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Quality and creativity in coding

Quality and creativity in coding. 4th Nordic Casemix Conference Helsinki, 3 June 2010 Jens Lind Knudsen Ministry of Interior and Health, Denmark. The quality of DRG depends on many factors. Good coding Good code classifications Good cost data Good systems for collecting the data

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Quality and creativity in coding

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  1. Quality and creativity in coding 4th Nordic Casemix Conference Helsinki, 3 June 2010 Jens Lind Knudsen Ministry of Interior and Health, Denmark

  2. The quality of DRG depends on many factors • Good coding • Good code classifications • Good cost data • Good systems for collecting the data • Good DRG classifications • Good studies on the data • Good systems to disseminate the results • Good ways to follow up on the results • Dedicated staffs to develop and maintain all this! 4th Nordic Casemix Conference, Helsinki 2010

  3. Quality of the systems around coding • You should be able to code what you do! • It should be easy to find the codes! • Cooperate with the medical associations! • The DRG classification must not provide incentives to poor coding! • Clear and transparent DRG classification! • Ongoing evaluation of the quality of coding! 4th Nordic Casemix Conference, Helsinki 2010

  4. 1. You should be able to code what you do! The Nordic DRG classifications are based on diagnoses (IDC10) and procedures: Surgical procedures(Nordic Classification of Surgical Procedures) Treatment procedures(National classifications) Examination procedures(National classifications) etc. 4 4th Nordic Casemix Conference, Helsinki 2010

  5. 1. You should be able to code what you do! Classifications must be kept up to date constantly! It must be possible to open new codes- quickly and easily! It must be possible to place new codes in the DRG classification as the codes are opened! The Danish code classifications are updated four times a year – with a corresponding update of the DRG classification! 14 November 2009 5 4th Nordic Casemix Conference, Helsinki 2010

  6. 2. It must be easy to find the codes! Simple access tocode classifications! Easy-to-use coding guidelinesthat fit in the coat pocket! It must be easy to code well! Central authorities setsthe principles! Let the medical societiesdevelop the guidelines! 4th Nordic Casemix Conference, Helsinki 2010

  7. 3. Cooperating with the medical societies When constructing DRGs we should emphasize The groups must be meaningful clinically The groups must be homogeneous as to resources Not TO many groups… When choosing between two good solutions to a classification problem in DkDRG, we often choose the more meaningful clinically. 4th Nordic Casemix Conference, Helsinki 2010

  8. 3. Cooperating with the medical societies The Ministry collaborates closely with all medical associations when developing and maintaining the DRG classification. The Danish hospitals are providing the data for the calculation of the cost weights. Result: The hospitals and the doctors areaccepting the measure! They have made the measure themselves! 8 4th Nordic Casemix Conference, Helsinki 2010

  9. 3. Cooperating with the medical societies Complicated reconstruction, knee Other surgical procedures, back % of discharges/visits % of discharges/visits Cost per discharge/visit Length of stay 4th Nordic Casemix Conference, Helsinki 2010

  10. 3. Cooperating with the medical societies Complicated reconstruction, knee Other surgical procedures, back % of discharges/visits % of discharges/visits Cost per discharge/visit Length of stay ongoing process 4th Nordic Casemix Conference, Helsinki 2010

  11. 4. No incentives to bad coding in DRG classifications! In Denmark secondary diagnoses should be coded if they are “clinical relevant”. Whether a diagnosis is clinical relevant or not is up to the physician to decide. Some doctors will see a diagnosis as relevant – others will see it as not relevant. Whether a secondary diagnosis is coded or not can be random. 14 November 2009 11 4th Nordic Casemix Conference, Helsinki 2010

  12. 4. No incentives to bad coding in DRG classifications! If the hospital is funded with a DRG system where secondary diagnoses might result in higher rates – there is an incentive to code diagnoses with a small indication. Denmark chose to base complication splits mainly on procedures. Splits on procedures can outline hospitals with highly specialised procedures. 14 November 2009 12 4th Nordic Casemix Conference, Helsinki 2010

  13. 5. A transparent classification In Denmark the DkDRG system moves around 145 billion DKK (20 billion Euros). An instrument that moves so much money must be transparent. If we want the patients classified correctly in the DRGs, we must make it easy for the doctors to choose the necessary and sufficient diagnoses for a correct grouping. 14 November 2009 13 4th Nordic Casemix Conference, Helsinki 2010

  14. 5. A transparent classification 4th Nordic Casemix Conference, Helsinki 2010

  15. 5. A transparent classification 4th Nordic Casemix Conference, Helsinki 2010

  16. 5. A transparent classification(?) 4th Nordic Casemix Conference, Helsinki 2010

  17. 5. A transparent classification 4th Nordic Casemix Conference, Helsinki 2010

  18. 5. A transparent classification 4th Nordic Casemix Conference, Helsinki 2010

  19. 5. A transparent classification 4th Nordic Casemix Conference, Helsinki 2010

  20. 5. A transparent classification(?) 4th Nordic Casemix Conference, Helsinki 2010

  21. 5. A transparent classification Non-transparency in the classification can lead to inefficient coding practices. In Denmark we are working on removing the build-in complication feature from DkDRG from 2012. 14 November 2009 21 4th Nordic Casemix Conference, Helsinki 2010

  22. 6. Ongoing evaluation of the coding • confidence is good • control is better 4th Nordic Casemix Conference, Helsinki 2010

  23. 6. Ongoing evaluation of the coding • confidence is good • control may be better • cooperation is even better • partnership may be best 4th Nordic Casemix Conference, Helsinki 2010

  24. 6. Ongoing evaluation of the coding Four main scenarios of bad coding: Under-coding (to few codes) Over-coding (to many correct, but unnecessary codes) Up-coding (fraud, with an effect on DRG rates) Errors (ends up in DRGs for errors) The evaluation should continuously follow at least these four scenarios. 14 November 2009 24 4th Nordic Casemix Conference, Helsinki 2010

  25. New born babies 4th Nordic Casemix Conference, Helsinki 2010 Discharges 2009, DkDRG 2010

  26. New born babies – healthy or not? 4th Nordic Casemix Conference, Helsinki 2010 Discharges 2009, DkDRG 2010

  27. New born babies – healthy or not? 4th Nordic Casemix Conference, Helsinki 2010 Discharges 2009, DkDRG 2010

  28. New born babies – healthy or not? 4th Nordic Casemix Conference, Helsinki 2010 Discharges 2009, DkDRG 2010

  29. New born babies – healthy or not? 4th Nordic Casemix Conference, Helsinki 2010 Discharges 2009, DkDRG 2010

  30. New born babies – healthy or not? 4th Nordic Casemix Conference, Helsinki 2010 Discharges 2009, DkDRG 2010

  31. New born babies – healthy or not? 4th Nordic Casemix Conference, Helsinki 2010 Discharges 2009, DkDRG 2010

  32. Discharges MDC 14 – no. of diagnoses Discharges 2009, DkDRG 2010 4th Nordic Casemix Conference, Helsinki 2010

  33. Discharges MDC 14 – no. of diagnoses Total no ofdiagnoses 35.996 5,4 => 22.232 3,3 => 15.744 Discharges 2009, DkDRG 2010 4th Nordic Casemix Conference, Helsinki 2010

  34. Quality and creativity in coding • You should be able to code what you do! • It should be easy to find the codes! • Cooperate with the medical associations! • The DRG classification must not provide incentives to poor coding! • Clear and transparent DRG classification! • Ongoing evaluation of the quality of coding! 4th Nordic Casemix Conference, Helsinki 2010

  35. Thank you Thank you! Jens Lind Knudsenjlk@im.dk 14 November 2009 35 4th Nordic Casemix Conference, Helsinki 2010

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