The importance of the ICD for Casemix/Activity Based Funding work in Australia Prof Ric Marshall and Stuart Mcalister Health Reform Transition Office Hospital Financing Reform

ICD-11 and DRGs Statistics using ICD-9, 10 etc codes tend to collect cases with similar codes together into categories of interest. Measuring variation over time and between settings. DRGs do the same for the particular use case of:- –Funding signals to hospitals and clinical service providers and also increasingly Raise questions about differences in practice Raise questions about quality of services

Some History DRG were developed in the early 1970’s by using administrative data held on medical records. Data coded with ICD codes were available for analysis.

More History Four guidelines were established as guiding principles for the DRG system’s formation: –The patient characteristics used in the DRG definition should be limited to information routinely collected on the hospital billing form. –There should be a manageable number of DRGs that encompass all patients seen on an inpatient basis. –Each DRG should contain patients with a similar pattern of resource intensity. –Each DRG should contain patients who are similar from a clinical perspective (i.e., each class should be clinically coherent).

More History Key Principal was that patient characteristics could be used to group similar conditions to compare practise. Initially to be used to review clinical variation in services provision. As the groups were also homogeneous in resource usage the groups could be used as a funding system. HCFA began using DRGs to fund the Medicare and Medicaid programs in the USA in 1983

ABF Data ABF systems rely on the accurate coding of data to a reproducible standard and having the coding system relevant to current clinical practise. DRG systems rely on this accurate and consistent recording on patient records to build a robust classification.

Having coding systems that have standards for recording patient information also assists in consistent recording and means the same codes would be recorded by experienced staff. The more closely ICD follows current clinical thinking the more likely the clinical documentation will be accurately coded and so the meaningfulness of the patient condition is captured.

Reasons for Updating ICD is updated regularly to ensure that the ICD remains relevant to current clinical practise. ICD updates are a chance to review and align the classification to current clinical thinking.

Process The updates to the ICD while important to the overall description of conditions with a current perspective do involve many in additional work. The creation of a new ICD version involves many people across the world from a range of backgrounds. Many systems need to be updated to cater for the new ICD.

Some Implications Maps between ICD versions need to be created –For longitudinal data analysis –To build new DRG systems so that variation between DRG versions can be managed smoothly. Implementation involves some re-training of the coding workforce.

Conclusion All this upheaval is ultimately for the good of the resulting system which is clearer and more clinically acceptable. If the new ICD-11 achieves this then the classification will be more robust in that data should be more consistent and be of more use clinically in describing and funding patient episodes.