Embed Size (px)
Citation preview
OVERVIEW
• International Classification of Diseases (ICD)( )• AR DRG / Australian Version
– Major Diagnostic Categories (MDC)– Australian Refined - Diagnosis Related Groups (AR-
DRG)INA DRG• INA-DRGIndonesian – Diagnosis Related Groups – Clinical Pathway (CP)Clinical Pathway (CP)– Casemix (CM)– Activity Based Costing (ABC) + Simple Distributiony g ( ) p
• Rekam Kesehatan Elektronik & INA-DRG
Overview of Th I i l Cl ifi iThe International Classification
of Diseases, 10th Revision (ICD 10)
• ICD X, Diseases classified into 21 Chapters, p- Chapters I – XVII : Diseases and morbid conditions- Chapter XIX : injuries, poisoning and certain other
consequences of external cause- Chapter XVIII : symptoms, signs and abnormal
clinical & laboratory findings not elsewhere classifiedclinical & laboratory findings, not elsewhere classified- Chapter XX : External causes- Chapter XXI : factors influencing health status and p g
contact with health services
Major Diagnostic Category (MDC)Australian Version
Th MDC i t ll b d• The MDC ia a category generally based on a single body system or etiology that is associated with a particular medical specialtyassociated with a particular medical specialty
• AR-DRG.v.4 – MDC’s are sub-divided into a maximum of three
separate partitions, for surgical, other anddi lmedical.
– 23 MDC’s ~ ICD X – Clinical Modification (CM) 1st ed661 DRG’s– 661 DRG s
1 Diseases and disorders of the nervous system
2 Disease and disorders of the eye
Major Diagnostic Categories (AR DRG)
3 Disease and disorders of the ear, nose, and throat
4 Disease and disorders of the respiratory system
5 Disease and disorders of the circulatory system
6 Disease and disorders of the digestive systemg y
7 Disease and disorders of the hepatobiliiary system and pancreas
8 Disease and disorders of the musculoskeletal system and connective tissue
9 Disease and disorders of the skin, subcutaneous tissue, and breast
10 E d i t iti l d t b li di d di d10 Endocrine, nutritional, and metabolic diseases and disorders
11 Disease and disorders of the kidney and the urinary tract
12 Disease and disorders of the male reproductive
13 Disease and disorders of the female reproductive system
14 Pregnancy, childbirth, and the purperium
15 Newborn and other neonates with conditions originating in the perinatal period
16 Disease and disorders of blood and blood forming organs and immunological disorders
17 Myeloproliferative disease and disorder and poorly differentiated neoplasm17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm
18 Infectious and parasitic disease (systemic or unspecified sites)
19 Mental diseases and disorders
20 Alcohol/drug use and alcohol/drug- induced organic mental disorders
21 Injuries, poisoning, and toxic effects of drugs
22 Burns
23 Factors influencing health status and other contact with health services
1 Diseases and disorders of the nervous system
2 Disease and disorders of the eye
Major Diagnostic Categories (Pedoman Tarif ?? DEPKES,2007)
3 Disease and disorders of the ear, nose, and throat
4 Disease and disorders of the respiratory system
5 Disease and disorders of the circulatory system
6 Disease and disorders of the digestive systemg y
7 Disease and disorders of the hepatobiliiary system and pancreas
8 Disease and disorders of the musculoskeletal system and connective tissue
9 Disease and disorders of the skin, subcutaneous tissue, and breast
10 Endocrine, nutritional, and metabolic diseases and disorders
11 Disease and disorders of the kidney and the urinary tract
12 Disease and disorders of the male reproductive
13 Disease and disorders of the female reproductive system
14 Pregnancy, childbirth, and the purperium
15 Newborn and other neonates with conditions originating in the perinatal period
16 Disease and disorders of blood and blood forming organs and immunological disorders
17 Myeloproliferative disease and disorder and poorly differentiated neoplasm17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm
18 Infectious and parasitic disease (systemic or unspecified sites)
19 Mental diseases and disorders
20 Alcohol/drug use and alcohol/drug- induced organic mental disorders
21 Injuries, poisoning, and toxic effects of drugs
22 Factors influencing health status and other contact with health services
23 Medical Outpatient Visit (?)
Diagnosis Related Group’s (DRG’s)Diagnosis Related Group s (DRG s)
• AR-DRG =AR DRG = • Australian Related – Diagnosis Related
Group is a character patient classificationGroup is a character patient classification scheme which provides a means of relating the number and types of patientsrelating the number and types of patients treated in a hospital to resources required by the hospitalby the hospital
• AR-DRG.ver 4.1 (1999), 661 DRG’s .
Casemix (1)Casemix (1)• The number of days they spend in hospital, the y y p p ,
types of treatment they receive, and the actual cost of treatmentA i f i l i l i h f i ifi• An information tool involving the use of scientific methods to build and make use of classifications of patient care episodes (C Aclassifications of patient care episodes (C.A, 1976)
• Is a scientific approach used to describe the mix or type of patient or cases for which care is provided in a care delivery setting (Scott & Scott, 1997)1997)
DRG Numbering• The format = A DD S• A = Pre MDC DRG’s ; B = nervous system ; y
DRG; O = Reproductive System; Z = DRG’s relating to other health factors; 9 = the error DRG’sDRG s
• DD = DRG’s partition; – Range 01 – 39 Surgical PartitionRange 01 39 Surgical Partition– Range 40 – 59 Other Partition– Range 60 – 99 Medical Partition
• S = split indicator– A = highest resources DRG
B d hi h t– B = second highest resources
General Logic,Diagnosis Related Group’sAll acute admited patien
Principal diagnosis
Major diagnostic category # 1 MDc # 4MDC # 3MDC # 2Yes No
What procedure
Surgical Partition of MDC # 1 Medical Partition of MDC # 1
Yes No
ProcedureCuster A
ProcedureCluster C
ProcedureCluster D
ProcedureCluster B
Procedure cluster A over age X
What age group’s
Procedure cluster A under age X
Over Under X
Significant secondary condition ?
ocedu e c uste o e age ocedu e c uste u de age
Yes No
Procedure cluster AOver Age X, with CC
Procedure cluster AOver Age X, without CC
DRG Decision Tree
PEDOMAN TARIF ?!*&#$%@PEDOMAN TARIF ?! &#$%@
PEDOMAN TARIF ?!*&#$%
INDONESIAN DRG’s
INDONESIAN DRG
International Classification of Disease (ICD)e a o a C ass ca o o sease ( C )
Major Diagnostic Categories (MDC)Major Diagnostic Categories (MDC)
Surgical / Other / MedicalClinical Pathway
Diagnosis Related Groups (DRG’s)
Casemix
INDONESIAN DRG’s
• Conceptual framework– ICD : X (WHO) usable– MDC : 23 (AR-DRG) temporarily usable( ) p y– Clinical Pathway : constructible
DRG : to be confirmed + constructible– DRG : to be confirmed + constructible– Casemix : to be confirmed +
t tiblconstructible– Costing : using Activity Based Costing +
Simple Distribution
INA DRG’s l f k (1)conceptual framework (1)
ICD
MDCMDC
DRG DRG DRG
1
CASEMIX
COS
COST2
COST
TARIFF
TARIFF
INA DRG’s l f k (2)conceptual framework (2)
INA - DRG
1.Confirm - DRG 2.Costing - DRG
Clinical Pathway & Casemix
Activity Based Costing
INA-DRG’s, Conceptual Framework (3).
Length of (hospital) stay
Utilization
Room & BoardRoom & Board
Medical ExamsNursing Treatments
Medical supporting
Patient Characteristics,Age, Sex
Case Mix
Therapy
Medical Services & Paramedics
Administration
Main Diagnosis
Clinical Pathway and Cost of Treatment
Co-Mortality, Co-Morbidity, CC Unit Cost
Room Investment Cost Medical Exams
Nursing Treatments
Supporting Exams
Therapy
Investment Cost
Operation cost
Maintenance Cost
Medical Services & Paramedics
Administration
DIREKTORAT JENDERAL BINA PELAYANAN MEDIKDEPARTEMEN KESEHATAN
2005
Clinical Pathway in Hospital
CLINICAL PATHWAYCLINICAL PATHWAYCLINICAL PATHWAYCLINICAL PATHWAY
• the integrated planning concept that documents treatments given to patients based on standard medical treatments, standard nursing care and other standard medical professional, that is evidence based with measurable results in a certain period of time within hospitals”.
CLINICAL PATHWAYCLINICAL PATHWAYCLINICAL PATHWAYCLINICAL PATHWAY
SYMPTOM DIAGNOSIS THERAPY FOLLOW UP
1 2 3 4 51 2 3 4 5
Admission Diagnosis Pre Therapy Therapy Follow up
ActivitiesABC
ActivitiesABC
ActivitiesABC
ActivitiesABC
ActivitiesABC
Relation with Medical Standard ServicesClinical Pathway
Relation with Medical Standard Services
I C D
Profession Standards D M D C
I.C.D
Profession Standards Dummy M.D.C
CLINICAL PATHWAY :measurable
Hospitalservices
Surgical MedicalOther
SOP(admission to discharge)
DRG
Case Mix
Alur Pelayanan Resep Rawat Jalan Kontan RKEPasen
PasienM em bawa Resep Ke
Apotik/ Zoning
Ass. Apoteker Cek resep danCek resep dan
kelengkapannya
Lengkap Tidak Ass. Apoteker Lengkap
Ass. ApotekerInput Resep dan Inform asi
H
YA
Tidak M enghub. P ihak Terkait
Harga
Setuju dgnHarga Pasien PulangTidak
2
YA
3.7.2 Alur Pelayanan Resep Rawat Jalan Kontan (Lanjutan) 2 RKE
Ass. ApotekerMencetak Slip Transaksi Ass. Apoteker
Memberikan Slip Transaksi resep ke
PasienPasien
HSPasienP lYA
Ass. ApotekerMenawarkan Home Service
PasienMembayar ke Kasir
Pasien Keruang Tunggu
Menunggu Obat Disiapkan
Pasien
TIDAK
HS
TIDAK
Pulang
PasienMenginginkan
Jasa HSPelaksana Peracikan
Menyiapkan Obat
Menunggu Obat Disiapkan
YA
Ass. Apoteker Iput Jasa Pelayanan
Home ServiceAss. Apoteker
Memberikan etiket &Mengemas Obat
Ass ApotekerAss Apoteker Ass. ApotekerMenyerahkan Obat dan
Memberi Info
Ass. ApotekerMencetak Slip Tansaksi
Home Service
Ass. ApotekerMemberikan Slip
Pasien HS
Pasien Terima Obat
pTransaksi Resep dan
HS ke Pasien
YA
TIDAK
REKAM KESEHATAN ELEKTRONIKREKAM KESEHATAN ELEKTRONIK
FLOW CHART PASIENFLOW CHART PASIENPASIEN OK DAN
KAMAR BERSALINPOLI DAN UGD
YABAYI
SEHAT PERINATOLOGI
BAWAH
PERINATOLOGI
YA
TIDAK
RAWAT GABUNG IBU
PERINATOLOGIATAS
KONSUL
PERBAIKAN DAN
OBSERVASI
KONSULSpA
NICUKELUAR RUJUKKELUAR SEMBUH
KELUAR MENINGGAL
Clinical Pathwayy
A ti itiActivities Day 1 Day 2 Day 3 Day 4 Day 5AdmissionDiagnosisPre TherapyTherapyFollow UpDischarge
DUMMY TABLE (1)Clinical Pathway Cost of Treatmenty
Activities Day.1 Day.2 Day.3 Day …..
Admission + + + +
Diagnosis + + + +
Pre Therapy + +Pre Therapy
Therapy +
Follow Up
Discharge
DUMMY TABLE (2)Clinical Pathway Cost of Treatment
No Activities Day.1Principal Co Co CC
y
PrincipalDiagnosis
Co-Morbid
Co-Mortal
CC
1 Nursing2 Consultation3 Doctor visits4 M di l P d4 Medical Procedures5 Nursing Procedures6 Medical Treatment6 Medical Treatment7 Supporting exams 8 Nutrition9 Physiotherapy10 Etc
RKE ~ CLINICAL PATHWAY ~ COST
Cost of Treatment (C t DRG/C i )(Cost DRG/Casemix)
No Cost of Treatment / A ti it B d
Direct Cost IndirectCostINDEXActivity Based
CostingInvestasi Operasional Pemeliharaan
1 Admission
INDEX
%1 Admission
2 Diagnostic
%
%
3 Pra Therapy
4 Therapy
%
%4 Therapy
5 Post Therapy
%
%
DUMMY TABLE (3)Clinical Pathway Cost of TreatmentClinical Pathway Cost of Treatment
No Activities U DC IC TC UC U x UC1 Admission
2 Diagnosis
3 Pre Therapy3 Pre Therapy
4 Therapy
5 Follow Up5 Follow Up
6 Discharge
T O T A L C/DRGT O T A L C/DRG
Lesson Learnt (INA-DRG’s 2000-2008)Year MDC Diseases DRG Casemix
2000 MDC.14 Abortion DRG.380 DRG.381
2001 MDC.01 Head Injury DRG.2
2002 MDC.18 Malaria DRG.4232002 MDC.18 Malaria DRG.423
2003 MDC.06 Appendicitis DRG.165DRG.166
DRG.164DRG.167
2004 MDC.18 Typhoid fever DRG.423
2005 MDC 14 Pregnancy DRG O01D DRG O01A2005 MDC.14 Pregnancy DRG.O01D DRG.O01ADRG.O01BDRG.O01C
2005 MDC.06 Gastro Enteritis DRG.G68B DRG.G68A
Lesson Learnt (INA-DRG’s 2000-2008)
Year MDC Diseases DRG Casemix
2006 MDC 01 St k B 70 D B 70 A2006 MDC. 01 Stroke B.70 D B.70 AB.70 BB.70 C
2006 MDC.18 HIV/AIDS S.64 B S.64 A
2006 MDC.18 DBD / Dengeu T 63 D T 63 AT 63 BT 63 C
2007 MDC.13 Ca Cervix with N 09 Z00 C 3 C CHysterectomy
09
2007 MDC.04 Pneumonia E 62 C E 62 A E 62 BE 62 B
Lesson Learnt (INA-DRG’s 2000-2008)
Year MDC Diseases DRG Casemix
2008 MDC 07 Ch l lithi i H 08 B H 08 A2008 MDC.07 Cholelithiasis H 08 B H 08 A
2008 MDC.03 Tonsilectomy D 11 C D 11 ZD 11 BD 11 B
2008 MDC.14 Partus per vaginam O 60 C
Australian Refined Diagnosis Related Group INA – DRG’sg pClassification, Version 4.1
INA – DRG s
MDC 14 ALOS COST / Public Sector
CITO3RD CLASS
Direct Overhead Total
DRG O01A 9 14 5 444 2 089 7 533DRG O01A 9,1411
5,4443.710.590
2,08998.622
7,5333.809.212
DRG O01B 6,13 3,998 1,550 5,5486 3.205.076 98.622 3.303.698
DRG O01C 5,006
3,7923.067259
1,37398.622
5,1663.165.8816 3.067259 98.622 3.165.881
DRG O01D 4,635
3,3272.721526
1,26298.622
4,5892.820.148
Australian Refined Diagnosis Related Group INA – DRG’sg pClassification, Version 4.1
INA – DRG s
MDC 06 ALOS COST / Public S t
CHILDSector 3RD CLASS
Direct Overhead Total
DRG. G68A 2,699
1,9341,143,221
712583,971
2,6451,727,192
DRG. G68B 1,652
1,040213,854
418240,547
1,458454,401
TARIFF DETERMINANT per layananTARIFF DETERMINANT per layananTARIFF
margin
UNIT COST ATP/WTP COMPETITORe’CRR POL
Total cost quantity
COST ANALYSIS
TARIFF DETERMINANT per DRG’STARIFF DETERMINANT per DRG S
TARIFF
COST/DRG’sMargin
UNIT COSTROOM & BOARD
UNIT COSTDRUGS
UNIT COSTOK
UNIT COSTMED SUPPLIES
UNIT COSTLAB
Total cost Q
ACTIVITY BASED COSTING + SIMPLE DISTRIBUTION
LAPORANLAPORANClinical Pathway & Cost of Treatment
Diagnosis Related Group (DRG’s)Diagnosis Related Group (DRG s)Sectio Caesaria, Diare Anak & Katarak
2008
DINAS KESEHATANDINAS KESEHATANPemerintah Propinsi Daerah Khusus Ibukota Jakarta
TemplateTemplate Clinical Pathwayy
Cost of Treatment Diare AnakCost of Treatment Diare Anak
M DRG DIAGNOSA KRITERIA ALOS COT Min COT Max KeteranganDC
/TINDAKAN
06 G68B Diare Murni 0-28 hari 2 hari 542,336.31
29-<1thn 701,242.74
1-<5 thn 739,693.37
5-14 thn 723,306.72
G68A Diare PP 0-28 hari 6 hari 1,468,584.50 2,368,057.93 * Cost Min & Max
29-<1thn 1,592,671.22 2,541,510.65 Tergantung pemeriksaan
1-<5 thn 1,452,715.71 2,424,356.14 Penunjangnya yang yang berkaitan
5-14 thn 1,495,298.45 2,419,428.88 dengan diagnosa
Cost of Treatment Sectio CaesariaMDC
DRG DIAGNOSA/
TINDAKAN
KRITERIA ALOS COT Min COT Max
Keterangan
14 O01D S i C i E 4 h i 2 126 186 8014 O01D Sectio Caesaria Emergency 4 hari 2,126,186.80
Murni Elektif 2,452,694.72
O01C Sectio Caesaria Emergency 4 hari 2,525,676.11 *dengan alternatif
Penyerta Elektif 2,384,251.93 konsul dr anak setelahoperasi & operasi & adanya penyulit
O01B Sectio Caesaria Emergency 4 hari 2,341,010.94 *dengan alternatif
Penyulit Elektif 2,576,597.13 konsul dr anak setelah operasi
O1A Sectio Caesaria Emergency 4 hari 2,312,680.75 *dengan lt tifalternatif
PP Elektif 2,584,276.82 konsul dr anak setelah operasi
Cost of Treatment KatarakMD
DRG DIAGNOSA/TINDAKAN
KRITERIA ALOS COT Min COT Max KeteranganDC
TINDAKAN
02 C16A Prosedur Lensa:
Katarak
SamedayECCE
ODC 1,840,901.58 2,051,951.58 Min COT adalah dengan Katarak dengan
standard minimum
pemeriksaan pasien tanpa ada kondisi
tertentu
SamedayPHACO
ODC 1,596,956.26 2,089,707.03 Max COT adalah semua pemeriksaan
yang y gmungkin
terjadi bila pasien ada kondisi2 tertentu
RKE & INA-DRG*)RKE & INA DRG )• Rekam Kesehatan Elektronik vs RekamRekam Kesehatan Elektronik vs Rekam
Medik (?)• Rekam Kesehatan Elektronik harus dapatRekam Kesehatan Elektronik harus dapat
merekam jumlah dan jenis tindakan yang diberikan ke pasienp
• Rekam Kesehatan Elektronik harus dapat dipertanggungjawabkan p gg gj
• Rekam Kesehatan Elektronik ~ Clinical Pathwayy
TERIMA KASIHatas perhatian & kesempatan
kerjasamanyaj y
