The future of DRG in psychiatry in Denmark By Medical Director Søren Rask Bredkjær, Psykiatrien Region Sjælland

Is DRG useful in psychiatry? Only system to reflect differences in weight Overcoming the problem concerning ’benefits without visiting’ Provides incentives for proper registration ► Better registrations of secondary diagnosis ► Promotes better registration Coherence between economy and activity The importance of continuous development of the charge system so as to steadily improve

Need for economic management Health costs and demand is increasing Psychiatry has moved from management needs to demand management The price of the psychiatric services is not the same nationwide Diagnosis- and treatment guarantee – agreement with private providers

The economic development of psychiatric treatment in Denmark

Requirements for possible charge control model The model should be: Transparent Fair Robust Built-in incentive for efficiency Suitable to be changed Attention at: ► Creep. ► Registration is important for the psychiatric patient (sensitive area)

History Board of Health, Danish Psychiatric Society and the Child and Adolescent Psychiatry Society drew up proposals for DRG grouping Board of Health conducted an economic validation through cost analysis after the Activity Based Costing method (ABC) The conclusion was that: ► Resources vary between individual DRG groups so that there is evidence to preserve the groups

Validation of clustering DRG (inpatient system) ► To start with there was 42 groups, now there is 35 groups of hospitalized patients ► The groups reflect both inpatient duration and gravity DAGS (outpatient system) ► 10 groups ► Covers outpatient visits, home visits and 'benefits without visits’ ► Charges reflect resource effort as in staff performance

Diagnosis- and treatment guarantee Child and Adolescent Psychiatry ► – Guarantee of diagnosis Measurement: 0-60 days ► – Guarantee of treatment Measurement: 0-60 days Adult Psychiatry ► – Guarantee of treatment Measurement: 0-60 days Package - settlement of private institutions: ► Pre examination ► Packages of diagnosis ► Packages of treatment

Psychiatry model for guarantee of treatment There is an overall economic adjustment of the psychiatry budget, but no direct link between budget and activity It is important to focus on the number of patients that are in treatment ► Demand increases ► An increase is expected in both public and private health care

Packages of diagnosis Existing charges for packages of diagnosis in Child and Adolescent Psychiatry: ► PB30A First visit kr. ► PB30B Second visit with physical examination kr. ► PB31A Basic examination kr. ► PB31B Basic examination with physical examination kr. ► PB32 Standard examination kr. ► PB33 Extended examination kr. ► PB34 Further extended examination kr.

Is DRG the future? If Psychiatric DRG is the future: ► Should charges apply ► Charges should be developed and adapted, not just price and earnings projected ► A basis for comparison of the psychiatric services nationwide is needed ► DRG is useful in psychiatry as it is the only system that reflects differences in gravity ► Would be preferable to use the charge system in the outpatient area, as part gains will probably be a higher degree of conversion to outpatient treatment Current alternative: ► At the moment work is concentrated around improving the key figures of the regional and national psychiatry. These key figures consist primarily of a series of key statements on regional costs and activities within psychiatry

Workgroup regarding the regional key figures Central in the work to improve the key figures are: ► Discuss the basic prerequisites for comparability across regions ► Consider standardized targets for activity and productivity ► Define the specific key figures, to be collected nationwide in the future The workgroup is expected to present their report autumn 2010

Summary At the moment Denmark has a DRG rate system in the psychiatric field but: ► The system is not being used actively, for example a charge control model ► It could be useful to undertake a charge control model at the outpatient area The current alternative is a thorough working with the regional key figures in the psychiatric field. It is only a flimsy substitute for an active used DRG system