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<div class="journal-details-container"> <h4> Task #818 has been updated by Mats Fernström. </h4> <div class="details"> <span><strong>Attachment</strong> <a title="Download file" target="_blank" href="https://nordcaseforum.easyredmine.com/attachments/2860/Preliminary%20analysis.xlsx?t=1742321264">Preliminary analysis.xlsx</a> added</span><br/> </div> <div id="journal-4973-notes" class="note"><p><strong>Mats Fernström, the National Board of Health and Welfare, Sweden, 2025-03-18 </strong>(SWE ID C926)</p><p>We have done a rough analysis to see how the number of secondary diagnoses with CC property affects the costs of care, see the Excel file “Preliminary analysis”.</p><p>The sheet “General summary” indicates that there must be at least three secondary diagnoses with CC property to make the episode as expensive as an MCC DRG. However, it is not possible to use this simple method by just counting number of diagnoses with CC property in the grouping logic, because the figures can differ from DRG to DRG, as you can see in the sheet “Summary per DRG in MDC 01”.</p><p>I think that we must go on with a much deeper analysis and try to find out what combinations of complication categories (DGCAT values) that will increase the costs so much that the episode should be grouped to a MCC DRG instead of a CC DRG.</p><p>Sweden will try to do such an analysis because I think that we are the only nation that uses DRGs of the type MCC (very complicated) all over. This much deeper analysis will take months to do.</p></div></div> <hr/> <p><strong>Mats Fernström, the National Board of Health and Welfare, Sweden 2022-02-17</strong> (SWE ID C926)<br>It has been pointed out that I did not mention inactive complication categories with the letter J in my documents “How to read NordDRG definition tables 2021-12-20” and “How to write technical changes for NordDRG - 2021-12-21”. <br>The purpose of COMPL values with the letter J is that they shall be activated to a corresponding COMPL value with the letter G (= MCC level) by certain DGPROP values (similar to activation of COMPL values with the letter I) and then potentially leading to a DRG of the type “very complicated”, i.e. with MCC.<br>I intentionally omitted this, because inactive complication categories with the letter J are not used in any version of NordDRG and they will probably never be used in the future either. What diagnosis should have the potential to elevate a patient case from ‘not complicated’ all the way to ‘very complicated’ without already having a COMPL value with the letter G? I doubt that we will find such a diagnosis.</p><p>Then I believe more in developing NordDRG so that two or more diagnoses with CC property will generate MCC property. Something that speaks for this, is that there is a strong connection between the number of diagnoses and cost, see the enclosed file Cost_number_dx.xlsx. <br>A function that generates a MCC property when two or more CC properties are present cannot just count the number of diagnoses, however. It will be too blunt. We experts must be able to choose which categories that should generate MCC property. Technically, it can be done in a similar way as the present activation of inactive complication categories.</p><p>The suggested development of NordDRG demands changes in the program code for the groupers so it could preferably be done in connection with transition to ICD-11, when the groupers must be re-programmed anyhow. <br>If there is an interest in such a development, we can go on with the analysis and suggest some complication categories that together should lead to "MCC". Otherwise, we close the case (or continue on the sly).</p>
