Diagnostic Cost Groups (DCGs).pptVIP

Month 00, 0000 Using DCGs in Advantage David C. Schutt, MD Bob Kelley Thomson Healthcare October 2007 Overview Definition Clinical Grouping Methods Implementation Considerations Reporting to Physician Organizations Example Analysis: Hypertension Definition Clinical Grouping Clinical Condition Episode building Accounting for Comorbidities Disease Staging Methodology Disease Staging Framework Initially developed under contract to NCHSR with ongoing private development by Medstat/Jefferson teams Software converts a stream of claims into clinically homogeneous groups Takes over 15,000 ICD-9-CM codes to 560 disease categories Independent of setting or treatment Etiology assigned to each category Severity stratification based on robust clinical criteria Predicts a balanced set of outcome measures Disease Staging Disease Staging Severity Stratification Stage 0 History of a disease Stage 1 Conditions with no complications or problems of minimal severity Stage 2 Problems limited to an organ system; significantly increased risk of complications Stage 3 Multiple site involvement; generalized systemic involvement; poor prognosis Stage 4 Death Episodes of Care Health care is typically provided in a series of separate but related services All of these services must be included to produce a comprehensive economic analysis of care provided to patients Using an episode approach enables an assessment of costs of care and lends itself to the analysis of the processes as well as the outcomes of care Episode Construction Case Mix Adjustment - Diagnosis codes from health care claims and other administrative data are grouped into one of over 560 Disease Staging disease categories and severity stages Clean periods unique to each disease category are used to develop boundaries around the episode Mappings of National Drug Codes NDCs and laboratory/diagnostic procedure codes enable pharmacy/lab/diagnostic claims to be grouped to relevant episodes Lab and diagnostic imaging claims