Background: In the Diagnosis Related Group (DRG) payment system, hospitals are usually suspected of ‘DRG creep,’ which has been narrowly regarded as reporting diagnostic and procedural codes that result in larger reimbursement.
Objective: This review was aimed to systematically explore ways in which hospital manipulations of DRG coding may occur.
Methods: A systematic scoping review was conducted using MEDLINE, EMBASE, Web of Science, EconLIT, Proquest Digital Dissertation and Theses, Conference Proceedings, and Thai Index Medicus, using appropriate search strategies. Based on predefined criteria, each article abstract was screened by two screeners with good inter-rater reliability. The included articles were qualitatively explored using thematic content analysis.
Results: Hospital manipulations of the DRG system can be categorized into three groups: corporate, clinical, and coding practices. Corporate includes all activities not directly related to patient care; possible manipulations are focused on hospital management, administration, or finance and therefore are the responsibility of the executive board or hospital director. Clinical manipulation deals with activities in the care process and is the responsibility of health care professionals. The last group covers conventional definition of DRG creep that focuses on documentation and coding.
Conclusion: Hospital managers who deal with the DRG payment system should be aware that DRG creep is not merely about upcoding. Indeed, the DRG system can be manipulated by hospitals in three different approaches, the so-called “3C”: corporate, clinical, and coding practices.
Mawin Vongsaisuwon, Krit Pongpirul and Kris Chatamara
While numerous randomized controlled trials have demonstrated long-term survival rates for patients with early-stage breast cancer treated with breast-conserving surgery (BCS) comparable to mastectomy, the latter remains the most prevalent surgical option to treat early-stage breast cancer in Thailand.
To investigate the potential determinants affecting the decision on selecting BCS or mastectomy for the treatment of early-stage breast cancer and to compare the disease-free survival and overall survival between the treatments using a propensity score-matched analysis.
Patients diagnosed nonmetastatic breast cancer at the Queen Sirikit Breast Cancer Center from January 2006 to December 2015, were retrospectively identified and grouped intro patients who received BCS or mastectomy. After propensity score matching, 356 BCS and 209 mastectomy patients were identified, and statistical analysis was conducted to determine treatment selection factors and compare disease-free and overall survival.
Disease-free survival and overall survival in months comparing BCS and mastectomy were not statistically different with P values of 0.11 and 0.77, respectively. Determinants of treatment selection found that younger age, surgeon preference, smaller tumor size, and lower tumor grade were statistically significant factors in the selection of BCS over mastectomy. The majority of surgeons had a preference for one treatment over the other (P < 0.001).
The outcome of BCS is comparable to mastectomy in early-stage breast cancer patients. Key determinants affecting the selection of treatment were identified to be patient age, characteristics of the tumor, and surgeon’s preference.