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Implementing patient-based costing to derive robust DRG weights for national reimbursement and hospital pathway management

Introduction Diagnosis-Related Group (DRG) payment systems depend on relative weights that approximate the average resource intensity of clinically coherent inpatient groups. When weights are weak - because costing is inconsistent, feeds are incomplete, or coding is unreliable - national tariffs can misprice care, destabilize provider incentives, and reduce confidence in performance analytics. In this essay I try to  synthesize established approaches to patient-level costing (PLICS/ABC/TDABC) and DRG tariff setting, drawing on documented national programs (e.g., England’s National Cost Collection, Australia’s AHPCS/NEP process, and Germany’s InEK cost accounting scheme), and propose an implementable framework to (1) produce reliable national reimbursement weights, (2) embed auditability via a practical controls checklist (General Ledger (GL)  reconciliation, feed completeness, allocation governance, coding QA/QC), and (3) operationalize patient-level costs for internal hospita...
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Designing a DRG-based hospital reimbursement for efficiency, effectiveness, and high quality

Introduction Diagnosis Related Groups (DRGs) are a case-based hospital payment mechanism that converts coded clinical and administrative data into clinically meaningful, resource-relevant groups to determine prospective reimbursement. A well-functioning DRG system must simultaneously (i) classify patients fairly (clinical coherence and resource homogeneity), (ii) price cases credibly (cost accounting and weight setting), (iii) control incentives that can degrade quality or induce volume inflation, and (iv) assure data integrity through governance, auditing, and quality measurement. International experience - including long-standing US Medicare prospective payment - shows that DRGs can improve transparency and managerial efficiency but also create incentives for shorter stays, coding inflation (“upcoding”), and strategic behavior unless counterbalanced by strong expenditure controls, quality monitoring, and anti-fraud capacity. 1. Conceptual foundations DRG systems were developed to def...
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Process Mining in de gezondheidszorg voor de analyse van zorgpaden

Inleiding  Met de toenemende druk op de gezondheidszorg om beter om te springen met de beschikbare middelen, wordt het belangrijker om zorgprocessen efficiënt en effectief te organiseren. Dat geldt zowel voor de normale werking als in tijden van gezondheidscrisissen. Nog steeds worden theoretische modellen gemaakt van zorgpaden die niet overeenstemmen met hoe het er echt aan toe gaat op de werkvloer. Process Mining kan helpen om in kaart te brengen hoe een zorgproces in de praktijk verloopt, zodat theorie en praktijk beter op mekaar kunnen worden afgestemd. Proces Mining Process mining is een analysetechniek die IT-logbestanden (event logs) gebruikt om werkelijke bedrijfsprocessen te visualiseren, analyseren en verbeteren. Het maakt inefficiënties, knelpunten en afwijkingen zichtbaar, wat kan leiden tot efficiëntere processen, lagere operationele kosten en hogere patiënt- en medewerkerstevredenheid (change management).  Process mining in de gezondheidszorg analyseert d...
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Semantics, Ontology, and Syntax in Health Informatics: Conceptual Distinctions and Practical Implications for Hospital EHR Implementation

Abstract Implementing a modern Electronic Health Record (EHR) in a hospital is fundamentally an exercise in representing, exchanging, and reusing clinical information safely across time, teams, and systems. This requires clarity about three related but distinct notions: syntax (how information is structured and encoded), semantics (what that structured information means), and ontology (a formal, explicit specification of the domain concepts and relations that underpin shared meaning and enable computational reasoning). In this essay I want to distinguish these concepts and demonstrates how their differences translate into concrete design, integration, governance, and patient-safety considerations in real-world hospital EHR implementations. 1. Introduction Hospitals depend on EHRs not only to store a longitudinal patient record, but to coordinate care across departments (e.g., laboratory, pharmacy, radiology, admissions), across professions, and often across organizational boundaries...
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