3: Summary of CCAG and DTG Consultation – Splitting Decisions ACCD Proposal CCAG Consultation DTG Consultation Outcome 1. Same day (57 ADRGs) and <2 day LOS (2 ADRGs) 1. Same day (57 ADRGs) and <2 day LOS (2 ADRGs) 1. Same day (57 ADRGs) and <2 day LOS (2 ADRGs) 1. Same day (57 ADRGs) and <2 day LOS (2 ADRGs) Removal of same day (57 and <2 day LOS (2 ADRGs) as splitting variables CCAG endorsed removal of same day and < 2 day LOS splits to allow splitting to be determined using ECCS DTG agreed with CCAG endorsement Remove Same day (57 ADRGs) and <2 day LOS (2 ADRGs) as splitting variables Comment: Both CCAG and DTG agreed that these issues are better dealt with by funding models rather than within the DRG classification 2. Died or transferred within 5 days splits (8 ADRGs) 2. Died or transferred within 5 days splits (8 ADRGs) 2. Died or transferred within 5 days splits (8 ADRGs) 2. Died or transferred within 5 days splits (8 Removal of Died as a splitting variable as it is accounted for within the ECCS CCAG endorsed the removal of Died as a splitting variable and agreed that patients who died should be accounted for in the ECCS DTG agreed with CCAG endorsement Remove Died as a splitting variable Comment: Patients who die can reasonably be regarded as part of the complexity spectrum and swept into the ECCS.
ACCD requested CCAG’s advice as to whether: Patients in these 8 ADRGs, who have early transfer, are clinically distinctive An administrative variable of transfer should be retained as a proxy for the relative resource use of those patients CCAG endorsed the removal of the <5 day transfer split for the following ADRGS: E40 Respiratory system disorders w ventilator support E64 Pulmonary Oedema and Respiratory Failure F09 cardiothoracic procedures w/o CPB pump F40 Circulatory disorders w ventilator support DTG agreed with CCAG endorsement Remove the <5 day transfer as a splitting variable for ADRGs E40, E64, F09, F40 n/a CCAG endorsed retaining a transfer for the following ADRGs: B70 Stroke and other cerebrovascular disorders B78 Intracranial injuries F60 Circulatory disorders, admitted for AMI w/o invasive cardiac investigation procedures F62 Heart failure and shock DTG agreed with CCAG endorsement Maintain a transfer splitting variable for ADRGs B70, B78, F60, F62 with analysis undertaken to determine whether the transfer split can be shortened n/a CCAG requested ACCD look at additional cost by day data for these four ADRGs to determine if the < 5 day transfer split could be shortened. Otherwise, DTG agreed with CCAG endorsement. Analysis to be undertaken by ACCD to look for transfer patterns across jurisdictions. If variance across the jurisdictions Following analysis, ACCD will maintain a <5 day transfer splitting variable for ADRGs B70, B78, F60, F62 due to variation in transfer patterns across
In addition, advice was also sought as to whether a departure from ECCS (no split) is justified for ADRG O60, and if so whether to adopt 2 or 3 splits CCAG endorsed ECCS but retaining 3 complexity splits for O60 Vaginal delivery DTG agreed with CCAG recommendation to use ECCS but retain 3 splits in O60. The same number of splits as in V7.0 to be maintained for ADRG O01 Caesarean delivery Use ECCS but maintain 3 splits in ADRG O60 and O01 5. Major problem splits (neonates)(10 DRGs) 5. Major problem splits (neonates)(10 DRGs) 5. problem splits (neonates)(10 DRGs) 5. Major problem splits (neonates)(10 DRGs) ACCD seeks endorsement from CCAG in relation to removal of the major problem list, other problem list and complicating procedures list from the neonatal ADRGs CCAG endorsed the removal of the major problem list, other problem list and complicating procedures list and the use of ECCS with no splits required for: P03 Neonate, 1000-1499g w significant OR procedures P04 Neonate, 1500-1999g w significant OR procedures P05 Neonate, AdmWt 2000-2499g w significant OR procedures P63 Neonate, AdmWt 1000-1249g w/o significant OR procedures CCAG endorsed using ECCS with proposed splits for: P06 Neonate, AdmWt >=2500g w significant OR procedures DTG requested to retain splits for all 10 ADRGs. DTG agreed with CCAG endorsement to remove major problem list, other problem list and complicating procedures list DTG agreed that neonatal clinical consultation through CCAG should be arranged in the future. This would be in the form of advice and education around the change to MDC 15 following the replacement of the major problem list with ECCS. It is anticipated that this consultation would note the outcome of the review of the ECC methodology which may yield the same number of ADRG splits as in AR-DRG V7.0 Major problem list, other problem list and complicating procedures list removed as splitting variables Same number of splits is maintained in all Neonatal ADRGs with the exception of P62 where there is now a split (V7.0 had no split)
CCAG advice was sought as to whether there is another purpose to be gained by retention of mental health legal status as a splitting variable within the AR-DRG classification CCAG endorsed: using ECCS for U61 Schizophrenia disorders using ECCS but maintaining the number of splits (as in V7.0) for U62 Paranoia and acute psychotic disorders (2 splits) DTG agreed with CCAG endorsement to remove mental health legal status as a splitting variable from U61 and U62 Mental Health Legal Status as a splitting variable removed. 7. Urgency of admission: 7. Urgency of admission: 7. Urgency of admission: 7. Urgency of admission: ACCD sought CCAG advice as to whether is a clinical reason for maintaining Urgency of admission as a splitting variable within the AR-DRG classification. CCAG endorsed the removal of Urgency of admission as a splitting variable and using ECCS for Y02 Skin graft for other burns as a better reflector of complexity. DTG agreed with CCAG endorsement to remove Urgency of admission from Y02 Urgency of admission as a splitting variable removed 8. Low volume 8. Low volume ADRGs 8. Low volume ADRGs 8. Low volume ACCD sought CCAG advice as to whether is any overwhelming clinical rationale to continue the practice of having a split in general for particular low volume ADRGs CCAG endorsed using the ECCS (adhering to criteria) and not splitting low volume ADRGs DTG requested there was a split in V7.0 but no split using ECCS, the split should be retained (e.g. A08, E76, J01, K10) DTG discussed K11 as there is no split in the ECC Model; the split would need to be forced (ACCD to review) A minimum number of splits have been maintained when compared to V7.0 (i.e. if an ADRG had a split in V7.0 then a split was maintained in V8.0)
Discussion about these low volume ADRGs generalized to situations where no split was being proposed and there was a split in V7.0. In these cases, DTG agreed that the number of splits as in V7.0 should be maintained 9. Other issues 9. Other issues 9. Other issues 9. issues DCL Precision After investigation of initial candidate codes identified for enhanced DCL precision in the Review of the AR-DRG Case Complexity Process Report, ACCD proposed that DCLs be recalculated at the fourth and 5th character level for N18.- Chronic Kidney Disease and T31.- Burns classified according to extent of body surface area involved N/A DCL precision in relation to N18.- and T31.- was discussed at DTG. It was agreed that the DCLs should be recalculated with enhanced precision (4th and 5th character level) for these two conditions. The DCL matrix has been recalculated with enhanced precision for N18.-. The low occurrence of episodes with T31.- diagnosis codes meant that DCLs calculated at the 4th and 5th character level were no different from those calculated at the 3 character level. Consequently, no enhanced DCL precision was possible for the T31.- (see Section 2.4.2) DCL Standardisation ACCD to investigate ways of increasing the ability of ECCS to be used as a splitting variable. N/A DTG discussed examples in which the ECCS values were too clustered to allow splitting on the basis of ECCS A minor modification to the standardisation factor used in the DCL formula was implemented allowing viable ECCS splitting models to be derived for all ADRGs. (see Section 2.4.3)