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ГqvhcGdF3xtno< #ղJ) XAb& ;Lz鼊CJX9qI! 8/ X:BfL4rKt[%nN$a壧CP< )Cr`ܠrbEKýEAsuovB+w6jf[|@GYUc l-2mܵk{Q=aep׬kc v_Hu\c)O 7JUYoe$\K`7 e؊.+O)whJ/N_Sʿ|?[ k u4 r3)(KLҾ}TkO me0_/:\뵍4Qx,ay14vLx+ ʐշЙ݂w mcbyܔ_98,|C=d{eEeT&v_|/L[OPK!fxnAdrs/downrev.xmlDMO@E&3q'S  4hΌL\ޜ3_Z9X#~#SZ٘Ja{0jѩ3Pf&~d[2;Z1*.vOd56&>sMwI)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!p|drs/downrev.xmlDQK0Co.ձݍQupܵuMRuް}nC#"BJ_O&v{4]#S^>$I*5u&>4pr}h![??fyUVvn~ ތG?ޕY:3ujC>CQ7\PK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!p|drs/downrev.xmlPKp@H$D 0 6  o?This is a great question and everyone should understand and agree on what case-based financing can achieve. A case-mix based financing system can distribute limited healthcare resources in a fair and equitable manner to providers A case-mix-based financing system if implemented with an appropriate set of rules can create incentives so that: the right amount of care is provided (i.e., appropriate length of stay) in the right setting (i.e., hospital vs. ambulatory), in the most efficient manner (i.e., appropriate length of stay), and in the most quality conscious manner (i.e., data allows us to look at hospitals, departments, and physicians). Case-mix based financing will NOT automatically solve broader system issues such as managing the demand for services or resolving issues between public and private hospitalsm { Z 2q Z7 Z 2 Zm'C'C.CRCC C7CCC @v }` ,C (Group 4"`< , Z@16 ?Rectangle 5}` ^  G zB , JjJ?Line 6`H , 0޽h ? 3333̙3ia___PPT10A+MC D%' = @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*,n%(D' =-o6Bdissolve*<3<*,nD' =%(D' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*,m%(D' =-o6Bdissolve*<3<*,mDn' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*,Z%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<*,ZD' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<*,ZD' =%(D' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*,Z%(D' =-6B'blinds(horizontal)*<3<*,ZD' =%(D' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*,%(D' =-6B'blinds(horizontal)*<3<*,D' =%(D' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*, %(D' =-6B'blinds(horizontal)*<3<*, D' =%(D' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*, %(D' =-o6Bdissolve*<3<*, D' =%(D' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*,@%(D' =-o6Bdissolve*<3<*,@+"8 0L0 ~v0(  0. 0  x04 0e0e ?Rectangle 2(P   bCase-Mix Is&         0  x8 0e0e ?Rectangle 3"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK! 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Purpose of defining cases using DRGs Understand the volume of services, which is a picture of what the hospital produces Allows a consistent way to begin making comparisons and a basis to discuss quality of care @ _Z@ _2@ _Z 2  Z% Z 2 ZCCC A CC%CA C   Jv }` <C (Group 5"Z` < Z ?Rectangle 6}` ^  G zB < JjJ?Line 7`H < 0޽h ? 3333̙3WO___PPT10/+)D' 6 = @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*<%(D' =-6B'blinds(horizontal)*<3<*<D' =%(D' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*<d%(D' =-6B'blinds(horizontal)*<3<*<dD' =%(D' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*<d%(D' =-6B'blinds(horizontal)*<3<*<dD' =%(D' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*<%(D' =-6B'blinds(horizontal)*<3<*<D' =%(D' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*<%(D' =-o6Bdissolve*<3<*<D' =%(D' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*<%(D' =-o6Bdissolve*<3<*<D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*<^%(D' =-o6Bdissolve*<3<*<^+"' 0   @@ (  @H @  x\t 0e0e ?Rectangle 20@p   | Component 2: Creating DRG Prices !      @  x\D 0e0e ?Rectangle 3"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!`|drs/downrev.xmlDN@E&䙸10@jTLH.\>:y̌Pމ ]ܛssf4Dז Kso deRp! 3mϼ."Bg ͤEE}߶ı;Xg0J#4r$`–V_oMOo8_~]oޕS?n(8\[􁜂(u*PK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!`|drs/downrev.xmlPKpH$@ 0   1/Calculating a cost for each case is necessary to generate DRG prices Financing basis = DRG groups (types of patients) Aggregate cost data used to calculate a price for each DRG Develop DRG price list and either make payments per discharged cases or develop budgets for each hospital based on the expected number and types of cases treated Purpose of basing financing using DRGs : Distribute limited resources equitably Promote hospital efficiency Link hospital production or case volume with costs Distribute resources based on types and severity of casesF@ _@ _@ _2)@ _@ _ECCCC)CC>E  *    v }` @C (Group 5"m` @ ZN ?Rectangle 6}` ^  G zB @ JjJ?Line 7`H @ 0޽h ? 3333̙33+___PPT10 + @BD'  = @B D' = @BA?%,( < +O%,( < +D ' =%(D< ' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@E%(D' =-o6Bdissolve*<3<*@ED3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@Fw%(D' =-o6Bdissolve*<3<*@FwD3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@w%(D' =-o6Bdissolve*<3<*@wD3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@T%(D' =-o6Bdissolve*<3<*@TDE' =%(D' =%(D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@U~%(D' =-o6Bdissolve*<3<*@U~D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@%(D' =-o6Bdissolve*<3<*@D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@%(D' =-o6Bdissolve*<3<*@D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@%(D' =-o6Bdissolve*<3<*@D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@0%(D' =-o6Bdissolve*<3<*@0D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@  %(D' =-o6Bdissolve*<3<*@  D3' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*@  %(D' =-o6Bdissolve*<3<*@  +"M  0 X P PD(  DT D  x4Z 0e0e ?Rectangle 2`p   *Bringing it Together& "    D  x0 0e0e ?Rectangle 3p`   T|Once cases are assigned to DRGs, we know the number and types of cases each hospital produces Once the average cost is computed for each DRG, prices can be established for each hospital product (DRG) which is used to create a financing system that reimburses hospitals for what they do  on average Payment system can be created Hospital budgets can be created Other means of distributing the money using this underlying information can be used^@ _@ _2  2@ _C CCC0_    ,v }` DC (Group 5"`J D ZDh ?Rectangle 6}` ^  G B D JjJ?Line 7`,$D  0H D 0޽h ? 3333̙3___PPT10e.+D='  = @B +" 0L0 `>(  _    x| 0e0e ?Rectangle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!aqedrs/shapexml.xmlUMo7 x ٲdK K-i,=#.ڈK$WH-h"z!g͇>Ŷ ?pʙ”~/'#| ]2ZN^zq+[x}a'|-z=/ֲ!Xk({I/u@OO/z ՚O.EIm儏55{/P<*fߡt´bsi-q{ X ]@$݄?v/)k*vk~ SU STr~ L@=:~ ./s8R-Ɣ_T&W9FȸgΞnGK4X @a05cnQd^pg0 84Mc)Ҋh·,"*rrMV&}ȤlGahɟ$%e~ڔ*Ԑ!'AmAxu L"G{⪔%$z+urZ N 8-EdU$Ć{i*M 7X,F:{3@gW:nMU?_1{nጩ\.`q0SҋmTN%x2^&㮖)@s\Wmٔ~xTޣK^U b;m ɩgҦH ͷDoB7 mry”}={A_Ç5c 4\ I\#tç4pL ?PK!%/drs/downrev.xmlDN0DHHܨ4[ RᐴnKMBc;M=+p\ͼz48 ' ӝmww)j% ^]_-1lK:U !CmC&e[2&n yOHpˇ$Izj>VFǸVżֹR7f"l[B+Hi:˧t!W˪ W?PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!aqe*drs/shapexml.xmlPK-!%/drs/downrev.xmlPK`P@   \Understanding the Link Between Assigning Diagnosis and Procedure Codes to DRGs and the Price] ]t\ v 4 C (Group 3"pp  # ~mamaA ?1 ?Object 4Q;8 $ 0'  f gֳgֳ?Rectangle 5uF  Avg. 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S6/fsK|zP E w4NKS_BzEtkhf~ێ=[! ; KS?xr PK!ˠ drs/downrev.xmlDN0HHܨFU[ԄX`4}{,p\j>j3N |kYt .nVV<\-AL Na>?[a4Q>CM}&/2''`vxrY\K-Dž{5T~FA?mbWt_,FŸh ϷU>Iǖ4ATw@NA싵\PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!i{J*drs/shapexml.xmlPK-!ˠ l drs/downrev.xmlPKs h8    Bulgaria has a long history studying DRGs and other tools Bulgaria s history shares similarities and differences with other countries Study and review began long-ago& early 1990s Many pilot projects have taken place, but DRGs have never been implemented Many trainings have been provided (i.e., coding training, costing training, hospital management etc.) Data collection and analyses efforts have been going on for years Simulations of hospitals budgets have been prepared Numerous infrastructure development activities YET, DRGs HAVE NOT BEEN IMPLEMENTED& WHY? Could it be because of the development of CCPs Could it be because of  imperfect data Could it be due to technical, political, cultural reasons, etc.  Z Z7 Z Z ZH Z2 2 )      L ZT ?Rectangle 6` ^  G B L JjJ?Line 7`,$D  0H L 0޽h ? 3333̙3" 0 tlP(  P- P  xt 0e0e ?Rectangle 2-   a CCPs vs. DRGs    P  xl 0e0e ?Rectangle 3" PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!֊]'drs/shapexml.xmlZmo6>`! 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Are international comparisons important? 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Understand the types of patients treated, where, how many etc. Allocate resources equitably using production/output data based on DRGs by hospital Monitor performance using data, reports, and various indicators Efficient resource use/less waste can result in more funding for other care settings and health initiatives Service/care migration to most appropriate settings over time Hospitals and Physicians Understand types of patients treated, by whom, how many, etc. Management tool for hospital, department, physician etc. level Efficiency incentives/control of internal costs Monitor performance using data, reports, and various indicators Knowledge that funding is directly tied to type and volume of patients treated Creation of a common language between management and medical staff Provision of services in the most appropriate care settings6@ _@ _@ _2@ _@ _6CCCCCnv  SB    !O  < ,v }` pC (Group 4"`9 p Z?Rectangle 5}` ^  G B p JjJ?Line 6`,$D  0H p 0޽h ? 3333̙3y___PPT10Y+D=' l = @B +"  0 tJ(  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CCPs, DRGs, neither, or both Ask some tough questions: What is driving the interest in using DRGs for financing? Has a S.W.O.T. analysis been conducted for CCPs and DRGs? Can DRGs and CCPs be used at the same time, to achieve different, yet complimentary objectives, in Bulgaria? What are the current inpatient financing reform initiatives and can a case-mix tool help achieve them? What data, infrastructure, and support is available both from a technical and political perspective? 1 G P ZLP Zf ZP Z @  G""K"  f ": f  x A??bd06663_Picture 1028bd06663_:~e x Z0?Rectangle 5K` ^  G rB x JjJ?Line 6`H x 0޽h ? 3333̙3"  0   | (  |$ |  ~Ggֳgֳ ?Rectangle 30   RFinal Thoughts &  |  ~hmama ?Rectangle 4 d\___PPT9>6 VRemember, case-mix does NOT have to be used for financing, but if it is, then the classification and payment system must be developed and implemented carefully Classification and payment systems continue to evolve so each country must determine where it is on its case-mix journey and implement appropriate mechanisms to achieve its goals REMEMBER& Case-mix is only a tool, and not a magic solution that can solve all healthcare problems Matching your needs with potential tools and then adapting to your country s needs or requirements is critical  l_Z l_2 l_Z  n2Z l_Zq  n2S Yp   ,A | Zy?Rectangle 5`I ^  G rB | JjJ?Line 6`H | 0޽h ? 3333̙3y___PPT10Y+D=' = @B +" 0 O(  .   ~m gֳgֳ ?Rectangle 30   \Thank You and Discussion &    ~Pmama ?Rectangle 4    Jugna Shah, MPH President, Nimitt Consulting Inc. and Secretary of Patient Classification Systems International 2038 18th Street NW #403 Washington DC 20009 www.nimitt.com Telephone: 1-215-888-6037 Fax: 1-208-460-6613 tI _ZlI _ZI _Zc b2X 0 0A=  Z ?Rectangle 5`I ^  G rB  JjJ?Line 6`  A??letterhead2Picture 11letterhead2p0H  0޽h ? 3333̙3y___PPT10Y+D=' = @B +" 0 TL (    hB y˼y˼?Rectangle 11p2   t*" G  `   xzuzu?Rectangle 1026   B    (B y˼y˼?Rectangle 10279 4  B  Welcome and Introductions Review of Agenda and Program of the day Few words on why we are here, who we are, and the overall objectives for the day.   H  0ηo~ ? 33 0 zr@ (     rzuzu?Rectangle 2      ~Xy˼y˼?Rectangle 39 4   R  H  0ηo~ ? 3380___PPT10.p#W f 0   pg (    fy˼y˼?Rectangle 7p2   t*" G  `   rzuzu?Rectangle 2   R   ~y˼y˼?Rectangle 39 f   hThese are all important goals given what we know about the old problems: Historic budgets (as they are often used) neither recognize nor reward improvements in efficiency. A large percentage of the health care budget is allocated to inpatient care, BUT WE DON T KNOW WHAT IS TRULY PRODUCED/PURCHASED. Allocation of funds among districts, hospitals, and departments within hospitals is arbitrary and inadequate (no consideration for patient type) An objective financing system will create the right incentives for hospitals to be efficient, while providing high quality healthcare services to patients while also allowing the government payor better understand what is being purchased. K cH _ " _2  2  2H _2H _ Kc  H  0ηo~ ? 3380___PPT10. 2# 0 -(    fy˼y˼?Rectangle 7p2   t*" G  `   rzuzu?Rectangle 2      ~xy˼y˼?Rectangle 39 4   R  H  0ηo~ ? 3380___PPT10.cW  0   g (    fy˼y˼?Rectangle 7p2   t*" G  `   rzuzu?Rectangle 2   R   ~y˼y˼?Rectangle 39 f   hThese are all important goals given what we know about the old problems: Historic budgets (as they are often used) neither recognize nor reward improvements in efficiency. A large percentage of the health care budget is allocated to inpatient care, BUT WE DON T KNOW WHAT IS TRULY PRODUCED/PURCHASED. Allocation of funds among districts, hospitals, and departments within hospitals is arbitrary and inadequate (no consideration for patient type) An objective financing system will create the right incentives for hospitals to be efficient, while providing high quality healthcare services to patients while also allowing the government payor better understand what is being purchased. K cH _ " _2  2  2H _2H _ Kc  H  0ηo~ ? 3380___PPT10. 2 0 -(    fy˼y˼?Rectangle 7p2   t*" G  `   rzuzu?Rectangle 2      ~x#y˼y˼?Rectangle 3M _   R  H  0ηo~ ? 33_  0   o (    f`0y˼y˼?Rectangle 7p2   t*" G  `   rzuzu?Rectangle 2   Z   ~+y˼y˼?Rectangle 38 fz  bZ___PPT9<4 *jCharacteristics of DRGs: Patients are clinically homogenous within a DRG, but not the exact same Patients have similar resource consumption within a DRG, but not the exact same Utilize routinely collected diagnosis and procedure code data WHAT ARE DRGS: DRGs are a patient classification method providing a way to relate the services given to patients in a hospital (DRG assignment occurs first) to the costs related or treatment resources used by the hospital by assigning patients to a finite number of categories that have relative weights/points (the relative weights multiplied by a base price leads to a price per DRG). 500  1500 groups depending on what version of DRGs is used  H " _ " _2 " _ I   H  0ηo~ ? 3380___PPT10. B_  0   0o (    fWy˼y˼?Rectangle 7p2   t*" G  `   rzuzu?Rectangle 2   Z   ~Ry˼y˼?Rectangle 38 fz  bZ___PPT9<4 *jCharacteristics of DRGs: Patients are clinically homogenous within a DRG, but not the exact same Patients have similar resource consumption within a DRG, but not the exact same Utilize routinely collected diagnosis and procedure code data WHAT ARE DRGS: DRGs are a patient classification method providing a way to relate the services given to patients in a hospital (DRG assignment occurs first) to the costs related or treatment resources used by the hospital by assigning patients to a finite number of categories that have relative weights/points (the relative weights multiplied by a base price leads to a price per DRG). 500  1500 groups depending on what version of DRGs is used  H " _ " _2 " _ I   H  0ηo~ ? 3380___PPT10. 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Case-Mix IsSlide 9-DRG-Based Financing Has Two Main ComponentsComponent 1: Defining the Case!Component 2: Creating DRG PricesBringing it Together]Understanding the Link Between Assigning Diagnosis and Procedure Codes to DRGs and the Price%Bulgarias Experience with Case-Mix!Bulgarias History with Case-MixCCPs vs. DRGsCCPs vs. DRGs (continued)$DRGs and Case-Mix Around the World/What Are DRGs Being Used for Around the World?Who is Using or Studying DRGs?&The Latest DRG Classification Systems3Classification Systems Being Used Around the World?Classification Systems Being Used Around the World (continued)?Classification Systems Being Used Around the World (continued)4Some Benefits of Using DRG-based Case-Mix FinancingBSome Measurable Outcomes That Can Be Seen with DRG ImplementationJPossible Next Steps for Bulgaria with Respect to Case-Mix Based FinancingFinal ThoughtsThank You and Discussion  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles 8@ _PID_HLINKSA http://www.nimitt.com/http://www.nimitt.com/(_C0Elizabeta PenevaElizabeta Peneva  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)PicturesCurrent UserSummaryInformation(XPowerPoint Document(gDocumentSummaryInformation8