How to incorporate DRGs into paths
How to incorporate DRGs into paths
Question: We’re from a small, private hospital that’s just now developing critical pathways. We’d like to know the best way to integrate diagnosis-related groups (DRGs) into the paths. What’s the best way to accomplish this?
Answer: Judy Homa-Lowry, RN, BS, CPHQ, director of quality improvement for The Delta Group in Greenville, SC, who works out of Canton, MI, recommends case managers use a three-pronged approach to incorporate DRGs into paths.
First, establish a baseline set of criteria for each DRG. Next, set targets or goals for each DRG. Last, use a team approach to develop paths that include both clinical and financial goals.
’You’ll need a list of DRG winners and losers and identify those to improve upon based on a set of criteria,” she says.
DRG losers are typically high in some, but not all, of the following criteria:
• length of stay (LOS);
• charges;
• resource utilization;
• morbidity.
’You could have a DRG that’s low in length of stay but high in resource utilization, so you need to look at them based on all the criteria,” explains Homa-Lowry.
Baseline data are gathered by looking at each DRG in the criteria mentioned above. Baseline averages or ranges then should be used in the path to gain actual measurements to see if the hospital meets the targets or goals, Homa-Lowry says.
Based on the data obtained from looking at each DRG, you’ll want to establish a set of goals, such as reducing resource utilization by 10% or reducing use of labs by 20%, she notes.
Having both clinical and financial representation on a path development team balances the process, Homa-Lowry says. ’The clinical people may have a recommendation, but the financial people know that its a high-cost item, and the result would either be a compromise or a justification of why the high-cost item needs to be on the path.”
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