Lifting the weight of a diagnosis-related groups family change: A comparison between refined and non-refined DRG systems for top-down cost accounting and efficiency indicators
Public healthcare providers in all Spanish Regions - Autonomous Communities (ACs) use All Patients Diagnosis- Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRG...
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Published in | Health Information Management Journal Vol. 44; no. 2; pp. 11 - 19 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
London, England
SAGE Publications
01.01.2015
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Subjects | |
Online Access | Get full text |
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Summary: | Public healthcare providers in all Spanish Regions - Autonomous Communities (ACs) use All Patients Diagnosis- Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRGs) has been scheduled for 2016. The analysis was performed on 202,912 inpatient care episodes ranging from 2005 to 2010. All episodes were grouped using AP-DRG v25.0 and APR-DRG v24.0. Normalised DRG weight variations for an AP-DRG to APR-DRG migration scenario were calculated and compared. Major differences exist between normalised weights for inpatient episodes depending on the DRGs family used. The usage of the APR-DRG system in Spain without any adjustments, as it was developed in the United States, should be approached with care. In order to avoid reverse incentives and provider financial risks, coding practices should be reviewed and structural differences between DRG families taken into account. |
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Bibliography: | HIMJ_c.gif Health Information Management Journal, Vol. 44, No. 2, 2015: 11-19 |
ISSN: | 1833-3583 1322-4913 1833-3575 |
DOI: | 10.1177/183335831504400202 |