id
HOSIZAH
hozisah@esaunggul.ac.id
hozisah@esaunggul.ac.id
PENGERTIAN
Diagnosis Related Groups (DRGs) represent an inpatient classification scheme to categorize patients who are medically related with respect to diagnoses and treatment, who are statistically similar in their lengths of stay
hozisah@esaunggul.ac.id
DRG assignment is usually performed by a computer with grouper software, but may be performed manually utilizing the decision trees and listings of OR procedures, complications, and comorbidities
hozisah@esaunggul.ac.id
Principal Diagnosis The principal diagnosis is defined as the condition which after study, was found to be chiefly responsible for occasioning the patients admission to the hospital for care.
hozisah@esaunggul.ac.id
Secondary Conditions All conditions should be listed that: 1. existed at the time of patients admission to hospital for which treatment was given, or 2. that arose during the patients stay in hospital, or 3. that affected the patients treatment and/or LOS by greater than one day.
hozisah@esaunggul.ac.id
MAJOR DIAGNOSTIC CATEGORY (MDC) 12 Diseases and disorders of the Male Reproductive System
DRG
Yes 334
Surgical Partitioning
Major Pelvic CC No 335 341 Yes Transurethal Prostatectomy Age>69 and/or CC No Other Male Reproductive System OR Procedures Principal Diagnosis Malignancy Yes No Yes No Yes No 337 344 345 346 347 348 349 350 351 352 336
OR Procedure
Penis Yes
No
Malignancy
Age>69 and/or CC
Age>69 and/or CC
hozisah@esaunggul.ac.id
hozisah@esaunggul.ac.id
INA-DRG
Indonesia-Diagnosis Related Groups adalah pengklasifikasian setiap tahapan pelayanan kesehatan sejenis ke dalam kelompok yang mempunyai arti relatif sama. Setiap pasien yang dirawat di RS diklasifikasikan ke dalam kelompok yang sejenis dengan gejala klinis yang sama serta biaya perawatan yang relatif sama. (Depkes, 2008).
hozisah@esaunggul.ac.id
INA-DRG
INA-DRG terdiri dari 23 Major Diagnostic Categories (MDC) sebanyak 1.077 kode INA-DRG beserta tarifnya yang terbagi ke dalam 789 kode rawat inap dan 288 kode rawat jalan. Kode Diagnosis penyakit (ICD-10) sebanyak 18.483 dan Tindakan (ICD-9-CM) sebanyak 2.945.
hozisah@esaunggul.ac.id
KEUNTUNGAN INA-DRG
Tarif terstandarisasi dan lebih transparan. Penghitungan tarif pelayanan lebih objektif dan berdasarkan kepada biaya yang sebenarnya. RS mendapat pembiayaan berdasarkan kepada beban kerja sebenarnya. Dapat meningkatkan mutu dan efisiensi pelayanan RS.
hozisah@esaunggul.ac.id
14 VARIABEL INA-DRG
1. Identitas Pasien 2. Tanggal masuk rumah sakit 3. Tanggal keluar rumah sakit 4. Lama hari rawat 5. Tanggal lahir 6. Umur ketika masuk rumah sakit (dalam satuan tahun) 7. Umur ketika masuk rumah sakit (dalam satuan hari) 8. Umur ketika keluar dari rumah sakit (dalam satuan hari) 9. Jenis kelamin 10. Status keluar rumah sakit (discharge disposition) 11. Berat badan baru lahir 12. Diagnosis utama 13. Diagnosis sekunder, seperti komplikasi dan komorbiditas 14. Prosedur atau pembedahan utama.
hozisah@esaunggul.ac.id
hozisah@esaunggul.ac.id
hozisah@esaunggul.ac.id
Description
ALOS
VIP (Rp.)
20.086.26 7
VVIP (Rp.)
25.107.83 3
IP Intracranial Vascular Procedures IP Intracranial Vascular Procedures w/CC IP Intracranial Vascular Procedures w/MCC
8,5
011012
14,4
12.749.41 0
16.999.21 4
25.498.82 0
33.998.42 7
42.498.03 4
011013
27,9
24.681.43 4
32.908.57 9
49.362.86 8
65.817.15 8
82.271.44 7
hozisah@esaunggul.ac.id
CONTOH
Description IP Intracranial Vascular Procedures
Kode INA-DRG
011011
MDC
Severity Level 1
011012
Severity Level 2
hozisah@esaunggul.ac.id
02
3383318
N 20.2
111203
22
18,421
23,685
24
-5,264
03
3384951
M51.2
8102
081073
39,721
38,465
19
1,256
04
3372630
O49.0
4029
161201
9,886
7,910
18
-2,056
05
3378640
C53.9
689 9964
131201
9,547
14,437
-4,890
Kuliah Umum Mahasiswa STIKES Panakukkang UEU, Jakarta (27 April 2011)
hozisah@esaunggul.ac.id
hozisah@esaunggul.ac.id
Tidak dapat berlangsungnya proses grouping menyebabkan tidak bisa berlangsungnya klaim karena tidak ada luaran kode DRG dan tarif
hozisah@esaunggul.ac.id
hozisah@esaunggul.ac.id
Ear, & throat Groups system Groups U 13nose, mouth Female reproductive J I K B M Cardiovascular system Groups
15
A F T S
Skin, tissue &and breast 19 subcutaneous Mental Health Behavioral Groups Groups L Substance abuse & dependence 20 Groups Endocrine system, nutrition & metabolism Gropus Injuries, poisonings & toxic effects of E
21 drugs Groups Nephro-urinary System Groups Factors influencing health status & Male reproductive Groups other System contacts with health services 22 Groups 23 24 Medical Ambulatory Groups Errors CMGs
N V
Z Q X
hozisah@esaunggul.ac.id
1 2 3 4 5 6
A 1
MDC
DRG Type
Severity Level
CMG
Service Level
hozisah@esaunggul.ac.id
hozisah@esaunggul.ac.id