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[DRG/ROD: limits to their application in nephrology]
1Direzione Sanitaria, UO Nefrologia e Dialisi, ASR USL n. 11, Vercelli.
Insights
Italian hospitals now use Diagnosis Related Groups (DRG) for payments, replacing older methods. The nephrology sector faces financial challenges due to DRG undervaluation, requiring budget adjustments and quality controls.
Area of Science:
- Healthcare finance
- Hospital administration
- Nephrology
Context:
- Italian ministerial decrees of 1994 introduced new hospital service payment schedules.
- The hospital discharge form (SDO) is the primary data source for these payments.
- Diagnosis Related Groups (DRG) replaced the traditional payment by production factor system.
Purpose:
- To analyze the impact of the DRG system on hospital service payments in Italy.
- To identify specific challenges faced by the nephrological sector within this new payment framework.
- To propose solutions for maintaining diagnostic and therapeutic efficacy while adhering to financial constraints.
Summary:
- The current DRG system, comprising 489 groups across 25 Major Diagnostic Categories (MDC), determines hospital payments based on diagnosis and length of stay.
- The 11th MDC specifically covers uronephrological DRGs (302-333).
- The nephrological sector is reportedly penalized by inadequate valuation of procedures and diagnostic limitations within the DRG system.
Impact:
- The current DRG system may inadequately value nephrological procedures, potentially impacting the sector's budget and operational autonomy.
- There is a need for quality controls and corrective measures to ensure fair financial compensation for nephrological services.
- Implementing these measures is crucial for maintaining high-quality diagnostic and therapeutic care without compromising financial stability or management autonomy.
Abstract:
The ministerial decrees of 15/4/94 and 14/12/94 defined the new payment schedules for hospital services during ordinary and day hospitalization; the hospital discharge form (SDO) is the main source of this information. The services are defined by the classification of ROD ("raggruppamenti omogenei di diagnosi"), adapted from the American DRG ("Diagnosis related groups"), which have substituted the traditional system of payment by production factor. On the basis of the DRG identified and the length of hospital stay, the Region pays the hospital the cost of hospitalization. The main diagnosis at discharge, secondary diagnosis, complications and diagnostic/therapeutic procedures all contribute to the determination of 489 DRG. Groups of pathologies are reclassified into 25 MDC ("Major Diagnostic Categories"). The 11th MDC includes the uronephrological DRG (302-333). The nephrological sector has been penalized by the inadequate value given to related procedures and diagnostic limitations. In order to guarantee efficacious diagnostic and therapeutic procedures, without impoverishing the nephrological budget and reducing the management autonomy of the divisions and autonomous services with hospitalization, it is necessary to introduce quality controls and corrective measures to the procedures that maintain the value of diagnosis and comply with financial considerations.