Development of New INA-CBG Reclassification
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1 Development of New INA-CBG Reclassification Rudi Yulianto Center for Health Financing and Health Security National Casemix Center Ministry of Health Indonesia
2 UHC in Indonesia Indonesian health financing reform replacing fee for service payment with prospective payment system (PPS). Universal Health Coverage (UHC) in Indonesia started since January 2014 called Jaminan Kesehatan Nasional (JKN) Benefit Primary and Secondary Health Care JKN program is mandatory for public health care facilities and voluntary for private health care facilities 2
3 Medical Benefit Health services Incl. promotive, preventive, curative and rehabilitative efforts Standardize benefits packages Non-Medical Benefit Accomodation Ambulance* Presidential Decree Health Technology Assessments Clinical Advisory Board National Formulary
4 Prospective Payment CAPITATION CASE BASED GROUP (INA-CBG) Public Health Center Public Hospital Private Clinic Primary Health Care Private Hospital Secondary Health Care Provider Private Doctors Specialist Clinics
5 INA-CBG System in Indonesia Jamkesmas programme JKN programme Oct / Jan 2013 Jan Setting INA- DRG In 15 hospitals owned by MOH Implementation of INA-DRG Updating INA- CBG tariff Changing grouper from IR-DRG to UNU grouper Implementation of updated tariff in Jamkesmas Updating INA-CBG tariff for JKN preparation Updating INA-CBG tariff & Updating INA-CBG software Implementation of INA-CBG in JKN Implementation of updated INA-CBG in JKN Commercial grouper UNU grouper 5
6 INA-CBG Payment Model in JKN Additional payment INA-CBG code A III INA-CBG (1075 groups) 786 IP & 289 OP Special CMG (Drugs,Procedures, Investigation, Prothesis, Subacute, Chronic) FFS separately reimbursed (some medical supplies, chemoteraphy agent, chronic diseases medicine, CAPD, Petscan) CMG Case Type CBG Type Resource Intensity Lev. 6
7 INA-CBG Re- classification project 7
8 Objectives The INA-CBG implementation in this program still needs improvement especially on INA-CBG logic of the grouper. This happens due to the grouper logic does not match with local conditions in Indonesia. Therefore, the improvements started from the classification (re-classifiation) of casemix grouping - To reclassify INA-CBG with medical specialists for better disease grouping - To develop new INA-CBG grouper - To assess statistical performance of the new INA-CBG 8
9 INA-CBG RECLASSIFICATION In this context, reclassification on INA-CBG is the process to reclassify cases, include diagnosis and procedure (which refers to ICD), to be adjusted with the Indonesian local norm Doctors Tariff Team MoHRI INA-CBG Reclassification Hospitals INA-CBG Tariff Team in Ministry of Health will be the main technical team in writing classification algorithms, statistical analysis, also creating the Indonesian native grouper. Within the process, medical professionals association will be involved in the formation of classification algorithms to their respective competencies Hospitals will be involved to provide data (billing or costing) for statistical analysis in describing the homogeneity of reclassification result 9
10 Material & Methods The project design is cross sectional and non experimental involving expert panel meeting with experienced physicians Data used: individual patient data in 2015 from selected hospitals Sample: 29 hospitals By ownership : 20 public hospitals and 9 private hospitals By hospital type : 22 General Hospitals, 1 Cardiac Hospital, 1 Eye Hospital, 3 psychiatric Hospitals and 2 Pulmonary Hospitals Number of individual claim data inpatient record outpatient record ICD used : ICD 10 for diagnosis ICD 9 CM for procedure Statistical Analysis using Coefficient Of Variant (CV) and Reduction in Variant (RIV) Benchmark with Thai DRG 10
11 Flow of INA-CBG Reclassification Process 11
12 RESULTS 12
13 Grouping Structure Logic Flow 13
14 INA-CBG code (exist.) A III New MDC Eye & Adnexa Diagram flow CMG Case Type CBG Type Resource Intensity Lev. New CBG Code Structure 14
15 Number of ICD-10 and ICD-9-CM codes in each MDC No MDC Diag (ICD 10) Proc (ICD 9 CM) IM* TM* Diag. Proc. Diag. Proc. 1 Eye & adnexa (H) Psychiatry (F) ENT & Dentistry (U) Obstetry (O) Gynaecology (W) Respiratory (J) Total 2,796 1, * IM : Indonesian Modification * TM : Thailand Modification 13
16 Comparison between INA-CBG existing and New Classification PDC No MDC Existing New Classification Surgical Medical Surgical Medical 1 Eye & adnexa (H) Psychiatry (F) ENT & Dentistry (U) Obstetric (O) Gynaecology (W) Respiratory (J)
17 STATISTICAL ANALYSIS % RIV MDC N (cases) CV INA-CBG Exist. New Classification Inpatient Outpatient Inpatient Outpatient Inpatient Outpatient Inpatient Outpatient Eye & Adnexa 16,377 27, ENT & Densitry 8,637 4, Respiratory 19,127 2, Gynecology 10,859 14, Obstetrics 18,240 9, Psychiatry 7,357 2, CV : Coeficient of Variant.The CV value describe the homogeneity of the cases within each group, value < 1.0 RIV : Reduction in Variant. To analyze overall new classification grouper performance (before and after) 17
18 Roadmap for Develop INA-Grouper 2016 : MDC 12 : EYE & ADNEXA MDC 13 : ENT & MOUTH MDC 14 : RESPIRATORY MDC 29 : PSYCHIATRY : other MDCs : Finalization & Trial New INA-CBG Grouper
19 Conclusion The result indicated that new classification was feasible with local expert inputs and could possibly be used as first version, however many points needed improvements Our limitations for this project : Only few hospitals provided good clinical data that ready to use Limited number of cases for statistical analysis Limited members of development team as this was the first core team Time consuming for mapping & partitioning ICD 10 and ICD9CM with medical association representatives but will be important knowledge assets for future maintenance Outpatient casemix needed further investigations why existing INA-CBG was better than the new classification. 19
20 INDONESIA Riau Islands Aceh North Sumatra Riau West Sumatra Jambi Bengkulu South Sumatra Bangka- Belitung Lampung West Kalimantan Banten Jakarta West Java Yogyakarta Central Java East Java Bali Central Kalimantan East Kalimantan South Kalimantan West Nusa Tenggara East Nusa Tenggara South Sulawesi Southeast Sulawesi West Sulawesi Central Sulawesi North Sulawesi Gorontalo Maluku North Maluku West Papua Papua
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