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Aplikasi

INA-DRG INA DRG *
Ronnie Rivany Health & Hospital Economist ronnie_rivany@yahoo.com

OVERVIEW
• International Classification of Diseases (ICD) ( ) • AR DRG / Australian Version – Major Diagnostic Categories (MDC) – Australian Refined - Diagnosis Related Groups (ARDRG) • INA DRG INA-DRG Indonesian – Diagnosis Related Groups – Clinical Pathway (CP) – Casemix (CM) – Activity Based Costing ( y g (ABC) + Simple Distribution ) p

• Rekam Kesehatan Elektronik & INA-DRG

Overview of The I Th International Classification i l Cl ifi i of Diseases, 10th Revision (ICD 10)
• ICD X, Diseases classified into 21 Chapters , p - Chapters I – XVII : Diseases and morbid conditions - Chapter XIX : injuries, poisoning and certain other consequences of external cause - Chapter XVIII : symptoms, signs and abnormal clinical & laboratory findings not elsewhere classified findings, - Chapter XX : External causes - Chapter XXI : factors influencing health status and p g contact with health services

Major Diagnostic Category (MDC)
Australian Version • Th MDC i a category generally b The ia t ll based on a d single body system or etiology that is associated with a particular medical specialty • AR-DRG.v.4
– MDC’s are sub-divided into a maximum of three separate partitions, for surgical, other and medical. di l – 23 MDC’s ~ ICD X – Clinical Modification (CM) 1st ed – 661 DRG s DRG’s

Major Diagnostic Categories (AR DRG)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Diseases and disorders of the nervous system Disease and disorders of the eye Disease and disorders of the ear, nose, and throat Disease and disorders of the respiratory system Disease and disorders of the circulatory system Disease and disorders of the digestive system g y Disease and disorders of the hepatobiliiary system and pancreas Disease and disorders of the musculoskeletal system and connective tissue Disease and disorders of the skin, subcutaneous tissue, and breast Endocrine, nutritional, and metabolic diseases and disorders E d i t iti l d t b li di d di d Disease and disorders of the kidney and the urinary tract Disease and disorders of the male reproductive Disease and disorders of the female reproductive system Pregnancy, childbirth, and the purperium Newborn and other neonates with conditions originating in the perinatal period Disease and disorders of blood and blood forming organs and immunological disorders Myeloproliferative disease and disorder and poorly differentiated neoplasm disorder, Infectious and parasitic disease (systemic or unspecified sites) Mental diseases and disorders Alcohol/drug use and alcohol/drug- induced organic mental disorders Injuries, poisoning, and toxic effects of drugs Burns Factors influencing health status and other contact with health services

Infectious and parasitic disease (systemic or unspecified sites) Mental diseases and disorders Alcohol/drug use and alcohol/drug. and metabolic diseases and disorders Disease and disorders of the kidney and the urinary tract Disease and disorders of the male reproductive Disease and disorders of the female reproductive system Pregnancy. nose. nutritional. and throat Disease and disorders of the respiratory system Disease and disorders of the circulatory system Disease and disorders of the digestive system g y Disease and disorders of the hepatobiliiary system and pancreas Disease and disorders of the musculoskeletal system and connective tissue Disease and disorders of the skin. and toxic effects of drugs Factors influencing health status and other contact with health services Medical Outpatient Visit (?) . childbirth. and breast Endocrine.2007) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Diseases and disorders of the nervous system Disease and disorders of the eye Disease and disorders of the ear. and the purperium Newborn and other neonates with conditions originating in the perinatal period Disease and disorders of blood and blood forming organs and immunological disorders Myeloproliferative disease and disorder and poorly differentiated neoplasm disorder. subcutaneous tissue.induced organic mental disorders Injuries. poisoning.Major Diagnostic Categories (Pedoman Tarif ?? DEPKES.

ver 4.Diagnosis Related Group’s (DRG’s) Group s (DRG s) • AR-DRG = AR DRG • Australian Related – Diagnosis Related Group is a character patient classification scheme which provides a means of relating the number and types of patients treated in a hospital to resources required by the hospital • AR-DRG. 661 DRG’s . .1 (1999).

the y y p p . types of treatment they receive.A. 1976) • Is a scientific approach used to describe the mix or type of patient or cases for which care is provided in a care delivery setting (Scott & Scott. 1997) .Casemix (1) • The number of days they spend in hospital. and the actual cost of treatment • A information tool i An i f i l involving the use of scientific l i h f i ifi methods to build and make use of classifications of patient care episodes (C A (C.

9 = the error DRG s DRG’s • DD = DRG’s partition. O = Reproductive System. Z = DRG’s relating to other health factors.DRG Numbering • The format = A DD S y • A = Pre MDC DRG’s . B = nervous system DRG. – Range 01 – 39 Surgical Partition – Range 40 – 59 Other Partition – Range 60 – 99 Medical Partition • S = split indicator – A = highest resources DRG – B = second hi h t resources d highest .

Diagnosis Related Group’s Principal diagnosis Major diagnostic category # 1 MDC # 2 MDC # 3 No MDc # 4 Yes Surgical Partition of MDC # 1 Medical Partition of MDC # 1 What procedure Procedure Custer A What age group’s Procedure Cluster B Procedure Cluster C Procedure Cluster D Over Procedure cluster A o e age X ocedu e c uste over Under X Procedure cluster A u de age X ocedu e c uste under Significant secondary condition ? Yes Procedure cluster A Over Age X. without CC .All acute admited patien General Logic. with CC No Procedure cluster A Over Age X.

DRG Decision Tree .

PEDOMAN TARIF ?!*&#$%@ ?! &#$%@ .

PEDOMAN TARIF ?!*&#$% .

INDONESIAN DRG’s .

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INDONESIAN DRG International C ass ca o o Disease ( C ) e a o a Classification of sease (ICD) Major Diagnostic Categories (MDC) Clinical Pathway Surgical / Other / Medical Diagnosis Related Groups (DRG’s) Casemix .

INDONESIAN DRG’s • Conceptual framework – ICD : X (WHO) usable – MDC : 23 (AR-DRG) temporarily usable ( ) p y – Clinical Pathway : constructible – DRG : to be confirmed + constructible – Casemix : to be confirmed + constructible t tibl – Costing : using Activity Based Costing + Simple Distribution .

INA DRG’s conceptual framework (1) lf k ICD 1 DRG MDC DRG COST TARIFF DRG CASEMIX COST COS TARIFF 2 .

Costing .DRG Clinical Pathway & Casemix Activity Based Costing .Confirm .DRG 2.INA DRG’s conceptual framework (2) lf k INA .DRG 1.

CC Administration Clinical Pathway and Cost of Treatment Unit Cost Room Investment Cost Operation cost Maintenance Cost Medical Exams Nursing Treatments Supporting Exams Therapy Medical Services & Paramedics Administration . Sex Medical Exams Nursing Treatments Medical supporting Main Diagnosis Therapy Medical Services & Paramedics Case Mix Co-Mortality. Conceptual Framework (3) . Length of (hospital) stay Utilization Room & Board Patient Characteristics. Age.INA-DRG’s. Co-Morbidity.

DIREKTORAT JENDERAL BINA PELAYANAN MEDIK DEPARTEMEN KESEHATAN 2005 .

Clinical Pathway in Hospital .

standard nursing care and other standard medical professional. .CLINICAL PATHWAY • the integrated planning concept that documents treatments given to patients based on standard medical treatments. that is evidence based with measurable results in a certain period of time within hospitals”.

CLINICAL PATHWAY SYMPTOM DIAGNOSIS THERAPY FOLLOW UP 1 Admission 2 Diagnosis 3 Pre Therapy 4 5 Therapy Follow up Activities ABC Activities ABC Activities ABC Activities ABC Activities ABC .

Clinical Pathway Relation with Medical Standard Services I.C MDC Hospital services Surgical CLINICAL PATHWAY : (admission to discharge) Other Medical measurable SOP DRG Case Mix .D ICD Profession Standards Dummy D M.D.C.

A poteker C ek resep dan kelengkapannya Lengkap T idak A ss. A poteker M enghub .Alur Pelayanan Resep Rawat Jalan Kontan P asen RKE P asien M em baw a R esep K e A potik/ Z oning A ss. P ihak T erkait YA A ss. A poteker Input R esep dan Inform asi H arga S etuju dgn H arga T idak P asien P ulang YA 2 .

Apoteker Iput Jasa Pelayanan Home Service Ass. Apoteker Memberikan Slip Transaksi resep ke Pasien Pasien HS YA Pasien Pulang P l Ass. Ass Apoteker Mencetak Slip Tansaksi Home Service Ass.7.3.2 Alur Pelayanan Resep Rawat Jalan Kontan (Lanjutan) 2 RKE Ass. Apoteker p Memberikan Slip Transaksi Resep dan HS ke Pasien Pasien HS TIDAK Pasien Terima Obat YA . Apoteker Mencetak Slip Transaksi Ass. Apoteker Memberikan etiket & Mengemas Obat Ass. Ass Apoteker Menyerahkan Obat dan Memberi Info Ass. Apoteker Menawarkan Home Service TIDAK Pasien Membayar ke Kasir TIDAK Pasien Keruang Tunggu Menunggu Obat Disiapkan Pasien Menginginkan Jasa HS Pelaksana Peracikan Menyiapkan Obat YA Ass.

REKAM KESEHATAN ELEKTRONIK .

FLOW CHART PASIEN POLI DAN UGD PASIEN OK DAN KAMAR BERSALIN BAYI SEHAT YA PERINATOLOGI BAWAH RAWAT GABUNG IBU TIDAK PERINATOLOGI ATAS PERBAIKAN DAN OBSERVASI KONSUL SpA KELUAR SEMBUH KELUAR RUJUK KELUAR MENINGGAL NICU .

Clinical Pathway y Activities A ti iti Admission Diagnosis Pre Therapy Therapy Follow Up Discharge Day 1 Day 2 Day 3 Day 4 Day 5 .

DUMMY TABLE (1) y Cost of Treatment Clinical Pathway Activities Admission Diagnosis Pre Therapy Therapy Follow Up Discharge Day. + + .3 + + + + Day ….2 + + + Day.1 + + Day..

1 Principal Diagnosis 1 2 3 4 5 6 7 8 9 Nursing Consultation Doctor visits Medical Procedures M di l P d Nursing Procedures Medical Treatment Supporting exams Nutrition Physiotherapy CoCo Morbid CoCo Mortal CC 10 Etc .DUMMY TABLE (2) y Cost of Treatment Clinical Pathway No Activities Day.

RKE ~ CLINICAL PATHWAY ~ COST .

Cost of Treatment (Cost DRG/C (C t DRG/Casemix) i ) No Cost of Treatment / Activity B A ti it Based d Costing 1 2 3 4 5 Admission Diagnostic Pra Therapy Therapy Post Therapy Direct Cost IndirectCost INDEX Investasi Operasional Pemeliharaan % % % % % .

DUMMY TABLE (3) Clinical Pathway Cost of Treatment No Activities 1 2 3 4 5 6 Admission Diagnosis Pre Therapy Therapy Follow Up Discharge U DC IC TC UC U x UC TOTAL C/DRG .

18 MDC.O01A DRG O01A DRG.06 Gastro Enteritis DRG.14 MDC.O01B DRG.164 DRG.167 Casemix DRG.423 DRG.18 MDC.381 2004 2005 MDC.423 DRG.O01C DRG.O01D DRG O01D DRG.06 Diseases Abortion Head Injury Malaria Appendicitis DRG DRG.G68A DRG.2 DRG.14 MDC 14 Typhoid fever Pregnancy 2005 MDC.01 MDC.G68B .166 DRG.380 DRG.Lesson Learnt (INA-DRG’s 2000-2008) Year 2000 2001 2002 2003 MDC MDC.165 DRG.

64 A T 63 A T 63 B T 63 C MDC.18 MDC.18 HIV/AIDS DBD / Dengeu S.64 B T 63 D 2007 00 2007 MDC. MDC 01 St k Stroke 2006 2006 MDC.70 B 70 D Casemix B.70 B B.70 C S.70 B 70 A B.Lesson Learnt (INA-DRG’s 2000-2008) Year 2006 MDC Diseases DRG B.13 C 3 MDC.04 C Cervix with Ca C Hysterectomy Pneumonia N 09 Z E 62 C E 62 A E 62 B .

03 MDC.Lesson Learnt (INA-DRG’s 2000-2008) Year 2008 2008 2008 MDC MDC.14 Diseases Cholelithiasis Ch l lithi i Tonsilectomy Partus per vaginam DRG H 08 B D 11 C O 60 C Casemix H 08 A D 11 Z D 11 B .07 MDC 07 MDC.

1 MDC 14 ALOS INA – DRG’s DRG s CITO 3RD CLASS Overhead Total 2.262 98.881 4.792 3.622 1.212 5.076 3.327 2.998 3.710.165.820.205.809.067259 3.00 6 4.089 2 089 98.148 COST / Public Sector Direct DRG O01A DRG O01B DRG O01C DRG O01D 9.533 7 533 3.Australian Refined Diagnosis Related Group g p Classification.550 98.721526 .548 3.590 3.303.622 1.622 1.622 7.63 5 5.589 2.444 5 444 3.373 98. Version 4.166 3.13 6 5.14 9 14 11 6.698 5.

G68B 2.645 1. G68A DRG.192 1.934 1.458 454.143.401 DRG.727.1 INA – DRG’s DRG s MDC 06 ALOS COST / Public Sector S t Direct CHILD 3RD CLASS Overhead Total 712 583.Australian Refined Diagnosis Related Group g p Classification.69 9 1.854 . Version 4.547 2.040 213.65 2 1.971 418 240.221 1.

TARIFF DETERMINANT per layanan TARIFF margin UNIT COST ATP/WTP CRR e’ COMPETITOR POL Total cost quantity COST ANALYSIS .

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TARIFF DETERMINANT per DRG S DRG’S TARIFF Margin COST/DRG’s UNIT COST ROOM & BOARD UNIT COST DRUGS UNIT COST LAB UNIT COST MED SUPPLIES UNIT COST OK Total cost Q ACTIVITY BASED COSTING + SIMPLE DISTRIBUTION .

Diare Anak & Katarak 2008 DINAS KESEHATAN Pemerintah Propinsi Daerah Khusus Ibukota Jakarta .LAPORAN Clinical Pathway & Cost of Treatment Diagnosis Related Group (DRG’s) (DRG s) Sectio Caesaria.

Template Clinical Pathway y .

428.715.510.74 739.057.22 1.584.71 2.336.50 1.592.468.495.65 2.93 2.693.419.37 723.14 * Cost Min & Max Tergantung pemeriksaan Penunjangnya yang berkaitan dengan diagnosa 5-14 thn 1.31 701.88 .242.671.Cost of Treatment Diare Anak M D C 06 DRG DIAGNOSA / TINDAKAN Diare Murni KRITERIA ALOS COT Min COT Max Keterangan G68B 0-28 hari 29-<1thn 1-<5 thn 5-14 thn 2 hari 542.298.45 2.72 G68A Diare PP 0-28 hari 29-<1thn 1-<5 thn 6 hari 1.368.452.306.541.356.424.

251.676.94 2.384.694.680.93 *dengan alternatif konsul dr anak setelah operasi & adanya penyulit *dengan alternatif konsul dr anak setelah operasi *dengan alternatif lt tif konsul dr anak setelah operasi O01B Sectio Caesaria Penyulit Emergency Elektif 4 hari 2.584.75 2.312.126.341.80 2 126 186 80 2.186.525.597.13 O1A Sectio Caesaria PP Emergency Elektif 4 hari 2.82 .72 O01C Sectio Caesaria Penyerta 4 hari 2.11 2.Cost of Treatment Sectio Caesaria M D C 14 DRG DIAGNOSA / TINDAKAN Sectio C S i Caesaria i Murni KRITERIA ALOS COT Min COT Max Keterangan O01D Emergency E Elektif Emergency Elektif 4h i hari 2.452.576.010.276.

707.901.58 2.Cost of Treatment Katarak M D C 02 DRG DIAGNOSA/ TINDAKAN Prosedur Lensa: Katarak KRITERIA ALOS COT Min COT Max Keterangan C16A Sameday ECCE ODC 1.26 2.951.03 .840.956.58 Min COT adalah dengan standard minimum pemeriksaan pasien tanpa ada kondisi tertentu Max COT adalah semua pemeriksaan y g yang mungkin terjadi bila pasien ada kondisi2 tertentu Sameday PHACO ODC 1.051.596.089.

RKE & INA-DRG*) INA DRG ) • Rekam Kesehatan Elektronik vs Rekam Medik (?) • Rekam Kesehatan Elektronik harus dapat merekam jumlah dan jenis tindakan yang p diberikan ke pasien • Rekam Kesehatan Elektronik harus dapat p gg gj dipertanggungjawabkan • Rekam Kesehatan Elektronik ~ Clinical y Pathway .

TERIMA KASIH atas perhatian & kesempatan j y kerjasamanya .