The aim of the project was to update the current psychiatric grouping logic to meet the needs of the psychiatric field. The project was carried out by a development team, which included members from FCG Finnish Consulting Group, Nordic Casemix Centre, Finnish institute for health and welfare and several hospital districts.

The data used in original analyses was from five Finnish university hospitals of year 2019. However, the final testing was done with more recent data (2021) from only one hospital district (see appendix 2). Throughout the project the so called “splitting criteria” was followed. In case of splitting a group of cases, the cost difference between the new groups must be at least 20% and the amount of cases must be at least 50. For strong clinical reasons, however, these rules can occasionally be stretched.

The main updates for the psychiatric grouping logic are:

Update of the psychiatric diagnosis categories (DGCAT) belonging to MDC 19. The psychiatric diagnoses were regrouped into 29 new categories (see TC for details in appendix 1) compared to 19 DGCATs in old logic.

The duration of care for short therapy groups was changed from < 2 to < 3 days, which allowed to group the short hospitalizations (overnight stays) into short therapy DRGs as was fair from the cost point of view.

The OR1 procedure cases for both short therapy and inpatients were split into two separate DRGs: OR1 cases related to one’s gender-identity and other OR1 cases. The gender-identity cases were identified by using the new DGCAT 19M53 Gender-identity related contacts.

Of psychiatric procedures, psychiatric neuromodulation treatments (for both short therapy and inpatients) and ketamine therapy (for short therapy only) are taken into account in grouping logic. A case involving any of these procedures will be grouped to a separate (short therapy or inpatient) DRG, regardless of the main diagnosis in question. To identify these procedures, two new procedure properties were created and added: 19V14 Ketamine therapy and 19V15 Psychiatric neuromodulation treatment.

Secondary diagnoses with cc property will complicate the cases with main diagnoses from DGCAT 19M40 ´Alcohol addiction´ and 19M20 ´Drug and alcohol abuse´. Complicated cases are grouped to a separate DRG.

For diagnoses categories 19M03 ´Anxiety disorder´, 19M45 ´Depression´, 19M51´Psychosis´, and 19M48 ´Neurocognitive disorder´ the cases will be grouped into two separate DRGs based on the age. For the first three the split will be made to those under the age of 18 and others. For ´Neurocognitive disorder´, however, the split will be for those under the age of 25 and others.

The updated logic has 66 DRGs, of which 34 are short therapy groups and 32 inpatient groups.

Technical changes, cost information and presentation about the project in pdf format are attached.