated Care Trialsmentioning

confidence: 99%

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The risk-adjusted vision beyond casemix (DRG) funding in Australia

Antioch

Walsh

2004

HEPAC

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Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

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Section: Developments In Germanymentioning

confidence: 99%

Section: Risk-adjustment Applications For Coordinated Care Trialsmentioning

confidence: 99%

The risk-adjusted vision beyond casemix (DRG) funding in Australia

Antioch

Walsh

2004

HEPAC

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“…A comparison of the reimbursement level with the level of costs within MDC 16 reveals an even more dramatic result. An unpublished analysis of the German University Hospital Consortium (Verband der Universitätsklinika Deutschlands, VUD) showed for 10 university hospitals that the medical DRGs Q60 and Q61 are not [17]. Comorbidities and complications (CC) are concomitant diagnoses that usually cause higher resource consumption.…”

Section: The G-drg 2010 System Has 4 Central Trigger Points To Find Tmentioning

confidence: 99%

DRGs in Transfusion Medicine and Hemotherapy in Germany

Bauer¹,

Ostermann²

2012

Transfus Med Hemother

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Patients requiring transfusion medicine and hemotherapy in an inpatient setting are incorporated into the German Diagnosis Related Groups (G-DRG) system in multiple ways. Different DRGs exist in Major Diagnostic Category 16 for patients that have been admitted for the treatment of a condition from the field of transfusion medicine. However, the reimbursement might be not cost covering for many cases, and efforts have to be intensified to find adequate definitions and prices. We believe that this can only be successful if health service research is intensified in this field. For patients requiring hemotherapy and transfusion medicine concomitant to the treatment of an underlying disease such as cancer, multiple systems exist to increase remuneration, among them the Patient Clinical Complexity Level (PCCL) and complex constellations to induce DRG splits. For direct reimbursement of high cost products, additional remuneration fees (Zusatzentgelte, ZE) are the most important. In addition, expensive innovations not reflected within the DRGs can be reimbursed after application and negotiation of the New Diagnostic and Treatment Methods (Neue Untersuchungs- und Behandlungsmethoden, NUB) system. The NUB system guarantees that medical progress is put rapidly into clinical practice and prevents financial issues from becoming a stumbling block for the use of innovative drugs and methods.

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Variation of Daily Care Demand in Swiss General Hospitals: Longitudinal Study on Capacity Utilization, Patient Turnover and Clinical Complexity Levels

Sharma¹,

Schwendimann²,

Endrich³

et al. 2021

J Med Internet Res

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Background Variations in hospitals’ care demand relies not only on the patient volume but also on the disease severity. Understanding both daily severity and patient volume in hospitals could help to identify hospital pressure zones to improve hospital-capacity planning and policy-making. Objective This longitudinal study explored daily care demand dynamics in Swiss general hospitals for 3 measures: (1) capacity utilization, (2) patient turnover, and (3) patient clinical complexity level. Methods A retrospective population-based analysis was conducted with 1 year of routine data of 1.2 million inpatients from 102 Swiss general hospitals. Capacity utilization was measured as a percentage of the daily maximum number of inpatients. Patient turnover was measured as a percentage of the daily sum of admissions and discharges per hospital. Patient clinical complexity level was measured as the average daily patient disease severity per hospital from the clinical complexity algorithm. Results There was a pronounced variability of care demand in Swiss general hospitals. Among hospitals, the average daily capacity utilization ranged from 57.8% (95% CI 57.3-58.4) to 87.7% (95% CI 87.3-88.0), patient turnover ranged from 22.5% (95% CI 22.1-22.8) to 34.5% (95% CI 34.3-34.7), and the mean patient clinical complexity level ranged from 1.26 (95% CI 1.25-1.27) to 2.06 (95% CI 2.05-2.07). Moreover, both within and between hospitals, all 3 measures varied distinctly between days of the year, between days of the week, between weekdays and weekends, and between seasons. Conclusions While admissions and discharges drive capacity utilization and patient turnover variation, disease severity of each patient drives patient clinical complexity level. Monitoring—and, if possible, anticipating—daily care demand fluctuations is key to managing hospital pressure zones. This study provides a pathway for identifying patients’ daily exposure to strained hospital systems for a time-varying causal model.

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Organ transplant AN-DRGs: Modifying the exceptions hierarchy in casemix classification

Cited by 4 publications

References 1 publication

The risk-adjusted vision beyond casemix (DRG) funding in Australia

The risk-adjusted vision beyond casemix (DRG) funding in Australia

DRGs in Transfusion Medicine and Hemotherapy in Germany

Variation of Daily Care Demand in Swiss General Hospitals: Longitudinal Study on Capacity Utilization, Patient Turnover and Clinical Complexity Levels

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