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Showing posts with the label ICD-11

A Belgian Implementation Blueprint for WHO ICD-11/WHO ICHI-Based MDCs and DRGs in Relation to SNOMED CT

Abstract A defensible Belgian pathway to Major Diagnostic Categories (MDCs) and Diagnosis Related Groups (DRGs) based on WHO ICD-11 and WHO ICHI could be built as a three-layer architecture: SNOMED CT for point-of-care clinical semantics, WHO ICD-11 Mortality and Morbidity Statistics (MMS) and WHO International Classification of Health Interventions (ICHI) for classification of diagnoses and interventions, and a transparent national grouper that consumes standardized episode variables and produces reimbursement classes. That architecture should not assume the existence of an official global SNOMED CT→WHO ICD-11 or SNOMED CT→WHO ICHI reimbursement-grade map. WHO states that the outcome of WHO ICD-11/SNOMED CT mapping collaboration remains under discussion and is not guaranteed, while WHO’s ICD-11 licensing materials also state that mappings and crosswalks are not covered by the base WHO ICD-11 licence and may require separate written agreement. SNOMED International documents official ma...
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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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Nomenclatuur - Een vergelijking van CCAM, WHO ICHI, CPT en HCPCS met daarenboven hun positie ten opzichte van WHO ICD-11.

 Inleiding De Classification Commune des Actes Médicaux (CCAM) van Frankrijk en de International Classification of Health Interventions (ICHI) van de WHO beschrijven allebei wat er in de zorg gedaan wordt. Toch verschillen ze fundamenteel in structuur (code-opbouw), syntaxis (hoe je een code samenstelt), semantiek (welke betekenis-aspecten je móét of kúnt vastleggen) en inhoud/scope. Daarnaast vragen ze om duiding ten opzichte van CPT/HCPCS (VS) en ICD-11 (diagnosen). Hieronder probeer ik die verschillen systematisch uit te werken en plaats ik elk stelsel in zijn natuurlijke gebruikscontext. CCAM versus ICHI Structuur en syntaxis (hoe ziet een code eruit?) CCAM (Frankrijk). Codeformaat : 7 tekens: AAAA000 (vier hoofdletters + drie cijfers). De 1e letter = grote anatomische eenheid; 2e = orgaan/functie binnen die eenheid; 3e = actie; 4e = toegang/techniek. De drie cijfers differentiëren varianten met dezelfde letters. De letters I en O worden vermeden om verwarring met 1/0 te voorko...
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