Outpatient care in NordDRG a new logic 2006

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Outpatient care in NordDRG a new logic 2006

• Rikard Lindqvist
• Mats Fernström
• Bengt Kron
• Per Sjöli
• Mona Heurgren
• Centre for Patient Classification Systems Sweden

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Agenda

• Background
• A new national classification for procedures
  (KVÅ)
• A new logic for outpatient visits in NordDRG
• Results
• Remaining work
• Work at the Nordic Centre

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Case-mix in Sweden The NordDRG system

• NordDRG a Nordic project (including Estonia)
• Different versions in different countries but
  also a common Nordic version
• The Nordic Centre for Classification of Diseases
  is responsible for the grouping logic
• Transparent grouping logic, available on the web
  at http//nordclass.uu.se
• Swedish version 2006 Approximately 500 groups
  for inpatients (including mental health care) and
  500 groups for outpatients

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Current use of NordDRG in Sweden

• The use of DRGs are not mandatory in Sweden
  therefore the way we use DRGs in the county
  councils differs
• More then 90 of all cases in Sweden are
  originally grouped in NordDRG - and all patients
  are grouped in the national discharge register
• About 50 of all cases in Sweden are reimbursed
  by NordDRG 6 county councils/regions are using
  DRGs for reimbursement within the county council,
  18 are using the system for the payment of
  patients from other county councils and
  countries.

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The use of DRGs in Sweden
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Background a new logic in NordDRG

• NordDRG was introduced in Sweden in 1996 the
  system was adopted to inpatient care only
  (NordDRG Classic)
• In 2004 a logic for day surgery and endoscopic
  procedures was introduced, the system was called
  NordDRG-O
• In 2004 we started a work aiming to include all
  outpatient care in NordDRG (SK-OP project)

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Why a new logic?

• 40 of the costs in Swedish somatic care and 50
  in mental health care are costs for outpatient
• Still outpatient care is poorly described and the
  classification systems in use are not suitable to
  reimburse outpatient visits
• The introduction of a new procedure
  classification and the development of
  case-costing for outpatient care have made it
  possible to develop a new grouper for outpatient
  visits

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A new classification for procedures (KVÅ)

• A national classification for procedures is
  available at the web at http//www.sos.se/epc/klas
  sifi/KVA.htm
• Includes both medical, surgical (NCSP) and mental
  health procedures
• Still some areas are missing, like
  physiotherapists others, as radiology, are not
  complete
• The new procedure classification will be
  mandatory in Sweden 2007

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The result of the SK-OP project

• The work is finished and a first version of an
  outpatient grouping logic has been developed
• In 2006 we will introduce the new grouping logic
  NordDRG-swe full version
• Two county councils will use the new groups to
  describe and reimburse outpatient care in 2006
  (Stockholm and Västra Götaland)
• The results are documented in a report available
  at the web (Slutrapport för SK-OP-projektet)

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Results NordDRG-swe 2006

• 210 new groups for outpatient visits
• 230 groups for day surgery and endoscopic
  procedures
• 526 groups for inpatient care
• - All in all 966 groups for all somatic and
  mental health in- and outpatient care in the
  NordDRG-system 2006

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Principles for the new outpatient grouping logic

• The new system is mainly driven by procedures but
  still most visits belong to an MDC
• Visits to all professionals in health care can be
  grouped in the system
• Only significant procedures are grouped in the
  system
• The system also includes groups for multiple
  procedures
• Two new MDC for outpatients
• MDC40 Non MDC specific treatments and other
  procedures
• MDC 50 Visits to other professionals then
  physicians

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Examples of new groups
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DRG-weights 2006

• DRG-weights for NordDRG 2006 for both inpatients
  and outpatient groups are available at CPKs
  homepage
• The Swedish National case-costing database is
  used for the calculation of new prospective
  weights every year
• For year 2004 we have about 30-40 of Swedish
  inpatient care in the case-costing database

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First results of the new grouping of outpatient
vistis

• Skaraborgs Sjukhus 2005

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Result of the grouping
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Most frequent medical procedures
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Most frequent surgical procedures
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Example 1 disorders of skin

• Outpatient care counts for 95 of the costs at
  the clinic

Performance at the clinic, august
2005 Performance No Average cost
Tot cost (SEK) (SEK) Physicians
visits 4 568 1 541 7 041
000Nurse visits 699 665
465 000Others 3 389
533 1 806 000 Total
8 656 1 076 9 312
000
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To describe performance with NordDRG full version
2006 disorders of skin
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Example 2 Orthopedic visits 2005.

• To describe performance 2 visits at the
  orthopedic department
• Performance Type of visit Cost
  (SEK)
• 1.Physician visit First visit
  1 910
• 2.Physician visit Re-visit
  1 910

What new information can NordDRG-full version and
the case-costing system in outpatient care give
us?
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Orthopedic visits in 2006

• Visit 1
• Problem Finger
• Diagnosis T92.2 Late problems
  for fracture on hand
• Procedure NDQ29 Revision of
  amputated finger
• NordDRG 4410 Hand surgery, operation
  after injury
• Type of visit First visit
  physician, team
• Acute visit Yes

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Orthopedic visits 2006

• Visit 2
• Problem Control of leg
• Diagnosis S72.0 Fracture of femur
• Procedure No significant
• NordDRG 8210 Visit to physician in
  MDC 8
• Type of visit Re-visit, physician
• Acute No

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Remaining work

• Further development of the grouping of mental
  health care procedures
• Better grouping of expensive and rare
  radiological procedures
• Development of the Swedish case-costing database
  for outpatients
• Analyses of the new groups cost homogeneousness
  and medical relevance

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Nordic work

• Why not include outpatient-groups in the common
  NordDRG algorithm?
• No common Nordic classification for non-surgical
  procedures!
• But could the national (FI, SWE, NO) versions
  be mapped? NCSP
• Can the work, regarding out-patient care, done in
  Sweden and Finland be a starting point for a
  common Nordic version?
• The NordDRG steering group have established a
  working group for out-patient care (chair Leena
  Kiviluoto, NO)

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To conclude

• We believe we now have a tool to get much better
  information on performance in outpatient care
• The critical parts are the implementation of the
  new classification of outpatient procedures and
  the implementation of case-costing systems in
  outpatient care
• Still we have a lot of work to do!

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Further information can be found at
http//www.socialstyrelsen.se/Om_Sos/organisation/
Epidemiologiskt_Centrum/Enheter/CPK/

• Rikard.lindqvist_at_socialstyrelsen.se
• Mona.heurgren_at_skl.se

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Thank you!