Disease Costing

QUESTION

I would like to know if the DRG batch Grouping come with already grouped diseases with costing?
If not how do we get disease grouping that we can begin to work with?

ANSWER

The short answer is that our software does not perform any financial calculations. However, the output of our DRG Assignment Engine (DAE) can be used as the input to many such calculations.

As we understand it, "disease costing" is the calculation of what an individual, group or community spends, directly or indirectly, as a result of a given health condition or conditions.

In the US, the DRGs were used as the basis of a prospective payment system for hospitals; each DRG is assigned a weight to represent the expected resource utilization (cost) of a typical inpatient stay for that DRG.

For more information, consult our manual's Reimbursement section.

In our experience, the usual method for disease costing using DRGs is to match either hospital-specific or regional "factors" with DRGs, so multiplying the factor times the DRG weight gives the expected disease cost for an individual case. Multiply again by the number of cases and you have the theoretical disease cost for the population under study:

Disease cost = (Number of cases with this DRG) x ((DRG weight) x (DRG factor))

We do not endorse or recommend any particular set of factors. We generally find such sets of factors to be published by the World Health Organization or local universities engaged specifically in this kind of research.

We are happy to provide support for implementing disease costing on a consulting basis.