Casemix in rehabilitation, psychiatry and geriatric care

1
Case-mix in rehabilitation, psychiatry and
geriatric care

• Meeting in Island 16/9 - 2002
• Mona Heurgren, Senior economist
• Federation of Swedish County Councils, Sweden

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Situation today

• We have not solved this yet!!
• Works and discussions are ongoing
• CPK have the ambition to be active in this matter
• A lot of effort has been made to find a secondary
  classification for outpatient care (NordDRG-O)

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Why dont we have case-mix systems yet?

• The Problem the two main criteria for a case-mix
  system
• The system must be medically relevant and cost
  homogeneous

4
Rehabilitation

• High priority in the NordDRG expert and steering
  group
• A Nordic working group is going to analyse the
  possibility to find a secondary classification
  for rehabilitation within NordDRG during this
  year and 2003

5
Psychiatry

• Work has started in Sweden to create a secondary
  classification and a Case-Costing model for
  Psychiatry
• This work will be presented at the PCS/E
  conference in Innsbruck by Mr Bo Ivarsson and Mr
  Jan Lindmark
• (bo.ivarsson_at_vgregion.se and
  jan.lindmark_at_lf.se)

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SRG State Related Groups

• 13 diagnosis groups
• Global Assessment of Functioning (GAF)
• Age
• Number of visits and number of inpatient days
• 26 SRG for psychiatry

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GAF - Costs
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Discussion

• SRGs are not tested with costs yet - R2-value?
• The SRG-system is a kind of episode grouper with
  both out- and inpatient care. Can we achieve cost
  homogenous groups this way?
• More groups?

10
Future

• CPK has started this work, we will try to find a
  system for psychiatry that can for fill the
  criteria for a DRG-system
• SRG is the starting point to develop a case-mix
  system for psychiatry

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Geriatric care

• First question What is Geriatric care?
  Definitions?
• 1. Internal medicine for elderly
• 2. A holistic care of all problems for elderly
  people, medical problems, care and housing,
  rehabilitation and mental health
• 3. Rehabilitation of elderly
• 4. Dementia care
• 5. all of the above

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DRG-founding of Geriatric care

• The Stockholm experience
• Splitting of DRG 462 (Rehabilitation) and DRG 467
  (Other factors influencing health status)
  reimbursement within the DRG-system
• Did not work lack of cost homogeneousness and
  acceptance among the physicians
• Back to provision
• Still a lot of geriatric patients are reimbursed
  at the hospitals by NordDRG at the internal
  medicine wards

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DRG-founding of Geriatric care

• The Västra Götaland experience
• Started with provision
• This year geriatric care is reimbursed within
  the NordDRG-system meaning the care given to
  elderly for internal medicine problems at
  geriatric wards
• R2 increased when costs for the geriatric
  patients were included

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Future

• No efforts are made today to find a secondary
  classification system for the total care of
  elderly
• Discussions about how to develop a grouper for
  the nursing care for elderly
• Discussions whether internal medicine for elderly
  should be separated from the NordDRG-system
• Case-costing in geriatric wards and better
  medical registration

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Summary

• Work has started to find a way to classify
  rehabilitation in NordDRG
• Work has started to find a secondary
  classification system in psychiatry starting
  point SRGs
• No work has started for geriatric care more a
  question of whether its possible or not to use
  NordDRG for internal medicine patients.

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Addresses on the web
Centre for Patient Classification
Systems www.sos.se/epc/cpk Information is
available in English
The National Case-costing project
www.lf.se/sek/kpp.htm