|
September 25, 2007
Transitioning From DRGs to MS-DRGs: IHA and COMPdata Assistance
Hospitals have all heard about the new MS-DRGs that take effect starting with
October 1, 2007 discharges; but it is important to realize the significant
impact it will have on hospital analysis, reimbursement, and strategic planning.
Highlighted Changes from DRG to MS-DRG
For those not that familiar with the details, the following changes
highlight the dramatic shifts in analysis that will impact their hospitals,
including:
- Expansion of Groupings from 538 DRGs to 745 MS-DRGs
- Almost all DRGs are assigned a different MS-DRG number requiring constant
use of cross-walks to understand changes and trends
- MS-DRGs can be subdivided into three groups which will be the basis of
payment:
- MS-DRG without complication or comorbidity
- MS-DRG with complication or comorbidity (CC)
- MS-DRG with major complication or comorbidity (MCC)
- Of the approximately 13,600 diagnoses codes, about 3,343 will be on CC
list and 1,589 will be on MCC list
- Based upon historical national level data, Medicare has found that 22% of
Medicare cases under MS-DRG will be classified as having a major complication
or comorbidity, 37% with complication or comorbidity, and 41% with no
complication or comorbidity.
- Select MS-DRGs may also have their severity increased based upon some
procedure/device codes as the procedure/device will serve as a ‘proxy’ for a
complication or comorbidity
To further challenge planning and analysis, IHA is also aware that some
health plans may not be ready to transition to the new MS-DRGs and therefore
hospitals may be straddling between two different payment systems for a year or
two.
IHA and COMPdata Transition Assistance
In order to better understand the changes and assist member hospitals in
their transition, COMPdata will be releasing 5 quarters of historical data
(April 1 2006 through June 30 2007) with MS-DRG assignments along with its
regularly scheduled quarterly update for 2nd Quarter 2007 next week.
By allowing hospitals to utilize both MS-DRG and DRG in the COMPdata reports and
data bases, hospitals will be positioned to better understand the DRG to MS-DRG
crosswalk, severity assignments, and reductions in the number of cases falling
into different severity levels.
In order to better acquaint hospitals with the changes and provide support
for optimizing COMPdata resources, a number of customer support services will be
provided, including:
- Conference call on understanding the MS-DRG reimbursement approach and
transitioning from DRG to MS-DRG analysis
- Conference call and Webinar training on COMPdata data and screen changes
and additions
- COMPdata manual update to accommodate the on-line screen changes and
COMPdata report information
MS-DRG Conference Call - Thursday, October 4, 2007 - 11:00 a.m.
Central Time.
Staff Contact: Pat Merryweather
|