search for




 

Quality Improvement Activities to Facilitate the Filing of Complexity Payment Claims for Patients with Malnutrition
영양불량환자의 중증도 적용 향상을 위한 영양지원팀 협의진료체계 개선활동의 중요성
J Clin Nutr 2018;10:20-24
Published online June 30, 2018
© 2018 Korean Society for Parenteral and Enteral Nutrition.

Kuk Hwan Kwon1, Hyung Soon Lee1, Jee Hyoung Yoo1, Soo Na Chi1, Hyun Hee Park1, So Won Kim1, Kyung Ran Kim1, Nan Hee Yun2, Kyoung Taek Ra3, Hyun Jung Song4
권국환1, 이형순1, 유지형1, 지수나1, 박현희1, 김소원1, 김경란1, 윤난희2, 라경택3, 송현정4

1Nutrition Support Team, 2Medical Insurance Review Team, 3Medical Information Management Team, 4Medical Record Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
국민건강보험 일산병원 1영양집중지원팀, 2보험심사팀, 3의료정보팀, 4의무기록팀
Soo Na Chi
Nutrition Support Team, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea
Tel: +82-31-906-0609, Fax: +0303-3448-7158, E-mail: soona@nhimc.or.kr
Received December 12, 2017; Revised February 24, 2018; Accepted February 25, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments.
Methods: The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information).
Results: Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015∼August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016∼August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P<0.01).
Conclusion: Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.
Keywords : Diagnosis-related groups, Complications, Comorbidity, Malnutrition

 

June 2018, 10 (1)