Health
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Hospital Circular 04/1999

Date Issued: 30 April 1999
Publication: 4/1999
Contact: Head Office
Distribution: Public and Private Hospitals, Software Suppliers
Subject: AN-DRG Version for Public Hospital Funding, 1999-2000

Background

1999-2000 will be the seventh year of casemix funding of public hospitals in Victoria. Casemix funding is based on Weighted Inlier Equivalent Separation (WIES) values derived from the Diagnosis Related Group (DRG) and length of stay of each eligible patient episode. Since 1996-97, Version 3.1 of the AN-DRG (Australian National Diagnosis Related Group) Grouper software has used to calculate WIES values.

The Policy and Funding Guidelines for the current financial year (1998-99) contain the following statement on page 23:

Version 4 of the classification (AR-DRG4) is expected to be available for implementation from 1 July 1999. A decision on its introduction must await further analyses. It will not be introduced before 1 July 1999. A collection of ICD-10-AM data is essential to the analyses and testing of the classification.

Issues

Version 4.1 of the AR-DRG Grouper would provide greater clinical currency than Version 3.1, but the late availability of V4.1 software (none of the authorised suppliers' product was available by the expected date of December 1998, and some of the authorised suppliers' product was still not available by February 1999) has limited the Department's ability to conduct the required analyses of the impact on individual hospital and network budgets.

Before making a decision on the Grouper Version to be used for public hospital funding, the Department consulted hospital sector representatives on the Victorian Advisory Committee for Casemix Data Integrity (VACCDI).

Decision

Following the receipt of advice from VACCDI members, the Department has decided to remain with AN-DRG Grouper Version 3.1 for funding for the 1999-2000 financial year. Version 3.1 will be supplemented by a small number of VIC-DRGS developed to cover recognised problem areas (in addition to those used in 1998-99, details will be provided in the 1999-2000 Policy and Funding Guidelines).

The advantages of this decision are that it provides for:

Continuation of code mapping and DRG adjustment are negative factors outweighed by the advantages of remaining with Version 3.1.

The Department is committed to moving to Version 4 in 2000-2001 and will group data using both Version 3.1 and 4.1 for its Victorian Admitted Episodes Dataset (formerly VIMD) during 1999-2000. Public hospitals are encouraged to utilise both grouper versions, if possible, in order to model their own data in planning for

2000-2001 and to provide flexibility in the supply of data to other external agencies, such as private health funds, Transport Accident Commission, etc.

Version 3.1 and Y2K

Hospitals, as part of the process of checking their supply chain, may have written to 3M, as sole supplier of Version 3.1 Grouper software, regarding its Y2K readiness. The official 3M statement on Y2K is that the 3M AN-DRG V3.1 mainframe product and the 3M AN-DRG V3.1 grouper that is operating as part of the 3M Australian Coding and Grouping Applications product (3M Encoder) are Y2K compliant. 3M advise that the AN-DRG V3.1 DOS PC Grouper software and sample programs shipped with the mainframe software are not Y2K compliant. Copies of 3M Y2K statements can be accessed from their web site at www.y2k.3m.com under 'Australian grouper software'.

The Department understands that, unless 3M make modifications to the Version 3.1 DOS PC Grouper, it will not operate effectively beyond 1 January 2000, if dates are specified using two digit years. However, Commonwealth Department Y2K laboratory tests have indicated that, provided four digit year fields are input to the V3.1 grouper, the software meets Y2K performance criteria. It is our understanding that the Commonwealth is following up with 3M regarding modification requirements and this information will be passed on when it becomes available.

Version 3.1 software actually provides a number of alternative ways to group data. AN-DRG software calculates length of stay, same day status, age in years and age in days from date fields where these are provided. Alternatively V3.1 grouper software provides an option to group without using dates. Under this option length of stay, intended same day flag, age in years and age in days (equal to 1 where birth date equals admission date) are calculated prior to grouping and input into the grouper software. This can be done by changing the input definition file to add 'alos', 'intendedlos', 'aged', and 'agey' variables and to remove date variables.

The following code is an example of the input definition file used by DHS so that date fields are not used in the allocation of Version 3.1 AN-DRGs.

u_filler(11);
alos(4);
intendedlos(1);
hmv(4);
wgt(4);
sex(1);
sep(2);
agey(3);
aged(3);
pdx(5);
sdx[11](5);
ppr(4);
spr[11](4);
u_seqnum(10);
u_eol(1);

As a precaution hospitals are advised to conduct internal system tests on grouper performance under Y2K scenarios. If you need to discuss the Y2K issue further please contact Steve Gillett on 96167297.

If you have more general queries please contact the PRS/2 Help Desk on 9616 8141.

DR C W BROOK
DIRECTOR
ACUTE HEALTH

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